Classification of

Periodontal Diseases

Why Classification ?
Helps in the development of frameworks to study the
I. aetiology,
II. Pathogenesis &
III. treatment of diseases;
. Provides the international healthcare community with a way
of communicating in a common language.

Where were we?

juvenile periodontitis (prepubertal, localized and

generalized);
early-onset periodontitis (formally prepubertal, juvenile and
rapidly progressive);
adult periodontitis;( This classification system is heavily age
dependent: a cut-off point of 35 Years)
acute necrotizing ulcerative periodontitis;
refractory periodontitis.

Periapical radiographs of a 36-year-old patient, showing severe

generalized bone loss.
Diagnosis: chronic adult periodontitis or early-onset
periodontitis?

Where are we now?

The following changes were implemented:
Gingival disease category introduced.
Adult periodontitis replaced by chronic periodontitis.
Refractory disease category removed.
Early-onset periodontitis replaced by aggressive
periodontitis.
The implications of systemic diseases on periodontal status
were expanded and more comprehensively defined.
Necrotizing periodontal diseases were introduced to cover
both necrotizing periodontitis and necrotizing gingivitis.
Periodontal abscess and periodontal-endodontic lesions
were added.
A category for developmental or acquired lesions was
introduced.

The 1999 International Workshop for the Classification of

Gingival Diseases
A. Dental plaque-induced gingival diseases
B. Non-plaque-induced gingival lesions

The 1999 International Workshop for the Classification of

Periodontal Diseases.
A. Chronic periodontitis
B. Aggressive periodontitis
C. Periodontitis as a manifestation of systemic diseases
D. Necrotizing periodontal diseases
E. Abscesses of the periodontium
F. Periodontitis associated with endodontic lesions
G. Developmental or acquired deformities and conditions

Gingival diseases: A simplified version of the 1999 International

Classification of Gingival
Diseases

Dental plaque-induced gingival diseases

1. Gingivitis associated with dental plaque only
a. Without other local contributing factors
b. With local contributing factors

Classification of Gingival
Diseases

Dental plaque-induced gingival diseases

2. Gingival diseases modified by systemic factors
a. associated with the endocrine system
1) puberty-associated gingivitis
2) menstrual cycle-associated gingivitis
3) pregnancy-associated
a) gingivitis
b) pyogenic granuloma
4) diabetes mellitus-associated gingivitis
b. associated with blood dyscrasias
1) leukaemia-associated gingivitis
2) other

Classification of Gingival
Diseases

Dental plaque-induced gingival diseases

3. Gingival diseases modified by medications
1) drug-influenced gingival enlargements
2) drug-influenced gingivitis
a) oral contraceptive-associated gingivitis
b) other

4. Gingival diseases modified by malnutrition

a. ascorbic acid-deficiency gingivitis
b. other

Classification of Gingival
Diseases
Non-plaque-induced gingival
lesions

1. Gingival diseases of specific bacterial origin

a. Neisseria gonorrhoea-associated lesions
b. Treponema pallidum-associated lesions
c. streptococcal species-associated lesions
d. other
2. Gingival diseases of viral origin
a. herpesvirus infections
1) primary herpetic gingivostomatitis
2) recurrent oral herpes
3) varicella-zoster infections
b. other

Classification of Gingival
Diseases
Non-plaque-induced gingival
lesions

3. Gingival diseases of fungal origin

a. candidal infections
1) generalized gingival candidosis
b. linear gingival erythema
c. histoplasmosis
d. other
4. Gingival lesions of genetic origin
a. hereditary gingival fibromatosis
b. other

Classification of Gingival
Diseases gingival
Non-plaque-induced
lesions

5. Gingival manifestations of systemic conditions

a. mucocutaneous disorders
1) lichen planus
2) pemphigoid
3) pemphigus vulgaris
4) erythema multiforme
5) lupus erythematosus
6) drug-induced
7) other
b. allergic reactions
1) dental restorative materials 2) reactions attributable to
a) mercury
a) toothpastes/dentifrices
b) nickel
b)
mouthrinses/mouthwashes
c) acrylic
c) chewing gum additives
d) other
d) foods and additives
3) other

Classification of Gingival
Diseases
Non-plaque-induced gingival
lesions

6. Traumatic lesions (factitious, iatrogenic, accidental)

a. chemical injury
b. physical injury
c. thermal injury
7. Foreign body reactions
8. Not otherwise specified (NOS)

