List of periodontal diseases
Periodontal pathology, also termed gum diseases or periodontal diseases, are diseases involving the periodontium. The periodontium is composed of alveolar bone, periodontal ligament, cementum and gingiva.Classification
An internationally agreed classification formulated at the World Workshop in Clinical Periodontics in 1989 divided periodontal diseases into 5 groups: adult periodontitis, early-onset periodontitis, periodontitis associated with systemic disease, necrotizing ulcerative periodontitis and refractory periodontitis.
In 1993 at the 1st European Workshop in Periodontology the earlier classification was simplified and the categories periodontitis associated with systemic disease and refractory periodontitis were dropped. Both of these classification systems were widely used in clinical and research settings. However, they failed to address a gingival disease component, had overlapping categories with unclear classification criteria and over focussed on age of onset and rate of disease progression.
Consequently, a new classification was developed at the International Workshop for a Classification of Periodontal Diseases and Conditions in 1999. This covered in much more detail the full range of periodontal diseases. "Adult periodontitis" was reclassified "chronic periodontitis" and "early-onset periodontitis" to "aggressive periodontitis". This article follows the 1999 classification, although the ICD-10 differs significantly.
The latest World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions was held in 2017. this updated classification overcomes some of the limitations of its predecessors, including:
- Defining the threshold between periodontal health and gingivitis
- Introducing reduced periodontium to the classification to take into account patients with loss of attachment in the absence of periodontitis and post-periodontal treatment
- Introduction of staging and grading system to categorise periodontitis by the severity and biological features instead of the old terms of "chronic periodontitis" and "aggressive periodontitis"
- Introduction of "Systemic Diseases" and Conditions Affecting the Periodontal Supporting Tissues"
- A new classification for peri-implant health, peri-implant mucositis and peri-implantitis.
Gingival diseases
Generally all gingival diseases share common features such as signs and symptoms being restricted to gingiva, clinically detectable inflammation, and the potential for the gum tissues to return to a state of health once the cause is removed, without irreversible loss of attachment of the teeth.Dental plaque-induced
is a microbial biofilm which forms on teeth. This biofilm may calcify and harden, termed calculus. Plaque tends to build up around the gingival margin and in gingival crevices or periodontal pocket. The release of waste products from the bacteria living in the biofilm causes an inflammatory response in the gums which become red and swollen, bleeding easily when disturbed. This is termed plaque-induced gingivitis and represents the most common form of gingival disease. This inflammatory response in the host can be strongly influenced by many factors such as hormonal fluctuations, drugs, systemic diseases, and malnutrition; which may allow further subdivision of plaque-induced gingivitis.Non-plaque-induced
These are far less common than plaque-induced gingival lesions. Non-plaque-induced gingival disease is an inflammation of the gingiva that does not result from dental plaque, but from other gingival diseases caused by bacterial, viral, fungal, or genetic sources. Although this gingival disease is less common than those which are plaque-induced, it can have a serious impact on the patient's overall health. Inflammation can also be caused by allergic reactions to materials used in dental restorations, specific toothpastes, mouthwashes, and even some foods. Trauma, reactions to foreign bodies, or toxic reactions can also contribute to this non-plaque-induced gingivitis. Furthermore, genetics can play a significant role. Specifically, hereditary gingival fibromatosis is known to cause non-plaque-induced gingival lesions. However, sometimes, there is no specific cause for this form of gingival disease.Specific bacterial origin
Plaque is composed of a complex community of many different species of bacteria. However, specific bacterial species are recognized as being capable of causing gingival disease in isolation. Neisseria gonorrhoeae and Treponema pallidum, the causative organisms in the sexually transmitted diseases gonorrhea and syphilis may cause gingival lesions. These lesions may appear as a result of systemic infection or direct infection. Streptococcal species may rarely cause gingivitis, which presents as fever, malaise and very painful, swollen red and bleeding gums, sometimes following tonsillitis.Viral origin
