: Elsevier/Saunders; 2017:371-8.4. host immune function;ii. J Periodontol 2001;72(12):1790-800.31. Micronutritional approached to periodontal therapy. Stop Smoking. National Cancer Institute: Cancer staging. host determinantsa. mm: millimeters. Antoniazzi RP, Zanatta FB, Rösing CK, Feldens CA. Find clinical practice guidelines from the American Academy of Periodontology. RBL: Radiographic bone loss. This paper summarizes the proceedings of the World Workshop on the Classification of Periodontal and Peri‐implant Diseases and Conditions. RECENTLY, a committee representing both the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) met in November 2017 with the charge of updating the 1999 classification of periodontal disease and conditions. Powered by WordPress. Our Membership. Demirer S, Özdemir H, Şencan M, Marakoḡlu I. Gingival hyperplasia as an early diagnostic oral manifestation in acute monocytic leukemia: A case report. BoP: Bleeding on probing. Albandar JM, Susin C, Hughes FJ. There are broadly two categories of gingival disease and conditions: dental plaque biofilminduced gingivitis and non-dental plaque-induced gingival disease. Jepsen S, Caton JG, Albandar JM, et al. Effects of menstrual cycle on periodontal health and gingival crevicular fluid markers. Mediators Inflamm 2015;2015:379626.46. Conversely, patients with thin periodontal phenotypes, with inadequate oral hygiene, and requiring cervical restorative and/or orthodontic treatment are at an increased risk for gingival recession.12,20 Monitoring specific gingival recession sites is considered a proper approach in the absence of any pathosis. Finally, no classification for diseases limited to the gingiva existed. Peri-implant diseases and conditionsThe 2017 World Workshop members developed a new classification for peri-implant health, peri-implant mucositis and peri-implantitis. Renvert S, Persson GR, Pirih FQ, Camargo PM. The American Dental Hygienists’ Association (ADHA) congratulates the American Academy of Periodontology (AAP) on the release of the proceedings from the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions and the new periodontal disease and peri-implant disease classification system. The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions was co-presented by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP). J Periodontol 2018;89(Suppl 1):S120-S139.24. Löe H. The gingival index, the plaque index and the retention index systems. J Periodontol 2010;81(5):673-81.40. Dis Mon 2011;57(4):184-91.3. Research > Register now to learn, share, and network! In 1999, an International Workshop for a Classification of Periodontal Diseases and Conditions was organized by the American Academy of Periodontology to address these concerns and to revise the classification system. Prevalence of periodontal disease in insulin-dependent diabetes mellitus (juvenile diabetes). J Periodontol 2018;89(Suppl 1):S223-S236.14. Copyright Am-Medicine.com  © 2013-2020. J Periodontol 2018;89(Suppl 1):S173-S182.25. Probing prior to the eruption of the first permanent molars is encouraged in the presence or suspicion of any clinical and/or radiographic signs of periodontal disease. Practitioners may define gingivitis as percentages of BoP sites (e.g., mild = <10 percent, moderate = 10-30 percent, severe = >30 percent sites) or based on grading (e.g., grade 1 to 5 in 20 percent quintiles for percent sites BoP).10 The gingival index by Löe31 also can be used to describe intensity of gingival inflammation as mild (area with a minor change in color and little change in the texture of the tissue), moderate (area with glazing, redness, edema, enlargement, and bleeding upon probing), and severe (area of overt redness and edema with a tendency toward bleeding when touched rather than probed). American Academy of Periodontology. The common features of plaque-induced gingivitis include (1) clinical signs and symptoms of inflammation confined to the free and attached gingiva that do not extend to the periodontal attachment (cementum, periodontal ligament and alveolar bone); (2) reversibility of the inflammation achieved by biofilm removal at and apical to the gingiva margin; (3) presence of a high bacterial plaque burden needed to initiate the inflammation; and (4) stable attachment levels on a periodontium, which may or may not have experienced a loss of attachment or alveolar bone (Table 3 - see PDF).11,22,28 The diagnostic criteria for gingivitis is based on clinical features. J Clin Periodontol 2018;45(Suppl 20):S278-S285.26. CHICAGO — Dentists treating patients with chronic periodontitis, a severe form of gum disease that can lead to tooth loss, are advised to use scaling and root planing (SRP), deep cleaning of the teeth, as initial treatment, according to new guidelines from the American Dental Association (ADA). J Periodontol 2018;89(Suppl 1):S74-S84.12. Systemic disease is defined as a disease that affects multiple organs and tissues or that affects the body as a whole.60 Several systemic disorders and conditions can affect the course of periodontal diseases or have a negative impact on the periodontal attachment apparatus independently of dental biofilm-induced inflammation.7,20 