Periodontal disease classifications – do they matter?

Dull as dishwater. List after list of gingival and periodontal diseases. If you are like me then it becomes difficult to remember them all, probably because in reality we see only a small cross section of these diseases.

Most of us working in practice, even in specialist practice, will mostly be dealing with the chronic inflammatory diseases with the restorative and cosmetic problems associated with the resultant tooth loss. How often do we see Papillon-Lefevre or Ehlers-Danlos?

Additionally, the periodontal diagnostic tools we have at our disposal are fairly basic and therefore the classifications are pretty broad at best. However we need some understanding of classifications. Firstly to help us determine our treatment plans and secondly so that our diagnoses can be recorded for medico-legal purposes.

For the purpose of general practice, we can look at a fairly simple system. Remember, if you see anything you are not sure about refer it for further diagnosis. I fully understand that in the academic world this approach may be vilified but we do have to have something simple, realistic and workable.

I have based this approach on the coalescing of a number of different classifications. For the inflammatory diseases the first steps are fairly basic.

• Is it gingivitis or periodontitis?

• Is the inflammation plaque induced or non-plaque induced?

• Is it localised or generalised?

• Acute or chronic?

• Mild, moderate or advanced?

• Are there any associated risk factors modifying either of these disease processes? Identify and control these.

Pretty basic stuff. Once we have this then we can begin to put some meat on the bones. We can begin to look at the specifics.

I think in the majority of cases the plaque induced diseases pretty much speak for themselves, as does the treatment. For localised gingival swellings you may need to investigate them further to determine the exact nature to differentiate a giant cell epulis from a vascular epulis or pregnancy epulis for example. If the problem clears up with thorough plaque control (maybe with a little corrective surgery) then it is more than likely plaque associated.

Plaque disease

For plaque induced periodontal disease, I like to categorise it in a somewhat old-fashioned way but one that is easy to remember – age:

• Early onset

• Pre-pubertal

• Juvenile (onset of puberty up to the age of 18)

• Rapidly progressive (onset between 18-35 years old approximately)

• Chronic adult (35 years old and up)

• Recurrent

• Refractory. I actually question whether this exists.

The term ‘aggressive’ is now used instead of the term ‘rapidly progressive’.

Non-plaque disease

For non-plaque associated diseases, whether it be gingival or periodontal, simply think in terms of the following:

• Bacterial

• Viral

• Fungal

• Hereditary

• Traumatic

• Allergic

• Nutritional

• Pharmacological

• Hormonal

• Systemic

• The catch all – non-specific.

A few additional things to throw in for completion are the necrotising conditions, abscesses and perio-endo lesions. This is a basic way of looking at classifications and covers more than you are likely to see on a day-to-day basis. If unsure, get a second opinion.

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