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. Shariff JA, Ahluwalia KP, Papapanou PN. 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. Severe presentation of necrotizing ulcerative periodontitis in a Nigerian HIV-positive patient: A case report. Mean annual attachment, bone level and tooth loss: A systematic review. Therefore, clinicians should become familiarized with the current classification of periodontal diseases and conditions, including gingivitis, in order to properly diagnose patients affected by these problems.3. 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 remaining clinical cases of periodontitis that do not present with the local characteristics of necrotizing periodontitis or the systemic characteristics of a rare immune disorder with a secondary manifestation of periodontitis should be diagnosed as periodontitis and be further characterized using the staging and grading system that describes clinical presentation,6,7,18,20,24,27 (Table 4 - see PDF).The concept of staging is adopted from the field of oncology that classifies staging of tumors based on baseline clinical observations of size or extent and whether it has metastasized or not.61 Understanding the stage of the periodontal disease helps the clinician communicate with the patient the current severity and extent of the disease (localized or generalized), assess the complexities of disease management, develop a prognosis, and design an individualized treatment plan for the patient. Tobacco use among middle and high school students – United States, 2011-2016. Occlusal trauma and excessive occlusal forces: Narrative review, case definitions and diagnostic considerations. ICD: International Statistical Classification of Diseases and Related Health Problems. Periodontol 2000 2013;61(1):69-88.34. Needleman I, Garcia R, Gkranias N, et al. Ercoli C, Caton JG. The new periodontitis classification was further characterized based on a multi-dimensional staging and grading framework system. AbbreviationsAAPD: American Academy of Pediatric Dentistry. Treatment of plaque-induced gingivitis, chronic, periodontitis, and other clinical conditions. Lancet 2008;371(9629):2027-38.51. Task Force members: Dr. Nico Geurs, chair; Drs. Berglundh T, Armitage G, Araujo MG, et al. Periodontal Diseases associated with Endodontic Lesions J Periodontol 2003;74(11):1696-704.5. In the absence of baseline radiographs, radiographic bone level ≥3 mm in combination with BoP and probing depths ≥6 mm is indicative of peri-implantitis. subgingival biofilm compositions.2. 2 This system was widely used among practitioners although a gingival disease component was missing and there was an overlap of disease categories. periodontal pockets;ii. Other signs and symptoms may include pain, tenderness and swelling of the gingiva, bleeding and suppuration on probing, deep periodontal pocket, bone loss observed radiographically, and increased tooth mobility.18,24 Facial swelling, elevated body temperature, malaise, regional lymphadenopathy, or increased blood leukocytes are less commonly observed.18 Etiologic factors such as pulp necrosis, periodontal infections, pericoronitis, trauma, surgery, or foreign body impaction may explain the development of PA. PA can develop in both periodontitis and non-periodontitis patients. Cianciola LJ, Park BH, Bruck E, Mosovich L, Genco RJ. Developmental or Acquired Deformities and Conditions, *Can be further classified on basis of extent and severity. These Case Types are commonly required for insurance billing. classification system for periodontal diseases Other factors that predispose to gingivitis in both male and female adolescents are dental caries, mouth breathing, dental crowding, and eruption of teeth. The print version will be mailed in late July, along with the … The major difference between the 1999 and 2017 classifications is the development of a more comprehensive nomenclature of non-plaque induced gingival diseases and conditions based on the primary etiology, as well as the inclusion of the International Statistical Classification of Diseases and Related Health Problems (ICD)–10 diagnostic codes (e.g., ICD–10 code for primary herpetic gingivostomatitis is B00.2).6,11,19 Several of these conditions may occur in pediatric patients, as well as in those with special health care needs; therefore, they are of great interest to pediatric dentists. The American Academy of Periodontology classification system was established to identify distinct types of periodontal diseases by taking into consideration factors such as age of onset, clinical appearance, rate of disease progression, pathogenic microbial flora and systemic influences. GH: Gingival health. Mucogingival deformities and conditionsNormal mucogingival condition is defined as the absence of pathosis such as gingival recession, gingivitis, and periodontitis. J Periodontol 2010;81(5):673-81.40. Available at: “http://www.lung.org/stop-smoking/”. Early diagnosis ensures the greatest opportunity for successful treatment, primarily by reducing etiological factors, establishing appropriate therapeutic measures, and developing an effective periodic maintenance protocol.2, In 2017, the American Academy of Periodontology and the European Federation of Periodontology co-sponsored the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. 