For some cases, the periodontal problems may be among the first signs of the disease. Available at: “http://www.lung.org/stop-smoking/”. With regards to orthodontic forces, observational studies suggest that orthodontic treatment has minimal adverse effects to the periodontal supporting apparatus, especially in patients with good plaque control and healthy periodontium.14,20 However, non-controlled orthodontic forces can have adverse effects such as pulpal disorders as well as root and alveolar bone resorptions. Tobacco addiction: Diagnosis and treatment. systemic health; andiii. Cortellini P, Bissada NF. Workgroup 1 discussed periodontal health and gingival diseases and conditions on an intact and a reduced periodontium.6Chapple ILC, Mealey BL, Van Dyke TE, Bartold PM, Dommisch H, Eickholz P, et al. Development of a classification system for periodontal diseases and conditions. Placement of restoration margins infringing within the junctional epithelium and supracrestal connective tissue attachment (biological width) also can be associated with gingival inflammation and, potentially, recession. Oral Health Prev Dent 2012;10(2):185-92.41. Probing prior to the eruption of the first permanent molars is encouraged in the presence or suspicion of any clinical and/or radiographic signs of periodontal disease. Dental prostheses and tooth-related factorsSeveral conditions associated with the fabrication and presence of dental restorations and fixed prostheses, placement of orthodontic appliances, as well as tooth-related factors may facilitate the development of gingivitis and periodontitis, especially in individuals with poor compliance with home care plaque control and attendance to periodic maintenance visits.13,20, Tooth anatomic factors (e.g., cervical enamel projections, enamel pearls, developmental grooves), root proximity, abnormalities and traumatic dental injuries potentially altering the local anatomy of both hard and soft tissues, as well as tooth relationships in the dental arch and with the opposing dentition, are associated with dental plaque-biofilm induced gingivitis and periodontitis. JCNDE.org: Classification at a Glance of Periodontal and Peri-Implant Diseases and Conditions Author: JCNDE Keywords: perio disease, perio classification, perio conditions, perio update Created Date: 9/24/2018 10:10:57 AM Periodontal health and gingival diseases and conditions on an intact and a reduced periodontium: Consensus report of workgroup 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Grading assesses the future risk of the periodontitis progression and anticipated treatment outcomes but also estimates the positive or negative impact that periodontitis and its treatment have on the overall health status of the patient. Association among periodontitis and the use of crack cocaine and other illicit drugs. Available at: “https://medlineplus.gov/ency/article/002294.htm”. The onset of this condition may occur within three months of the drug use,11 but not all individuals taking these medications are susceptible and will develop gingival overgrowth. J Clin Pediatr Dent 2013;38(2):95-9.2. J Periodontol 2018;89(Suppl 1):S28-S45.20. Accessed November 28, 2018. Increased incidence of chronic gingivitis and risk of periodontitis among children with poorly controlled type 1 diabetes mellitus have been reported.41-43 The severity of gingival inflammation may be more associated with the level of glycemic control rather than the quality of plaque control.36-40 Hyperglycemia can alter the immune system and have a negative direct effect on periodontal cells and neutrophil activity, as well as have an indirect adverse effect by stimulating immune system cells to release inflammatory cytokines.44,45 Early diagnosis of periodontal problems among children and adolescents with poorly controlled diabetes through periodic periodontal screenings, as well as prevention of periodontal diseases among this population, is of fundamental importance. 1. Xerostomia may occur as a side effect of medications such as antidepressants, antihistamines, decongestants, and antihypertensive medications. Helv Odontol Acta 1981;25(1):25-42.38. Oral contraceptives and the periodontium. Drug-influenced gingival enlargements occur as a side effect in patients treated with anticonvulsant drugs (e.g., phenytoin, sodium valproate), certain calcium channel–blocking drugs (e.g., nifedipine, verapamil, diltiazem, amlodipine, felodipine), immune-regulating drugs (e.g., cyclosporine), and high-dose oral contraceptives.11,57 For drug-influenced gingival conditions to occur, the presence of plaque bacteria is needed. (Archived by WebCite® at: “http:www.webcitation.org/70MIuyCej”)54. American Dental Association Classifications (based primarily on attachment loss) Case Type I: Gingivitis: no attachment loss, bleeding may or may not be present Case Type II: Early Periodontitis: pocket depths or attachment loss 3 - 4 mm BOP may be present localized areas of recession possible class I … J Periodontol 2018;89(Suppl1):S159-S172.28. Lim H, Kim C. Oral signs of acute leukemia for early detection. Crit Rev Oral Biol Med 1994;5(1):27-53.33. These levels are: (1) pristine periodontal health, characterized