ADA: Risk Management Series, diagnosis and Managing the Periodontal patient, 1986. Clinically, a patient is characterized as a periodontitis case if: (1) interdental CALis detectable at ≥2 non-adjacent teeth; or (2) buccal or oral CAL ≥3 mm with pocketing >3 mm is detectable at ≥2 teeth. Eur J Dent 2007;1(2):111-4.47. Monitoring gingival health or inflammation is best documented by the parameter of bleeding on probing since it is considered the primary parameter to set thresholds for gingivitis and the most reliable for monitoring patients longitudinally in clinical practice. J Periodontol 1967;38(6):Suppl:610-6.32. 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. 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. Marty M, Palmieri J, Noirrit-Esclassan E, Vaysse F, Bailleul-Forestier I. Necrotizing periodontal diseases in children: A literature review and adjustment of treatment. Periodontol 2000 2013;61(1):69-88.34. Herrera D, Retamal-Valdes B, Alonso B, Feres M. Acute periodontal lesions (periodontal abscesses and necrotizing periodontal diseases) and endo-periodontal lesions. Available at: “http://www.lung.org/stop-smoking/”. These Case Types are commonly required for insurance billing. Periodontitis Associated with Systemic Diseases 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. Antoniazzi RP, Zanatta FB, Rösing CK, Feldens CA. Accessed November 28, 2018. Lang NP, Bartold PM. Jepsen S, Caton JG, Albandar JM, et al. J Dent Res 2015;94(4):540-6.58. Cianciola LJ, Park BH, Bruck E, Mosovich L, Genco RJ. Crit Rev Oral Biol Med 1994;5(1):27-53.33. Information from 61 papers for review was chosen from this list and from references within selected articles. Classification of Periodontal Diseases and Conditions was organized by the American Academy of Periodontology to address these concerns and to revise the classification The workshop proceedings have been published in the Annals of Periodontology. 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. American Academy of Periodontology, SUNSTAR Announce 2018 Innovation Grant Recipients; World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions; Best Evidence Consensus Meeting on Cone-Beam Computed Tomography (CBCT) American Academy of Periodontology Installs New President, Officers in Boston National Cancer Institute: Cancer staging. Highlights of the changes are as follows: 3. subgingival biofilm compositions.2. Periodontists are also dentistry's experts in the treatment of oral inflammation and receive three … Within each category there are specific types of diseases identified, Gingivitis Associated with Systemic Conditions or Medications, Gingival Manifestations of Systemic Diseases and Mucocutaneous Lesions, Blood Dyscrasias (for example Acute Monocytic Leukemia), Mucocutaneous Diseases (Lichen Planus, Cicatricial Pemphigoid), Periodontitis Associated with Systemic Diseases, Addition of a section on “Gingival Diseases”, Replacement of “Adult Periodontitis” with “Chronic Periodontitis“, Replacement of “Early-Onset Periodontitis” with “Aggressive Periodontitis”, Elimination of a separate disease category for “Refractory Periodontitis”, Replacement of “Necrotizing Ulcerative Periodontitis” with “Necrotizing Periodontal Diseases”, Addition of a category on “Periodontal Abscess”, Addition of a category on “Periodontic-Endodontic Lesions”, Addition of a category on “Developmental or Acquired Deformities & Conditions”, Gingival diseases of specific bacterial origin, Gingival manifestations of systemic conditions. systemic health; andiii. The print version will be mailed in late July, along with the … 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. PPD or probing attachment levels alone should not be used as evidence of gingival health or disease; rather, they should be considered in conjunction with other important clinical parameters such as BoP, as well as modifying and predisposing factors. Stop Smoking. Created by Meks. While probing, clinicians should rule out the presence of pseudo pockets associated, for example, with tooth exfoliation or partially erupted teeth. With regards to periodontal probing depth (PPD), there is strong evidence that deep pockets are not necessarily consistent with disease. Oral manifestations include gingival enlargement/bleeding, petechiae, oral ulcerations/infections, and cervical lymphadenopathy. 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 The potential lifespan impact of gingivitis and periodontitis in children. The definitions of mild, moderate, and severe gingivitis continue to be a matter of professional opinion. Billings M, Holtfreter B, Papapanou PN, Mitnik GL, Kocher T, Dye BA. Sex steroid hormones and cell dynamics in the periodontium. 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. J Periodontol 2018;89(Suppl 1):S173-S182.25. