Crit Rev Oral Biol Med 1994;5(1):27-53.33. J Periodontol 2018;89(Suppl 1):S291-S303.17. dental restorations;iii. Even though there is a predilection of attachment loss to occur at inflamed sites of the gingiva, not all affected areas are destined to progress to periodontitis. Periodontitis is a complex and dynamic interplay of multiple causal factors including lifestyle, tooth anatomy, systemic diseases, genetics, and environment. 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). Grading also allows the clinician to incorporate the individual patient risk factors (e.g., smoking, uncontrolled Type 2 diabetes) into the diagnosis, which may influence the comprehensive case management. Jepsen S, Caton JG, Albandar JM, et al. The Thesis-based MSc in Medical Sciences-Periodontology / PhD in Medical Sciences-Periodontology will provide extensive, cutting-edge, top-of-the-line training in these areas. In 2017, the American Academy of Periodontology and the European Federation of Periodontology co-sponsored the World Workshop on the Classification of Periodontal and … Albandar JM, Susin C, Hughes FJ. CHICAGO — Dentists treating patients with chronic periodontitis, a severe form of gum disease that can lead to tooth loss, are advised to use scaling and root planing (SRP), deep cleaning of the teeth, as initial treatment, according to new guidelines from the American Dental Association (ADA). 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. Systemic disease is defined as a disease that affects multiple organs and tissues or that affects the body as a whole.60 Several systemic disorders and conditions can affect the course of periodontal diseases or have a negative impact on the periodontal attachment apparatus independently of dental biofilm-induced inflammation.7,20 For some cases, the periodontal problems may be among the first signs of the disease. Effects of menstrual cycle on periodontal health and gingival crevicular fluid markers. Periodontal Diseases associated with Endodontic Lesions Becerik S, Ozcaka O, Nalbantsoy A, et al. host immune function;ii. These official guideline summaries are developed from the American Academy of Periodontology guidelines and are authored to support clinical decision making at the point of care. The new periodontitis classification was further characterized based on a multi-dimensional staging and grading framework system. Classification of periodontal diseasesThe new classification of periodontal disease proposed in the 2017 workshop defines three distinct forms: (1) periodontitis (single category grouping the two forms of the disease formerly recognized as aggressive or chronic); (2) necrotizing periodontitis; and (3) periodontitis as a manifestation of systemic conditions. 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. Med Princ Pract 2011;20(4):374-6.59. J Periodontol 2018;89(Suppl 1):S17-S27.23. Traumatic occlusal forces and occlusal traumaTraumatic occlusal force is defined as “any occlusal force that causes an injury to the teeth and/or the periodontal attachment apparatus.”20 It may be indicated by one or more of the following: fremitus (visible tooth movement upon occlusal force), tooth mobility, thermal sensitivity, excessive occlusal wear, tooth migration, discomfort/pain on chewing, fractured teeth, radiographically widened periodontal ligament space, root resorption, and hypercementosis.20 Occlusal trauma is alesion in the periodontal ligament, cementum, and adjacent bone caused by traumatic occlusal forces. The AAP released two documents titled “Three Steps to Staging and Grading a Patient” and “Staging and Grading Periodontitis.” Tonetti MS, Greenwell H, Kornman KS. Conversely, patients with thin periodontal phenotypes, with inadequate oral hygiene, and requiring cervical restorative and/or orthodontic treatment are at an increased risk for gingival recession.12,20 Monitoring specific gingival recession sites is considered a proper approach in the absence of any pathosis. systemic health; andiii. Baser U, Cekici A, Tanrikulu-Kucuk S, Kantarci A, Ademoglu E, Yalcin F. Gingival inflammation and interleukin1 beta and tumor necrosis factor-alpha levels in gingival crevicular fluid during the menstrual cycle. Xerostomia may occur as a side effect of medications such as antidepressants, antihistamines, decongestants, and antihypertensive medications. 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. Trombelli L, Farina R, Silva CO, Tatakis DN. J Periodontol 2018;89(Suppl 1):S173-S182.25. For patients with special health care needs receiving dental treatment under sedation and/or general anesthesia, clinicians are encouraged to take this opportunity and perform the periodontal probing. A classification scheme for periodontal and peri‐implant diseases and conditions is necessary for clinicians to properly diagnose and treat patients as well as for scientists to investigate etiology, pathogenesis, natural history, and treatment of the diseases and conditions. Marty M, Palmieri J, Noirrit-Esclassan E, Vaysse F, Bailleul-Forestier I. Necrotizing periodontal diseases in children: A literature review and adjustment of treatment. J Clin Periodontol 2018;45(Suppl 20):S286-S291.10. Puberty gingivitis in insulin-dependent diabetic children. Oral dryness is a clinical condition frequently associated with xerostomia, which in turn is a symptom caused by a decrease in the salivary flow (hyposalivation). 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 … Dental plaque biofilm-induced gingivitisDuring the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions, revisions of the 1999 classification system5 for dental plaque-induced gingival diseases included four components: (1) description of the extent and severity of the gingival inflammation; (2) description of the extent and severity of gingival enlargements; (3) a reduction in gingival disease taxonomy; and (4) discussion of whether mild localized gingivitis should be considered a disease or variant of health.22 These four components are addressed in this review. Eur J Dent 2007;1(2):111-4.47. Early diagnosis of periodontal diseases ensures the greatest opportunity for successful treatment, primarily by reducing etiological factors, establishing appropriate therapeutic measures, and developing an effective periodic maintenance protocol.2. The print version will be mailed in late July, along with the … In addition, the ADA provides treatment recommendations for each Case Type which is not part of this presentation. A review of the classification system from Association among periodontitis and the use of crack cocaine and other illicit drugs. Albert DA, Severson HH, Andrews JA. Information from 61 papers for review was chosen from this list and from references within selected articles. The definitions of mild, moderate, and severe gingivitis continue to be a matter of professional opinion. The current classification of non-dental plaque-induced gingival conditions is based on the etiology of the lesions. 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. Of interest to pediatric dentists, PA can occur in healthy sites due to impaction of foreign bodies (e.g., dental floss, orthodontic elastic, popcorn hulls), harmful habits (e.g., nail biting, clenching), inadequate orthodontic forces, gingival enlargement, and alterations of the root surface (e.g., invaginated tooth, alterations, enamel pearls, iatrogenic perforations, vertical root fracture, external root resorption). 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