by total absence of clinical inflammation, and physiological immune surveillance on a periodontium with normal support; (2) clinical periodontal health, characterized by an absence or minimal levels of clinical inflammation in a periodontium with normal support; (3) periodontal disease stability, characterized as a state in which the periodontitis has been successfully treated and clinical signs of the disease do not appear to worsen in extent or severity despite the presence of a reduced periodontium; and (4) periodontal disease remission/control, characterized as a period in the course of disease when symptoms become less severe but may not be fully resolved with a reduced periodontium (Table 2  see PDF).6,21 It should be noted that “pristine periodontal health” characterized by no attachment loss, no bleeding on probing (BoP), no sulcular probing >3 millimeters (mm) in the permanent dentition and no redness, clinical swelling/edema or pusis a rare entity, especially among adults.21 Therefore, minimal levels of clinical inflammation observed in “clinical periodontal health” is compatible with a patient classified as periodontally healthy. When data did not appear sufficient or were inconclusive, recommendations were based upon expert and/or consensus opinion by experienced researchers and clinicians. Because oral health and systemic health are strongly interrelated, it is important that dentists and other health care providers collaborate to adequately diagnose, educate the patient about his condition, treatment plan, treat, or refer to a specialist for treatment. The new classification was agreed at the joint meeting of the American Association of Periodontology and European Federation of Periodontology at the World Workshop in Periodontology, held in Chicago during November 2017. The Academy as the national voice of periodontists, supports success of its members, promotes excellence in the practice of periodontics and in partnership advances the periodontal health of the public as an integral part of optimal oral and general health. Patient symptoms may include bleeding gums, metallic/altered taste, pain/soreness, halitosis, difficulty eating, appearance of swollen red gums, and reduced oral health-related quality of life.11 Although there are no objective clinical criteria for defining gingivitis severity, the extent of gingivitis (referred as mild, moderate, and severe) can be used as a patient communication tool. Needleman I, Garcia R, Gkranias N, et al. Periodontal health. crowding.b. Examples of systemic conditions include: (1) sex steroid hormones (e.g., puberty, pregnancy, menstrual cycle, oral contraceptives); (2) hyperglycemia; (3) leukemia; (4) malnutrition; and (5) smoking.11,22, Elevations in sex steroid hormones, especially, during puberty and pregnancy may modify the gingival inflammatory response and result in an exaggerated gingival inflammation in the presence of even relatively small amounts of plaque. J Periodontol 2018;89(Suppl 1):S267-S290.27. Local oral factors that exacerbate plaque-induced gingivitis are those that can influence the initiation or progression of gingival inflammation by facilitating accumulation of bacterial plaque at a specific site, inhibiting daily mechanical plaque removal, and/or creating a biological niche that encourages increased plaque accumulation. Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Periodontol 2000 2013;61(1):125-59.35. The literature lacks information regarding the exact role of nutrition in the initiation and/or progression of periodontal diseases. This paper was developed under the direction of the Task Force to Update the Classification of Periodontal Diseases and Conditions and approved by the Board of Trustees of the American Academy of Periodontology in April 2015. dental restorations;iii. 4. EPL are pathological communications between the endodontic and periodontal tissues at a given tooth that occur in either an acute or a chronic form and are classified according to the signs and symptoms that have direct impact on their prognosis and treatment (e.g., presence or absence of fractures and perforations, presence or absence of periodontitis and the extent of periodontal destruction around the affected teeth). Nevertheless, clinicians must understand their crucial role in ongoing management of gingivitis for their patients of all ages with and/or without a history of periodontal disease. Periodontists are also dentistry's experts in the treatment of oral inflammation and receive three … Becerik S, Ozcaka O, Nalbantsoy A, et al. The AAP released two documents titled “Three Steps to Staging and Grading a Patient” and “Staging and Grading Periodontitis.” Many factors are determined controllable (e.g., removal of overhangs, smoking cessation, good diabetes control) while others are not (e.g., genetics, immune status, use of critical medications).21. Centers for Disease Control and Prevention. Created by Meks. HIV/AIDS: Human immunodeficiency virus and acquired immune deficiency syndrome. Murakami S, Mealey BL, Mariotti A, Chapple ILC. Accessed June 22, 2018. These lesions may be manifestations of a systemic condition or medical disorder. systemic modifying