AAP Classification of Periodontal Diseases and Conditions (1999)

AAP Classification of Periodontal
Diseases and Conditions (1999)
• Gingival Diseases
– Dental plaque-induced gingival diseases
– Non-plaque induced gingival lesions
• Chronic Periodontitis (Slight: 1-2mm CAL; moderate:
3-4mm CAL; severe: >5mm CAL)
– Localized
– Generalized (>30% of sites are involved)
• Aggressive Periodontitis (Slight: 1-2mm CAL; moderate:
3-4mm CAL; severe: >5mm CAL)
– Localized
– Generalized (>30% of sites are involved)
AAP Classification of Periodontal
Diseases and Conditions (1999)
• Periodontitis as a Manifestation of Systemic Diseases
– Associated with hematological disorders
– Associated with genetic disorders
– Not otherwise specified
• Necrotizing Periodontal Diseases
– Necrotizing ulcerative gingivitis
– Necrotizing ulcerative periodontitis
• Abscesses of the Periodontium
– Gingival abscess
– Periodontal abscess
– Pericoronal abscess
AAP Classification of Periodontal
Diseases and Conditions (1999)
• Periodontitis Associated with Endodontic Lesions
– Combined periodontic-endodontic lesions
• Developmental or Acquired Deformities and Conditions
– Localized tooth-related factors that modify or
predispose to plaque-induced gingival diseases
periodontitis
– Mucogingical deformities and conditions around teeth
– Mucogingival deformities and conditions on edentulous
ridges
– Occlusal trauma
The Periodontal Disease Classification System of the American Academy of Periodontology - An Update,
Journal of Canadian Dental Association, 2002; 66:549-7
Crystal S. Baik
What is Refractory Periodontal
Disease
• Refractory periodontal disease refers to
destructive periodontal diseases in patients who
demonstrate continued attachment loss in spite of
adequate treatment and proper oral hygiene.
• Contributing factors include:type of therapy
provided, furcation involvement, microflora, and
smoking history.
Journal of Canadian
Dental Association, December 2000
Elizabeth Black
Periodontal Disease and Diabetes
• The diabetic state is associated with:
– Decreased collagen synthesis
– Increased collagenase activity
– Altered neutrophil function
• Elevated blood sugar levels suppress
the host’s immune response and results
in:
– Poor wound healing
– Susceptibility to recurrent infections
• Periodontal disease is often considered
the 6th complication of diabetes and may
place the individual at risk for future
diabetic complications
*From The Amer Acad of
Periodontology, pamphlet "Diabetes
Periodontal Disease & Diabetes
BRITTLE DIABETICS:
• More susceptible to gingivitis,
gingival hyperplasias and
periodontitis
• More harmful proteins (cytokines)
in their gingival tissues
• Decreased beneficial proteins
(growth factors)  interferes with
the healing response
• Increased levels of serum
triglycerides may be related to
greater probing depths and
attachment loss
*From Fedi, The Periodontic
Syllabus, 4th ed., 2000
Periodontal Disease and Diabetes
TREATMENT:
• Closely monitor blood glucose levels
• Maintenance of meticulous oral
hygiene and strict recall appointments
• Short appointments in relaxed, nonstressful environment
• Have source of oral glucose available
• Effective treatment of periodontal
infection and reduction of periodontal
inflammation are associated with a
reduction in the level of glycosylated
hemoglobin – the marker of diabetic
control
*From Little & Falace, Dental
Management of the Medically
Periodontal Treatment and Diabetes
-The diabetic patient requires special precautions prior to
periodontal treatment
-treatment in the uncontrolled diabetic is
contraindicated
-treatment in the “brittle” diabetic requires
prophylactic antibiotics, started 2 days
preoperatively (Penicillin VK) and continuing
through the immediate post-op period
-treatment of the well-controlled diabetic may
the same as an ordinary patient
Periodontal Treatment and Diabetes
• Protocol for Treatment:
– Clinician should make sure that prescribed insulin has been taken,
followed by a meal
– Morning appointments are appropriate because of optimal insulin levels
– Monitor vitals, including blood glucose prior to treatment
– Procedures performed may alter the patient’s ability to maintain caloric
intake, therefore post-op insulin doses should be altered accordingly
– Tissues should be handled as atraumatically and minimally as possible
(less than 2 hrs)
– Epinephrine should not be used in concentration greater than 1:100,000
due to epinephrine effects on insulin
– Diet recommendations should be made to maintain proper glucose
balance
– Frequent recall and fastidious home oral care should be stressed
Periodontal Treatment and Diabetes
• Recent Studies:
-Effective treatment of periodontal infection and reduction of periodontal
inflammation are associated with a reduction in the level of glycated
hemoglobin
-Increased serum triglyceride levels in uncontrolled diabetics have been
shown to be related to greater attachment loss and probing depths
-Therefore…Control of periodontal disease should be an important part of
the overall management of the diabetic patient
Sources:
Carranza and Newman, Clinical Periodontology, 8th ed.
