Editing Periodontal disease (section)

==Classification==
[[File:Depiction of a Periodontitis patient.png|thumb|upright=1.3|Person with periodontitis]]
{{See also|List of periodontal diseases}}
There were several attempts to introduce an agreed-upon classification system for periodontal diseases: in 1989, 1993, 1999,<ref name=armitage1999/> and 2017.

=== 1999 classification ===
The 1999 classification system for periodontal diseases and conditions listed seven major categories of periodontal diseases,<ref name="armitage1999">{{cite journal | vauthors = Armitage GC | title = Development of a classification system for periodontal diseases and conditions | journal = Annals of Periodontology | volume = 4 | issue = 1 | pages = 1–6 | date = December 1999 | pmid = 10863370 | doi = 10.1902/annals.1999.4.1.1 | s2cid = 24243752 | doi-access = free }}</ref> of which 2–6 are termed ''destructive'' periodontal disease, because the damage is essentially irreversible. The seven categories are as follows:

* [[Gingivitis]]
* [[Chronic periodontitis]]
* [[Aggressive periodontitis]]
* [[Periodontitis as a manifestation of systemic disease]]
* [[Necrotizing periodontal diseases|Necrotizing ulcerative gingivitis/periodontitis]]
* [[Abscesses of the periodontium]]
* [[Combined periodontic-endodontic lesions]]

Moreover, terminology expressing both the extent and severity of periodontal diseases are appended to the terms above to denote the specific diagnosis of a particular person or group of people.

====Severity====

The "severity" of disease refers to the amount of [[periodontal ligament]] fibers that have been lost, termed "clinical attachment loss". According to the 1999 classification, the severity of chronic periodontitis is graded as follows:<ref>{{cite web|url=http://www.cda-adc.ca/jcda/vol-66/issue-11/594.html|title=The Periodontal Disease Classification System of the American Academy of Periodontology — An Update|website=American Academy of Periodontology}}</ref>
* Slight: {{convert|1|–|2|mm|abbr=on}} of attachment loss
* Moderate: {{convert|3|–|4|mm|abbr=on}} of attachment loss
* Severe: ≥ {{convert|5|mm|abbr=on}} of attachment loss

====Extent====
{{unreferenced section|date=November 2018}}
The "extent" of disease refers to the proportion of the dentition affected by the disease in terms of percentage of sites. Sites are defined as the positions at which probing measurements are taken around each tooth and, generally, six probing sites around each tooth are recorded, as follows:

* [[Commonly used terms of relationship and comparison in dentistry|Mesiobuccal]]
* Mid-buccal
* Distobuccal
* Mesiolingual
* Mid-lingual
* Distolingual

If up to 30% of sites in the mouth are affected, the manifestation is classified as "localized"; for more than 30%, the term "generalized" is used.

=== 2017 classification ===
The 2017 classification of periodontal diseases is as follows:<ref>{{cite journal | vauthors = Jepsen S, Caton JG, Albandar JM, Bissada NF, Bouchard P, Cortellini P, Demirel K, de Sanctis M, Ercoli C, Fan J, Geurs NC, Hughes FJ, Jin L, Kantarci A, Lalla E, Madianos PN, Matthews D, McGuire MK, Mills MP, Preshaw PM, Reynolds MA, Sculean A, Susin C, West NX, Yamazaki K | title = Periodontal manifestations of systemic diseases and developmental and acquired conditions: Consensus report of workgroup 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions | journal = Journal of Clinical Periodontology | volume = 45 | pages = S219–S229 | date = June 2018 | issue = Suppl 20 | pmid = 29926500 | doi = 10.1111/jcpe.12951 | url = https://research-information.bristol.ac.uk/files/161189168/R2corr_Workgroup3_Consensus_Report.pdf | doi-access = free }}</ref><ref>{{cite journal | vauthors = Berglundh T, Armitage G, Araujo MG, Avila-Ortiz G, Blanco J, Camargo PM, Chen S, Cochran D, Derks J, Figuero E, Hämmerle CH, Heitz-Mayfield LJ, Huynh-Ba G, Iacono V, Koo KT, Lambert F, McCauley L, Quirynen M, Renvert S, Salvi GE, Schwarz F, Tarnow D, Tomasi C, Wang HL, Zitzmann N | title = Peri-implant diseases and conditions: Consensus report of workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions | journal = Journal of Clinical Periodontology | volume = 45 | pages = S286–S291 | date = June 2018 | issue = Suppl 20 | pmid = 29926491 | doi = 10.1111/jcpe.12957 | doi-access = free | hdl = 2027.42/144618 | hdl-access = free }}</ref><ref name=":2" />

Periodontal health, [[Gums|gingival]] disease and conditions

* Periodontal health and [[Gums|gingival]] health
** Clinical gingival health on an intact periodontium
** Clinical gingival health on an intact periodontium
*** Stable periodontitis
*** Non periodontitis person
*[[Gingivitis]] — Dental [[biofilm]] induced
**Associated with the dental biofilm alone
**Mediated by systemic and local risk factors
**Drug induced gingival enlargement.
*[[Gingival disease]]s — Non dental [[biofilm]] induced
**Genetic/developmental disorders
**Specific infections
**Inflammatory and immune conditions
**Reactive processes
**Neoplasms
**Endocrine, nutritional and metabolic
**Traumatic lesions
**Gingival pigmentation.