Gingival diseases: A simplified version of the 1999 International

The 1999 International Workshop for the

Classification of Gingival Diseases
A. Dental plaque-induced gingival diseases
B. Non-plaque-induced gingival lesions

The 1999 International Workshop for the Classification of

Periodontal Diseases.
A. Chronic periodontitis
B. Aggressive periodontitis
C. Periodontitis as a manifestation of systemic diseases
D. Necrotizing periodontal diseases
E. Abscesses of the periodontium
F. Periodontitis associated with endodontic lesions
G. Developmental or acquired deformities and conditions

Periodontal diseases: A simplified version of the 1999 International

Workshop.5

Classification of Periodontal Diseases.

A. Chronic periodontitis
a. Localized : up to 30% of sites
b. Generalized
: more than 30% of sites

Severity of the disease

I. Slight: CAL 12 mm.
II. Moderate: CAL 34 mm.
III. Severe: CAL 5 mm or more.
[clinical attachment loss (CAL)]:

Clinical features and characteristics of

Chronic Periodontitis:
Most prevalent in adults (but can occur in children and
adolescents).
Amount of destruction of the periodontium is consistent with the
presence of local risk factors.
Subgingival calculus is a frequent finding.
Slow to moderate rate of progression (but can have periods of
rapid attachment loss).
May be modified by systemic disease.
Can be modified by factors such as smoking and stress.

Classification of Periodontal Diseases.

B. Aggressive periodontitis
a.Localized. : Onset around puberty.
First molar and incisor involvement.
Raised serum antibody response to
pathogens.
b. Generalized : Usually under 30 years, but does occur in older
patients.
Poor antibody response to pathogens.
Pronounced episodic nature of loss of
attachment and alveolar bone.
Generalized interproximal attachment loss
affecting at least three permanent teeth (other
than
first molars and incisors).

Classification of Periodontal
Diseases.

C. Periodontitis as a manifestation of systemic

diseases
a. Associated with haematological disorders
1. Acquired neutropenia
2. Leukaemias
3. Other
b. Associated with genetic disorders
1. Familial and cyclic neutropenia
2. Downs syndrome
3. Leukocyte adhesion deficiency syndromes
4. PapillonLefvre syndrome
5. ChediakHigashi syndrome
6. Histiocytosis syndromes
7. Glycogen storage disease
8. Infantile genetic agranulocytosis
9. Cohen syndrome
10. EhlersDanlos syndrome (Types IV and VIII)
11. Hypophosphatasia
12. Other

Classification of Periodontal
Diseases.

D. Necrotizing periodontal diseases

a. Necrotizing ulcerative gingivitis (NUG)
b. Necrotizing ulcerative periodontitis (NUP)

E. Abscesses of the periodontium

a. Gingival abscess
b. Periodontal abscess
c. Pericoronal abscess

F. Periodontitis associated with endodontic

lesions
Combined periodontic-endodontic lesions

Classification of Periodontal
Diseases.

G. Developmental or acquired deformities and

conditions
a. Localized tooth-related factors that modify or
predispose to plaque-induced gingival
diseases/periodontitis
1.
2.
3.
4.

Tooth anatomic factors

Dental restorations/appliances
Root fractures
Cervical root resorption and cemental tears

Classification of Periodontal
Diseases.

G. Developmental or acquired deformities and

conditions
b. Mucogingival deformities and conditions around teeth
1. Gingival/soft tissue recession
a) facial or lingual surfaces
b) interproximal (papillary)
2. Lack of keratinized gingiva
3. Decreased vestibular depth
4. Aberrant fraenum/muscle position
5. Gingival excess
c) pseudopocket
d) inconsistent gingival margin
e) excessive gingival display
f) gingival enlargement
6. Abnormal colour

Classification of Periodontal
Diseases.

G. Developmental or acquired deformities and

conditions
c. Mucogingival deformities and conditions on edentulous
ridges
1.
2.
3.
4.
5.
6.

Vertical and/or horizontal ridge deficiency

Lack of gingiva/keratinized tissue
Gingival/soft tissue enlargement
Aberrant fraenum/muscle position
Decreased vestibular depth
Abnormal colour

Classification of Periodontal
Diseases.

G. Developmental or acquired deformities and

conditions
d. Occlusal trauma
1. Primary occlusal trauma
2. Secondary occlusal trauma

Periodontal diseases: A simplified version of the 1999 International

Workshop.5

THANK YOU