Periodontal disease: consensus report of working group 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. Consensus report of Working Group 4 of the 2017 World Workshop on Classification of Periodontal and Peri-implant Diseases and Conditions.
Is there a level of gingival inflammation that is consistent with clinical periodontal health at a site
Periodontal health must be assessed and defined at both the patient and site level to achieve these goals. Is there a level of gingivitis that corresponds to clinical periodontal health at a site.
What is the spectrum of clinical periodontal health at a site level?
Furthermore, clinical periodontal health involves physiological immune surveillance involving levels of biological and inflammatory markers compatible with homeostasis.2 Periodontal disease is a chronic inflammatory disease that can currently be successfully controlled, and teeth can be preserved for life. Furthermore, the definitions of periodontal health used to inform treatment decisions for individual patients may differ from those used in epidemiological studies.
CASE DEFINITIONS FOR PERIODONTAL HEALTH AND GINGIVITIS
How do we define a case of gingival health on an intact and a reduced periodontium for
How do we define a case of gingival health on an intact and a reduced periodontium for clinical
How do we define gingivitis at a site level (biological &
Plaque biofilm-induced gingivitis is defined at the site level as “an inflammatory lesion resulting from interactions between the plaque biofilm and the host's immune-inflammatory response, which re. Gingivitis on a reduced periodontium in a patient with periodontitis successfully treated (note that recurrence of periodontitis cannot be excluded in this case).
What are the determinants of the rate of
Gingivitis is a non-specific inflammatory condition and therefore results from sustained plaque biofilm accumulation at and apical to the gingival margin.7 Longitudinal studies have shown that sites that do not progress to attachment loss are characterized by less gingival inflammation over time. , while those sites that do progress have persistently higher levels of gingivitis.8‒14 Therefore, gingivitis is a major risk factor, and a necessary prerequisite, for periodontitis. Periodontitis patients who are currently stable but develop gingivitis at specific sites should continue periodontal maintenance and should be closely monitored during periodontal maintenance for any reactivation of periodontitis.
Complex biological responses in the gingival tissues result from such elevated sex steroid levels and generate more than expected inflammation in response to relatively small levels of plaque. Symptoms include swollen, purplish or occasionally pale gingiva due to infiltration of leukemic cells, gingival bleeding inconsistent with levels of dental plaque biofilm accumulation, due to thrombocytopenia and/or coagulation factor deficiency.22.
What are the diagnostic criteria for a gingivitis case?
Increases in sex hormones – at puberty, during pregnancy or after medication with first generation oral contraceptives can modify the gingival inflammatory response.
Should we classify dental plaque biofilm‐induced gingivitis?
How do we define a case of dental plaque‐induced gingivitis on an intact and a reduced periodontium for
How do we classify a patient with dental plaque‐
Gingivitis can occur in certain places, and where probing depths are ≤ 3 mm, gingivitis is termed in a stable periodontal patient. However, such patients remain at high risk of recurrent periodontitis and require close monitoring, as such sites are at high risk of periodontitis recurrence (Table 1).
How do we classify non–dental plaque‐induced gingival conditions?
Which non–dental plaque‐induced gingival conditions may have associated systemic involvement and
Considering that the terms are marked with an “a.” (Table 2) have associated systemic involvement or are oral manifestations of systemic conditions, other healthcare providers may be involved in the diagnosis and treatment.
FUTURE RESEARCH NEEDS
Diabetes and periodontal disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Disease. Periodontal health and gingival diseases and conditions in an intact and reduced periodontium: consensus report of working group 1 of the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions.
INTRODUCTION
Plaque‐induced gingivitis: Case definition and diagnostic considerations
Abstract
A peculiarity of plaque-induced gingivitis, compared to periodontitis, is the complete reversibility of the tissue changes once the dental biofilm is removed. The established relationship between gingivitis and periodontitis makes it necessary to establish the clinical criteria that define a case of gingivitis (GC).
From gingival inflammation to gingivitis case definition
Purpose of the review
MATERIALS AND METHODS
Individuals who did not meet these criteria were considered not to have a significant degree of gingivitis. However, no clear definition is given of the most appropriate parameter used to characterize gingival inflammation at the patient level.
Clinical and biological parameters used to define gingival inflammation
Clinical parameters
Bleeding is assessed by gently palpating the soft tissue wall of the gingival sulcus. Probe The periodontal probe is inserted into the gingival sulcus at the base of the papilla from the mesial side and then moved coronally to the tip of the papilla.
Biomarkers in oral fluids
Not reportedNot reported – No significant differences in the levels of cystatin C, TNF-α and IL-1b between G and H. Mesio-buccal aspects of two anterior teethPD ≤3 mm No gingival recessions attributable to periodontitis CAL ≤ 2 mm at ≥ 90 % of sites BOP score < 10% Radiographic distance between the CEJ and the bone crest ≤3 mm in > 90% of proximal tooth sites Varying degrees of gingival inflammation CAL ≤2 mm in ≥90% of sites Radiographic distance between the CEJ and bone crest ≤3 mm at > 90% of the proximal tooth sites.