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. Dental plaque biofilm-induced gingivitis usually is regarded as a localized inflammation initiated by microbial biofilm accumulation on teeth and considered one of the most common human inflammatory diseases (Table 2 - see PDF).6,19 When dental plaque is not removed, gingivitis may initiate as a result of loss of symbiosis between the biofilm and the host’s immuneinflammatory response. As for the use of oral contraceptives, exaggerated gingival inflammatory response to plaque is not reported in current, lower-dosage formulations as previously was observed with first generation high-dose oral contraceptives.32-34 Although modest gingival inflammation changes have been reported during ovulation,35-37 most women with gingival inflammation associated with menstrual cycles will present with non-detectable clinical signs of the condition.38-40. Nevertheless, it is important that all clinicians are able to diagnose potential problems, complications, and failures associated with dental implants in order to either provide proper treatment or refer the patient to a specialist. Alrayyes S, Hart TC. Assessment of periodontal health status in smokers and smokeless tobacco users: A cross-sectional study. Needleman I, Garcia R, Gkranias N, et al. Available at: “http://www.who.int/about/mission/en/”. 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. J Periodontol 2018;89(Suppl 1):S74-S84.12. (Archived by WebCite® at: “http:www.webcitation.org/70MIuyCej”)54. Oral Health Prev Dent 2012;10(2):185-92.41. Muhlemann HR. 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. 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. : Elsevier/Saunders; 2017:371-8.4. Register now to learn, share, and network! Stenberg WV. Centers for Disease Control and Prevention. The American Academy of Periodontology (AAP) has released a comprehensive update to the classification of periodontal and peri-implant diseases and conditions. 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. American Academy of Periodontology. 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. 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. Research > 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. American Academy of Periodontology. 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 … Predisposing factors are any agent or condition that contributes to the accumulation of dental plaque (e.g., tooth anatomy, tooth position, restorations), while modifying factors are any agent or condition that alters the way in which an individual responds to subgingival plaque accumulation (e.g., smoking, systemic conditions, medications). Umeizudike KA, Savage KO, Ayanbadejo PO. 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. A patient with a current GH status who has a history of successfully treated and stable periodontitis remains at an increased risk of recurrent periodontitis; therefore, the patient should be monitored closely to ensure optimal disease management. J Clin Diagn Res 2016;10(10):ZC143-ZC146.50. 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. While analyzing dental radiographs of children, it is important that clinicians not follow only on diagnosing interproximal carious lesions, but also evaluate the periodontal status, especially as the child grows older. Smoking is a major lifestyle and behavioral risk factor for periodontitis mostly attributed to alterations in the microflora and/or host response.11,22 Increased pocket depth measurements, attachment loss, and alveolar bone loss are more prevalent in smokers than non-smokers.49 Tobacco use is no longer classified as a habit but as a dependence to nicotine and a chronic relapsing medical disorder.50 Smoking and smokeless tobacco use almost always are initiated and established in adolescence.51-57 The most common tobacco products used by middle school and high school students are reported to be e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, and bidis (unfiltered cigarettes from India).52 However, the exposure to cannabis (marijuana) among children and adolescents has increased in the United States due to its legalization in many states.55 Frequent cannabis use has been associated with deeper probing depths, more CAL, and increased risk of severe periodontitis.55 Periodontitis, visible plaque, and gingival bleeding also have been reported among crack cocaine users.56 Clinical signs associated with smokeless tobacco may include increased gingival recession and attachment loss, particularly at the sites adjacent to mucosal lesion associated with the habit.55 Health professionals who treat adolescents and young adults should be aware of the signs of tobacco use and be able to provide counseling (or referral to an appropriate provider) regarding the serious health consequences of tobacco and drug use, as well as use brief interventions for encouragement, support, and positive reinforcement for cessation when the habit is identified. 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