Grossi, et al. Treatment of Periodontal Disease in Diabetics Reduces Glycated
Hemoglobin. Journal of Periodontology, Vol. 68, No. 8
Chris VanDeven
Smoking and Periodontal Disease
• Smoking is a major cause of
periodontal disease.
• Smokers are 4x as likely to develop
periodontitis as non-smokers.
• Smoking may be responsible for
more than half of the periodontal
disease among adults in the U.S.
• Up to 90% of refractory periodontitis
patients are smokers.
References:
1) Tomar, S., Asma, S. ; J Periodontol 2000;71:743-751
2) Johnson GK. Slach NA. Impact of tobacco use on periodontal
status. [Review] Journal of Dental Education. 65(4):313-21, 2001 Apr.
Graham Smith
Smoking and Periodontal Disease
• Smoking may increase levels of
certain periodontal pathogens.
• Smoking has a negative effect on
host response, such as neutrophil
function and antibody production.
• Smoking has been shown to have a
cytotoxic effect on gingival fibroblasts
and could slow down wound healing.
References:
3) Rota MT.; Tobacco smoke in the development and therapy of periodontal disease: progress and
questions. [Review] Bulletin du Groupement International Pour la Recherche Scientifique en
Stomatologie et Odontologie. 41(4):116-22, 1999 Oct-Dec.
2) Johnson GK. Slach NA. Impact of tobacco use on periodontal status. [Review] Journal of Dental
Education. 65(4):313-21, 2001 Apr.
Graham Smith
Smoking and Periodontal Disease
• Smoking may be one parameter to
use in deciding to treat refractory
periodontitis in smokers with a
systemic antibiotic therapy directed
against smoking-associated
periodontal bacteria.
• Smoking cessation seems to have a
beneficial effect on periodontal
health.
References:
4) Lie MA. [Smoking as a risk factor for periodontitis]. [Review] [Dutch] Nederlands Tijdschrift voor
Tandheelkunde. 106(11):419-23, 1999 Nov.
5) van Winkelhoff AJ. Bosch-Tijhof CJ. Winkel EG. van der Reijden WA. Smoking affects the subgingival
microflora in periodontitis. Journal of Periodontology. 72(5):666-71, 2001 May.
Graham Smith
What is Periostat?
• Doxycycline Hyclate- inhibits collagenase activity and
reduces the collagenase activity in gingival crevicular
fluid of patients with adult periodontitis
• Indicated for use as an adjunct to scaling and root
planing to promote attachment level gain and to
reduce pocket depths
• Periostat is available as a tablet(20mg) to be taken
orally two times a day (about an hour before, or two
hours after meals). Should be taken with plenty of
fluids.
• Typical treatments range from 3months to 12months.
•
www.Periostat.com R.Macnowski
What is Periostat?
• Clinical studies have shown that the use of Periostat,
along with SC/RP is more effective at regaining
attachment level, than treatment with SC/RP alone
• Periostat is the first and only therapeutic agent
designed to modulate the host response and helps to
slow the progression of periodontal disease.
• Periostat should be used when traditional SC/RP
treatments alone are ineffective, but before surgery is
indicated.
•
www.Periostat.com R. Macnowski
What is Periostat?
• Periostat is not an antibiotic- the low dosages of
periostat have no detectable effect on bacteria.
• Periostat should not be used with children, expecting
mothers, nursing mothers, or anyone with a
tetracycline hypersensitivity.
• Periostat may cause hypersensitivity to sunlight
• No reports of tooth staining
• May reduce the effect of BCPs
•
www.periostat.com R.Macnowski