Microbiologic markers
Several studies have characterized the salivary proteomic profile of gingivitis (ie, a patient with a certain amount of gingival inflammation and no attachment/bone loss) compared to periodontal health (Table 1). Analyzes showed that gingivitis was associated with significant of increased blood proteins (serum albumin and hemoglobin), immunoglobulin peptides and ker- The concentrations of MIP-1α and PGE2 were significantly higher (2.8 times) in G compared to H BOP: bleeding on investigation; CAL: level of clinical connection; CEJ: cemento-enamel junction; IL-1ß: interleukin 1ß; IL-6: IL-35: interleukin 35; IL-37: interleukin 37; MIP-1α: macrophage inflammatory protein 1α; MMP-8: matrix metalloproteinase 8; MMP-9: matrix metalloproteinase 9; PD: probing depth; PGE2: prostaglandin E2; TNF-α: tumor necrosis factor α.
Systemic inflammation markers (CRP)
Although these studies identified previously unrecognized species in gingivitis, they confirmed that the biofilms associated with gingivitis and periodontitis share most species (albeit with quantitative differences). New evidence suggests that clusters of bacteria, rather than individual species, may be useful as diagnostic markers for each disease; and that bacterial functions (eg, proteolysis, flagellar assembly, bacterial motility) may be a more robust discriminant of disease than species.
Genetic markers
The GCC/GCC genotype, which was associated with increased production of IL‐10, was significantly more frequent in H than in G. The IL‐1RN*2 allele (A2) was significantly more frequent in H, and carrying A2 appeared to be protective against gingivitis.
Self‐reported diagnosis
Emerging evidence indicates that the inflammatory response can be dynamically modulated by epigenetic processes that are heritable and reversible. In particular, the modern concepts of epigenetics imply that gene expression can be modified by the environment.
Oral health‐related quality of life (OHRQoL)
Finally, when considering the pandemic spread of gingivitis and its high prevalence in different populations, it can hardly be expected that a GC definition can be solely based on genetic/epigenetic profiling/susceptibility, which currently remains to be determined become
RESULTS AND DISCUSSION
The use of BOP to define and grade a GC
The authors are aware that the BOP score is only a measure of the extent of gingival inflammation and not a method for assessing the severity of the inflammatory condition. Although the severity of gingivitis can be well defined on a site-specific basis35, signs of gingivitis such as gingival volume and color changes (how . when assessed) are difficult to correlate with % BOP at the patient level, and would eventually result in subjective, long-term and im ‐‐
Definition of gingivitis in a patient with an intact periodontium
The relationship between "bleeding on probing" and "gingival index bleeding" as clinical parameters of gingivitis.
Periodontal health
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”1 In accordance with this World Health Organization definition, periodontics is used. Therefore, a more practical definition of periodontal health would be a state free of inflammatory periodontal disease.
HISTOLOGICAL EVIDENCE OF HEALTH Animal studies – pristine periodontal health and early
Human histological studies on health and gingivitis
DETERMINANTS OF CLINICAL PERIODONTAL HEALTH
PL AQUE AND CLINICAL PERIODONTAL HEALTH
Subgingival biofilm
Oral hygiene
INDICATORS OF CLINICAL PERIODONTAL HEALTH
Bleeding on probing
Standardization of periodontal probe design
Periodontal probing depth
This highlights, as noted above, that the most useful indicator of disease is clinical evidence of inflammation and that historical evidence of disease (increased PPD, recession and loss of attachment, bone loss) may be less relevant in the context of periodontal health. on reduced periodontium.34.
Radiographic features of periodontal health
Tooth mobility
PERIODONTAL HEALTH AND TREATMENT TARGETS FOR A DISEASED OR REDUCED
Periodontal disease remission/control is defined as a period in the course of disease during which treatment has resulted in a reduction (although not total resolution) of inflammation and some improvement. If the concept of disease remission/control is embraced as a treatment target for the management of periodontal diseases, peri‐.
CONCLUSIONS
Periodontal disease stability will be defined as a state in which periodontal disease has been successfully treated through control of local and systemic factors, resulting in minimal BoP, optimal im‐. Principles in periodontal disease prevention: consensus report of group 1 of the 11th European workshop on periodontology on the effective prevention of periodontal and peri-implant disease.
Dental plaque–induced gingival conditions
2018 American Academy of Periodontology and European Association of Periodontology. Gingivitis caused by dental plaque can show different observation patterns. This review updates and revises the previous classification of plaque-induced gingival disease reported in the 1999 classification.