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. Assessing periodontal health is important to establish a common reference point for diagnosing disease and determining therapy outcomes by practitioners.11,21 Four levels of periodontal health have been proposed, depending on whether (1) the periodontium (attachment and bone level) is structurally and clinically sound or reduced, (2) the ability to control local and systemic modifying factors, as well as (3) the relative treatment outcomes. Created by Meks. 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. Centers for Disease Control and Prevention. Erratum in MMWR Morb Mortal Wkly Rep 2017;66(23):765.53. (Archived by WebCite® at: “http://www.webcitation.org/74HGZ7CO0”)61. Armitage GC. HIV/AIDS: Human immunodeficiency virus and acquired immune deficiency syndrome. J Periodontol 2018;89(Suppl1):S159-S172.28. Gingival healthGingival health (GH) is usually associated with an inflammatory infiltrate and host response in relatively stable equilibrium.21 GH in a patient with intact periodontium is diagnosed by (1) no probing attachment loss, (2) no radiographic bone loss (RBL), (3) <3 mm of PPD, and (4) <10 percent BoP.11 GH can be restored following treatment of gingivitis and periodontitis. J Periodontol 2018;89(Suppl 1):S267-S290.27. Novotna M, Podzimek S, Broukal Z, Lencova E, Duskova J. Periodontal diseases and dental caries in children with type 1 diabetes mellitus. Peri-implant diseases and conditionsThe 2017 World Workshop members developed a new classification for peri-implant health, peri-implant mucositis and peri-implantitis. 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. The AAP updated its classification system for periodontal diseases in 2018 to create a common terminology compatible with scientific knowledge of periodontal diseases. 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. Micronutritional approached to periodontal therapy. Case definitions and clinical criteria of these conditionsare presented below. FDA: Food and Drug Administration. J Periodontal Implant Sci 2014;44(6):293-9.48. This is because the inter-relationship between health, gingivitis, and periodontitis is highly dependent on the host’s susceptibility and immune-inflammatory response. (Archived by WebCite® at: “http://www.webcitation.org/74HG4LjO1”)30. However, it appears that adequate periodontal assessment and treatment, appropriate instructions, and motivation in self-performed plaque control and compliance to periodic maintenance protocols are the most important factors to limit or avoid the potential negative effects on the periodontium caused by fixed and removable prostheses whenhypersensitivity reactions are not suspected.13. J Periodontol 2016;87(12):1396-405.57. Oral Health Prev Dent 2012;10(2):185-92.41. 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. 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. Demirer S, Özdemir H, Şencan M, Marakoḡlu I. Gingival hyperplasia as an early diagnostic oral manifestation in acute monocytic leukemia: A case report. 387-401, Originating CouncilCouncil of Clinical Affairs. In addition to reports that were prepared prior to the World Workshop, there were 4 working groups at the meeting and each issued a consensus report at the conclusion of the meeting. Table 4 (see PDF) shows the framework for staging and grading of periodontitis, as well as the criteria for periodontitis stage and grade, respectively.27 Table 5 (see PDF) presents the three steps to staging and grading a patient with periodontitis.27 For a more comprehensive description of staging and grading of periodontitis, the reader is encouraged to review an outcome workshop paper by Tonetti et al.27 and the workshop consensus report by Papapanou et al.24. dental restorations;iii. 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. American Academy of Periodontology Task Force Report on the Update to the 1999 Classification of Periodontal Diseases and Conditions Journal of Periodontology … Oral manifestations include gingival enlargement/bleeding, petechiae, oral ulcerations/infections, and cervical lymphadenopathy. Periodontal health, gingival diseases and conditionsPeriodontal healthThe World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-beingm and not merely the absence of disease or infirmity”.29 Following this framework, periodontal health is defined as the absence of clinical inflammation associated with gingivitis, periodontitis, or any other periodontal conditions, and may include patients who have had a history of successfully treated gingivitis or periodontitis, or other periodontal conditions, and who have been and are able to maintain their dentition without signs of clinical gingival inflammation.11 According to the WHO health framework,29 the absence of inflammatory periodontal disease allows an individual to function normally and avoid the consequences (mental or physical) associated to present or past disease.11. local predisposing factorsi. This document