The most common viral infections causing gingival lesions are herpes simplex virus type 1 and 2, and varicella-zoster virus. Typically gingival lesions appear as a manifestation of recurrence of a latent viral infection.Fungal origin
Sometimes fungal infections occur on the gums. Candida species such as C. albicans, C. glabrata, C. krusei, C. tropicalis, C. parapsilosis, and C. guillermondiiare the most common fungi capable of causing gingival lesions. Linear gingival erythema is classified as a candida-associated lesion, that is to say Candida species are involved, and in some cases the lesion responds to antifungal therapy, but it is thought that other factors exist, such as oral hygiene and human herpesviruses. Linear gingival erythema presents as a localized or generalized, linear band of erythematous gingivitis. It was first observed in HIV infected individuals and termed "HIV-gingivitis", but the condition is not confined to this group. This condition can develop into necrotizing ulcerative periodontitis. Histoplasma capsulatum is the causative organism in histoplasmosis, which may occasionally involve the gums.Genetic origin
is the main example of a genetic disease causing gingival lesions. There is fibrous enlargement of the gums which may completely cover the teeth and interfere with the normal eruption of teeth in growing children.Manifestations of systemic conditions
Occasionally systemic conditions may be the sole cause of gingival inflammation rather than merely influencing background plaque-induced gingivitis. Certain mucocutaneous produce gingival inflammation which may manifest as desquamative gingivitis or oral ulceration. Such conditions include lichen planus, pemphigoid, pemphigus vulgaris, erythema multiforme, and lupus erythematosus. Allergic reactions may also trigger gingival lesions. Sources of allergens include toothpastes, mouthwash, chewing gum, foods, additives, medicines, dental restorative materials, mercury, nickel and acrylic, acrylic. Plasma cell gingivitis is a rare condition thought to be a hypersensitivity reaction. Lichenoid lesions may also occur on the gingival mucosa.Traumatic lesions
Trauma may be chemical, physical or thermal. It can be self-inflicted, iatrogenic or accidental.Foreign body reactions appear as red or red and white, possibly painful longstanding lesions similar to desquamative gingivitis, or be granulomatous or lichenoid in nature. Tiny particles of dental materials may become impregnated in the gingival tissues and trigger a chronic inflammatory cell response.Periodontitis
The defining feature of periodontitis is connective tissue attachment loss which may manifest as deepening of periodontal pockets, gingival recession, or both. This loss of support for the teeth is essentially irreversible damage. Chronic periodontitis is generally slow to moderate in terms of disease progression, although short bursts of increased tissue destruction may occur. Ultimately, tooth loss may occur if the condition is not halted. It is termed localized when less than 30% of sites around teeth are involved, and generalised when more than 30% are involved. clinical attachment loss can be used to determine the severity of the condition, where 1–2mm is slight, 3–4mm is moderate and more than 5mm is severe.Aggressive periodontitis
Aggressive periodontitis is distinguished from the chronic form mainly by the faster rate of progression. Loss of attachment may progress despite good oral hygiene and in the absence of risk factors such as smoking. Aggressive periodontitis may occur in younger persons and there may a genetic aspect, with the trait sometimes running in families.Manifestation of systemic diseases
Systemic diseases may be associated with the development of periodontitis. It is thought that the host immune response to plaque is altered by the systemic condition. Hematological disorders associated with periodontitis include acquired neutropenia, leukemias and others. Genetic disorders potentially associated include familial and cyclic neutropenia, Down syndrome, leukocyte adhesion deficiency syndromes, Papillon-Lefèvre syndrome, Chediak-Higashi syndrome, histiocytosis syndromes, glycogen storage disease, infantile genetic agranulocytosis, Cohen syndrome, Ehlers-Danlos syndrome, hypophosphatasia, and others.Necrotizing periodontal diseases are non-contagious infections but may occasionally occur in epidemic-like patterns due to shared risk factors. The milder form, necrotizing ulcerative gingivitis, is characterized by painful, bleeding gums and ulceration and necrosis of the interdental papilla. There may also be intra-oral halitosis, cervical lymphadenitis and malaise. Predisposing factors include psychological stress, sleep deprivation, poor oral hygiene, smoking, immunosuppression and/or malnutrition. Necrotizing ulcerative periodontitis is where the infection leads to attachment loss, and involves only the gingiva, periodontal ligament and alveolar ligament. Progression of the disease into tissue beyond the mucogingival junction characterizes necrotizing stomatitis.