Observations and discussion
PL AQUE‐INDUCED GINGIVITIS
Clinical Health
In this regard, gingivitis is a nonspecific inflammatory condition caused by dental plaque, a concept that has remained unchanged since 1999. The molecular characteristics or pattern of the gingival transcriptome (i.e., the sum of all mRNAs expressed by genes found in the gingiva) during gingival inflammation that it is caused by plaque. tions have been closely examined since the last classification. shop.
Plaque‐induced gingivitis on a reduced periodontium
MODIF YING FACTORS OF PL AQUE‐
INDUCED GINGIVITIS
Plaque‐induced gingivitis exacerbated by sex steroid hormones
Puberty
Menstrual cycle
Pregnancy
Oral contraceptives
EX ACERBATED BY SYSTEMIC CONDITIONS
Hyperglycemia
Leukemia
Smoking
Malnutrition
PL AQUE‐INDUCED GINGIVITIS EX ACERBATED BY OR AL FACTORS
Prominent subgingival restoration margins
Hyposalivation
DRUG‐INFLUENCED GINGIVAL ENL ARGEMENTS
Common clinical features of drug-induced gingival enlargement include inter-hospital or intra-patient variation.
REVISIONS TO THE 1999 DENTAL
PL AQUE–INDUCED GINGIVAL DISEASES CL ASSIFICATION SYSTEM
SIGNIFICANCE OF DENTAL PL AQUE–
INDUCED GINGIVAL CONDITIONS
Diabetes and periodontal disease: Consensus report of Joint EFP/AAP workshop on periodontitis and systemic dis‐. Several diseases and their treatments have recently been reviewed.2‒4 The purpose of the current review is not to repeat the details of such texts, but to present a modern classification of the most relevant ones.
DESCRIPTION OF SELECTED DISEASE ENTITIES
2018 American Academy of Periodontology and European Federation of Periodontology Human gingiva as well as other oral tissues can contain various non-.
ABNORMALITIES
1.1 | Hereditary gingival fibromatosis (HGF)
Non–plaque‐induced gingival diseases
Palle Holmstrup 1 | Jacqueline Plemons 2 | Joerg Meyle 3
2.1 | Bacterial origin
Necrotizing periodontal disease
Other bacterial infections
2.2 | Viral origin
Coxsackie viruses
HSV‐1 and HSV‐2
Herpetic gingivostomatitis
Varicella‐zoster virus
Molluscum contagiosum virus
Human papilloma virus (HPV)
2.3 | Fungal origin
Candidosis
CONDITIONS AND LESIONS
3.1 | Hypersensitivity reactions Contact allergy
Granuloma in the soft tissue of the oral cavity or in the soft tissue of the intestine General complications, pain in the intestine, anal fissure, diarrhea. Subtitle and diagnosis ICD‐10 code Clinical presentation Etiology Associated conditions Diagnostic investigations SarcoidosisD86.8 Gingival swelling, nodules, ulceration and gingival recession, loosening of teeth and swelling of salivary glands Granuloma in soft tissue of soft tissue of oral gut.
Plasma cell gingivitis
Erythema multiforme (EM)
3.2 | Autoimmune diseases of skin and mucous membranes
Pemphigus vulgaris (PV)
Pemphigoid
Lichen planus
Lupus erythematosus (LE)
3.3 | Granulomatous inflammatory conditions (orofacial granulomatosis)
4.1 | Epulides
Fibrous epulis
Calcifying fibroblastic granuloma
Pyogenic granuloma
Peripheral giant cell granuloma (or central)
5.1 | Premalignant Leukoplakia
Erythroplakia
5.2 | Malignant
Squamous cell carcinoma
Oral lesions occur in both acute and chronic leukemia, but are more common in the acute form.
Lymphoma
METABOLIC DISEASES 6.1 | Vitamin deficiencies
7.1 | Physical/mechanical insults Frictional keratosis
Toothbrushing‐induced gingival ulceration
Factitious injury (self‐harm)
7.2 | Chemical (toxic) insults Etching
7.3 | Thermal insults
Gingival pigmentation/melanoplakia
Smoker's melanosis
Drug‐induced pigmentation (DIP)
Amalgam tattoo
Potentially malignant disorders of the oral cavity: Current practice and future directions in the clinic and laboratory. Periodontitis: Consensus report of working group 2 of the 2017 World Workshop on the Classification of Periodontal and Peri‐.
Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri‐
Implant Diseases and Conditions
Periodontal abscesses are defined as acute lesions characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction, and are associated with a risk of systemic spread. They are characterized by localized accumulation of pus within the gingival wall of the periodontal pocket/sulcus, cause rapid tissue destruction that may compromise dental prognosis, and are associated with a risk of systemic spread (Table 4).