Periodontitis

*[[Necrotizing periodontal diseases]]
**[[Acute necrotizing ulcerative gingivitis|Necrotizing Gingivitis]]
**Necrotizing periodontitis
**Necrotizing stomatitis
* [[Periodontitis as a manifestation of systemic disease]]
* Periodontitis

Other conditions affecting the [[periodontium]]

(Periodontal Manifestations of Systemic Diseases and Developmental and Acquired Conditions)

* Systemic disease of conditions affecting the [[periodontal]] support tissues
* Other Periodontal Conditions
** Periodontal [[abscess]]es
** [[Endodontics|Endodontic-]] periodontal [[lesion]]s
*[[Mucogingival junction|Mucogingival]] deformities and conditions
**Gingival Phenotype
**Gingival/Soft Tissue Recession
**Lack of Gingiva
**Decreased Vestibular Depth
**Aberrant Frenum/muscle position
**Gingival Excess
**Abnormal Color
**Condition of the exposed root surface
*[[Occlusal trauma|Traumatic occlusal forces]]
**Primary Occlusal Trauma
**Secondary Occlusal Trauma
* Tooth and [[Dental prosthesis|prosthesis]] related factors
** Localized tooth-related factors
** Localized dental prostheses-related factors

Peri-implant diseases and conditions

* Peri-implant health
*[[Peri-implant mucositis]]
*[[Peri-implantitis]]
* Peri-implant soft and hard tissue deficiencies

==== Staging ====
The goals of staging periodontitis is to classify the severity of damage and assess specific factors that may affect management.<ref name=":2" />

According to the 2017 classification, periodontitis is divided into four stages; after considering a few factors such as:

* Amount and percentage bone loss radiographically
* Clinical attachment loss, probing depth
* Presence of furcation
* Vertical bony defects
* History of tooth loss related to periodontitis
* Tooth hypermobility due to secondary occlusal trauma<ref name=":2">{{cite journal | vauthors = Caton JG, Armitage G, Berglundh T, Chapple IL, Jepsen S, Kornman KS, Mealey BL, Papapanou PN, Sanz M, Tonetti MS | title = A new classification scheme for periodontal and peri-implant diseases and conditions — Introduction and key changes from the 1999 classification | journal = Journal of Periodontology | volume = 89 | pages = S1–S8 | date = June 2018 | issue = Suppl 1 | pmid = 29926946 | doi = 10.1002/jper.18-0157 | s2cid = 49353912 | url = http://pure-oai.bham.ac.uk/ws/files/50172936/Caton_et_al_Version_3.0_NO_TABLES_PNP_amendments_1_ILC.pdf | doi-access = free }}</ref>

==== Grading ====
According to the 2017 classification, the grading system for periodontitis consists of three grades:<ref name=sgp2017>{{Cite web|url=http://perio.org/sites/default/files/files/Staging%20and%20Grading%20Periodontitis.pdf|title=Staging and Grading Periodontitis }}</ref>

*Grade A: Slow progression of disease; no evidence of bone loss over last five years
*Grade B: Moderate progression; < 2mm of bone loss over last five years
*Grade C: Rapid progression or future progression at high risk; ≥ 2mm bone loss over five years

Risk factors affecting which grade a person is classified into include:<ref name=sgp2017/>

*Smoking
* Diabetes

=== Periodontal probing ===
{{Unreferenced section|date=April 2024}}
Dentists and dental hygienists measure periodontal disease using a device called a [[periodontal probe]]. This thin "measuring stick" is gently placed into the space between the gums and the teeth, and slipped below the gumline. If the probe can slip more than {{convert|3|mm|abbr=on}} below the gumline, the person is said to have a gingival pocket if no migration of the epithelial attachment has occurred or a periodontal pocket if apical migration has occurred. This is somewhat of a misnomer, as any depth is, in essence, a pocket, which in turn is defined by its depth, i.e., a 2-mm pocket or a 6-mm pocket. However, pockets are generally accepted as self-cleansable (at home, by the person, with a toothbrush) if they are 3&nbsp;mm or less in depth. This is important because if a pocket is deeper than 3&nbsp;mm around the tooth, at-home care will not be sufficient to cleanse the pocket, and professional care should be sought. When the pocket depths reach {{convert|6|to|7|mm|abbr=on}} in depth, the hand instruments and ultrasonic scalers used by the dental professionals may not reach deeply enough into the pocket to clean out the microbial plaque that causes gingival inflammation. In such a situation, the bone or the gums around that tooth should be surgically altered or it will always have inflammation which will likely result in more bone loss around that tooth. An additional way to stop the inflammation would be for the person to receive subgingival antibiotics (such as [[minocycline]]) or undergo some form of gingival surgery to access the depths of the pockets and perhaps even change the pocket depths so they become 3&nbsp;mm or less in depth and can once again be properly cleaned by the person at home with his or her toothbrush.