factorsi. PA are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket, initiated by either bacterial invasion or foreign body impaction.18,24 The most prominent sign associated with PA is the presence of an ovoid elevation in the gingiva along the lateral part of the root. (Archived by WebCite® at: “http://www.webcitationorg/74HGmCmHS”), 211 East Chicago Avenue, Suite 1600Chicago, IL 60611(312) 337-2169. environment determinantsa. The probing force should not exceed 0.25 Newton (light probing) in order to rule out the confounding issue of BoP induced by too much pressure, as well as unnecessary bleeding resulting from trauma.21 When probing positioning and pressure into the sulcus/pocket are performed correctly, the patient should not feel discomfort. J Clin Diagn Res 2016;10(10):ZC143-ZC146.50. Periimplant health, peri-implant mucositis, and periimplantitis: Case definitions and diagnostic considerations. U.S. Department of Health and Human Services. Oral manifestations include gingival enlargement/bleeding, petechiae, oral ulcerations/infections, and cervical lymphadenopathy. The diagnostic criteria for GH in a patient following treatment of gingivitis are the same as those just mentioned. It is worth mentioning that, in addition to gingivitis and periodontitis, xerostomia and candida infections also are associated with diabetes.45 Certain hematologic malignancies (e.g., leukemia) are associated with signs of excess gingival inflammation inconsistent with levels of dental plaque biofilm accumulation. Araujo MG, Lindhe J. Peri-implant health. For patients with special health care needs receiving dental treatment under sedation and/or general anesthesia, clinicians are encouraged to take this opportunity and perform the periodontal probing. 3 … Radiographic assessment is a critical component of clinical assessment of the periodontal tissues. The American Academy of Pediatric Dentistry (AAPD) recognizes that although the prevalence of destructive forms of periodontal disease is low among children and adolescents, this population can develop several forms of periodontal diseases and conditions most frequently associated with an underlying systemic or immunologic disorder.1-4 In addition, current and early studies show that gingivitis occurs in half of the population by age of four or five years and peaks nearly to 100 percent at puberty.3 The prevalence of gingivitis can be similar to or greater than dental caries during childhood.1 Nevertheless, when compared to dental caries, gingivitis in children has received much less attention in understanding the long-term impact that chronic inflammation of the periodontal tissues in childhood may have on overall health of the periodontium throughout life.1 Therefore, it is critical that pediatric dental patients receive a periodontal assessment as part of their routine dental visits. Classification and diagnosis of aggressive periodontitis. Lastly, the extent or the number of gingival sites exhibiting gingival inflammation can be described as either localized (<30 percent of the teeth are affected) or generalized (≥30 percent of the teeth are affected).22, As mentioned above, one revision from the 1999 classification system5 was the proposal to introduce the term incipient gingivitis…“where, by definition, only a few sites are affected by mild inflammation, expressed as mild redness and/or a delayed and broken line of bleeding rather than edema or an immediate unbroken line of bleeding on probing. The former indicates the disease severityand complex management, while the latter estimates the rate and likelihood of the disease progression and/or response to standard periodontal therapy taking into consideration the patient’s biological features.6,24,26 An individual case of periodontitis should be further defined using a simple matrix that describes the stage and grade of the disease24 as seen in Table 4 - see PDF. Recession is defined as an apical shift of the gingival margin caused by different conditions and pathologies that is associated with CAL in any surface (buccal/lingual/interproximal) of the teeth.20 Although, gingival thickness has been referenced in the literature as gingival biotype, the 2017 World Workshop group strongly suggested the adoption of the term periodontal phenotype, which is determined by gingival phenotype (gingival thickness, keratinized tissue width) and bone morphotype (thickness of the buccal bone plate). There are three major determinants of clinical periodontal health. However, the role of vitamin C (ascorbic acid) in supporting periodontal tissues due to its essential function in collagen synthesis is well-documented.10,19 Vitamin C deficiency, or scurvy, compromises antioxidant micronutrient defenses to oxidative stress and collagen synthesis leading to weakened capillary blood vessels, consequently increasing the predisposition to gingival bleeding.48 Nevertheless, gingival inflammation due to vitamin C deficiency may be difficult to detect clinically and indistinguishable from plaque-induced gingivitis.22 Scurvy may occur in certain populations of pediatric interest such as infants and children from low socioeconomic families.22, One major change in the 2017 classification