presents an abbreviated overview of the new classification of periodontal and peri-implant diseases and conditions.6-28 In addition to reviewing the proceeding papers from the 2017 World Workshop, an electronic search was conducted using PubMed®/MEDLINE using the terms: periodontal health AND children, periodontal health AND adolescents, gingival disease AND children, gingival disease AND adolescents, periodontal disease AND children, periodontal disease AND adolescents, gingivitis AND prevalence, periodontitis AND prevalence, gingival disease AND prevalence, periodontal disease AND prevalence, dental plaque AND children, dental plaque AND adolescents; fields: all; limits: within the last 10 years, humans, English, and clinical trials. Accessed June 22, 2018. Peri-implant health can occur around implants with normal or reduced bone support.6,25, Peri-implant mucositisPeri-implant mucositis is characterized by visual signs of inflammation such as redness, swelling, and line or drop of bleeding within 30 seconds following probing, combined with no additional bone loss following initial healing. Trombelli L, Farina R, Silva CO, Tatakis DN. J Periodontol 2018;89(Suppl 1):S28-S45.20. 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). 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. The American Dental Association (ADA) accredited programs are a minimum of three years in length. Radiographic assessment is a critical component of clinical assessment of the periodontal tissues. Ervasti T, Knuutila M, Pohjamo L, Haukipuro K. Relation between control of diabetes and gingival bleeding. The system developed by the American Dental Association classification. System is primarily based on the severity of attachment loss. 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. There are broadly two categories of gingival disease and conditions: dental plaque biofilminduced gingivitis and non-dental plaque-induced gingival disease. Bimstein E, Huja PE, Ebersole JL. The primary signs associated with EPL are deep periodontalpockets reaching or close to the apex and/or negative or altered response to pulp vitality tests. Oral Health Policies & Recommendations (The Reference Manual of Pediatric Dentistry), The Reference Manual of Pediatric Dentistry2019-2020/P. Dental plaque–induced gingival conditions. Finally, no classification for diseases limited to the gingiva existed. 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 … Umeizudike KA, Savage KO, Ayanbadejo PO. The American Academy of Periodontology has recently published changes in the Stability is characterized by minimal inflammation (<10 percent in BoP sites), optimal therapeutic response (no probing depths >4 mm), and lack of progressive periodontal destruction while controlling for risk factors. 11 Journal of the Canadian Dental Association C LINICAL P RACTICE F rom 1977 to 1989, the American Academy of Periodontology (AAP) went from 2 main periodontal disease categories to 5 (Table 1).1 The 1989 periodon- tal disease classification was a significant improvement over Assessment of periodontal health status in smokers and smokeless tobacco users: A cross-sectional study. Hatsukami DK, Stead LF, Gupta PC. The clinician uses the clinical and radiographic data gathered and classifies the patient into one of the four Case Types. Highlights of the changes are as follows: 3. Monitoring gingival health or inflammation is best documented by the parameter of BoP since it is considered the primary parameter to set thresholds for gingivitis and the most reliable for monitoring patients longitudinally in clinical practice.6,21 Clinicians are encouraged to start probing regularly when the first permanent molars are fully erupted and the child is able to cooperate for this procedure in order to establish a baseline, detect early signs of periodontal disease, and prevent its progression. Find clinical practice guidelines from the American Academy of Periodontology. RBL: Radiographic bone loss. The American Academy of Periodontology Classifications are designed to help dental hygienists diagnose and treat periodontitis. host determinantsa. Radiographs and probing attachment level analysis should not be used to diagnose gingivitis since they usually do not indicate loss of supporting structures. 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. Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. However, this condition often is associated with patient esthetic concerns, dentinal hypersensitivity and carious/non-carious cervical lesions on the exposed root surface.12,20 While lack of keratinized tissue is a predisposing factor for gingival recession and inflammation, periodontal health can be maintained despite the lack of keratinized tissues in most patients with optimal home care and professionalmaintenance. 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 Periodontol 2011;38(s11):142-58.49. The American Academy of Periodontology (AAP) has released a comprehensive update to the classification of periodontal and peri-implant diseases and conditions. 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. 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