of dental plaque-induced gingival diseases was to simplify the system for the clinician and condense the catalog to include only conditions affecting the gingiva that could be clinically identified. For a comprehensive review on this topic, the reader is encouraged to review the position paper on non-dental plaque-induced gingival diseases by Holmstrup et al.19 and the workshop consensus report by Chapple et al.11. Grading also allows the clinician to incorporate the individual patient risk factors (e.g., smoking, uncontrolled Type 2 diabetes) into the diagnosis, which may influence the comprehensive case management. Hefti A, Engelberger T, Buttner M. Gingivitis in Basel schoolchildren. genetics.3. Periodontitis Associated with Systemic Diseases J Periodontol 1983;54(12):714-20.43. If the hypersensitivity does not resolve with adequate measures of plaque control, additional treatment may be required, including removal of material or appliance. Trackman PC, Kantarci A. Molecular and clinical aspects of drug-induced gingival overgrowth. Oral Health Policies & Recommendations (The Reference Manual of Pediatric Dentistry), The Reference Manual of Pediatric Dentistry2019-2020/P. Prior to the newly developed system, the classification of periodontal disease was very broad, encompassing several categories of … The workshop was co‐sponsored by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP) and included expert participants from all over the world. Preshaw PM, Alba AL, Herrera D, et al. J Periodontol 2018;89(Suppl 1):S1-S8.7. These include: genetic/developmental disorders (e.g., hereditary gingival fibromatosis); specific infections of bacterial (e.g., necrotizing periodontal diseases, Streptococcal gingivitis), viral (e.g., handfoot-and-mouth disease, primary herpetic gingivostomatitis), and fungal (e.g., candidiasis) origins; inflammatory and immune conditions and lesions (e.g., hypersensitivity reactions, autoimmune disease of skin and mucous membranes); reactive processes (e.g., epulides); premalignant neoplasms (e.g., leukoplakia); malignant neoplasms (e.g., leukemia, lymphoma); traumatic lesions (e.g., physical, chemical, thermal insults); endocrine, nutritional, and metabolic diseases (e.g., vitamin deficiencies); and gingival pigmentation (e.g., amalgam tattoo). classification system for periodontal diseases Tooth-supported and/or tooth-retained restorationsand their design, fabrication, delivery, and materials often have been associated with plaque retention and loss of periodontal supporting tissues. PPD: Periodontal probing depth. In addition, this document aims to emphasize the key role dentists have in diagnosing, treating and/or referring pediatric patients and those medically compromised or with special health care needs affected by periodontal problems. J Periodontol 2016;87(12):1396-405.57. Mariotti A, Mawhinney MG. Endocrinology of sex steroid hormones and cell dynamics in the periodontium. The phenotype is classified as thin when a periodontal probe inserted into the sulcus is visible through the tissue, indicating the tissue is ≤1 mm thick. Other conditions affecting the periodontiumPeridontal abscesses and endodontic-periodontal lesionsBoth periodontal abscesses (PA) and endodontic-periodontal lesions (EPL) share similar characteristics that differentiate them from other periodontal conditions. Vincent Iacono, Joe Krayer, Brian Mealey, David Paquette, Bryan Pearson, Paul Rosen, Robert Sabatini, and Marie Schweinebraten. Highlights of the changes are as follows: 3. While probing, clinicians should rule out the presence of pseudo pockets associated, for example, with tooth exfoliation or partially erupted teeth. Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. Some highlights of the discussion at the meeting are provided below. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, Georgia, 2012. Tobacco use among middle and high school students – United States, 2011-2016. In order to attain or maintain clinical periodontal health, clinicians should not underestimate predisposing and modifying factors for each patient and should recognize when these factors can be fully controlled or not. Periodontal diseases of children and adolescents. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Tooth mobility is not recommended as a clinical parameter of either periodontal health or disease status.21, Important main differences between periodontal disease stability and periodontal disease remission/control are the ability to control for any modifying factors and the therapeutic response. American Academy of Periodontology. Task Force members: Dr. Nico Geurs, chair; Drs. The American Academy of Periodontology Classifications are designed to help dental hygienists diagnose and treat periodontitis. 5. A classification scheme for periodontal and peri‐implant diseases and conditions is necessary for clinicians to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment of the diseases and conditions. D, Chapple ILC 1999 ; 4 ( 11 ):1696-704.5, Gkranias N, et al categories! Will be available in a future publication of the classification of diseases and conditions: plaque. 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