Which are the main features that identify periodontitis?
Which criteria would need to be fulfilled to support the contention that chronic and aggressive periodontitis are
Does current evidence suggest that we should continue to differentiate between “aggressive” and
Is there evidence suggesting that early‐onset forms of periodontitis (currently classified under “aggressive
Likewise, the mechanisms for the development of generalized periodontitis in young people are poorly understood. What are the determinants of mean annual attachment loss based on existing longitudinal studies.
What are the determinants for the mean annual attachment loss based on existing longitudinal studies
How do we define a patient as a periodontitis case?
Which different forms of periodontitis are recognized in the present revised classification system?
How is a periodontitis case further characterized by stage and grade?
Do the acute periodontal lesions have distinct features when compared with other forms of
Do periodontal abscesses have a distinct pathophysiology when compared to other
What is the case definition of a periodontal abscess?
Do necrotizing periodontal diseases have a distinct pathophysiology when compared to other
What are the case definitions of necrotizing periodontal diseases?
Do endo‐periodontal lesions have a distinct pathophysiology when compared to other
What is the case definition of an endo‐periodontal lesion?
Which are the current key gaps in knowledge that would inform a better classification of periodontitis and
Integrate multidimensional data platforms (clinical, radiographic, .-omics) to facilitate systems biology approaches to the study of periodontal and peri-implant diseases and conditions. Manifestations of systemic diseases and conditions affecting the periodontal attachment apparatus: case definitions and diagnostic considerations.
Periodontal manifestations of systemic diseases and
Kazuhisa Yamazaki 25
A variety of systemic diseases and conditions can influence the course of periodontitis or have a negative impact on the periodontal attachment apparatus. A variety of systemic diseases and conditions can influence the course of periodontitis or have a negative impact on the periodontal attachment.
SYSTEMIC DISEASES AND CONDITIONS THAT AFFECT THE PERIODONTAL
The objectives of Task Force 3 were to revise the 1999 AAP classification of periodontal diseases and conditions, evaluate updated evidence regarding epidemiology and etiopathogenesis, and propose a new classification system along with case definitions and diagnostic considerations.. documents. were submitted and accepted for publication. Discussions were based on these four reviews covering 1) periodon‐. soil manifestations of systemic diseases and conditions;1 2) mucogyn‐ . ginal conditions around natural teeth; 2 3) traumatic occlusal forces and occlusal trauma; 3 and 4) dental prostheses and factors related to teeth. 4.
Is it possible to categorize systemic diseases and conditions based on the underlying mechanisms of
Gingival recessions are very common and often associated with hypersensitivity, development of caries and non-. carious cervical lesions on the exposed root surface and reduced aesthetics. Several developmental or acquired conditions associated with teeth or prostheses can predispose to periodontal disease.
Are there diseases and conditions that can affect the periodontal supporting tissues?
Should diabetes‐associated periodontitis be a distinct diagnosis?
Can obesity affect the course of periodontitis?
Can osteoporosis affect the course of periodontitis?
Can rheumatoid arthritis affect the course of periodontitis?
Should smoking‐associated periodontitis be a distinct diagnosis?
Case definitions and diagnostic considerations
MUCOGINGIVAL CONDITIONS AROUND THE NATUR AL DENTITION
What is the definition of recession?
What are the possible consequences of gingival recession and root surface exposure to oral
Is the development of gingival recession associated with the gingival phenotype?
Phenotype: Appearance of an organism based on a multifactorial combination of genetic traits and environmental factors (its expression includes biotype). The periodontal phenotype is determined by the gingival phenotype (gingival thickness, keratinized tissue width) and bone morphotype (buccal bone plate thickness).
How can the periodontal phenotype be assessed in a standardized and reproducible way?
The phenotype indicates a dimension that can change through time depending on environmental factors and clinical intervention and can be site specific (phenotype can be modified, not the genotype).
Is there a certain amount (thickness and width) of gingiva necessary to maintain periodontal health?
Does improper toothbrushing influence the
Does intrasulcular restorative margin placement influence the development of gingival recession?
What is the effect of orthodontic treatment on the development of gingival recession?
Do we need a new classification of gingival recession?
Mucogingival conditions
Gingival Recession
OCCLUSAL TR AUMA AND TR AUMATIC OCCLUSAL FORCES
Does traumatic occlusal force or occlusal trauma cause periodontal attachment loss in humans?
Can traumatic occlusal force cause periodontal inflammation?
Does traumatic occlusal force accelerate the progression of periodontitis?
Can traumatic occlusal forces cause non‐carious cervical lesions?
What is the evidence that abfraction exists?
Can traumatic occlusal forces cause gingival recession?
Are orthodontic forces associated with adverse effects on the periodontium?
Does the elimination of the signs of traumatic occlusal forces improve the response to treatment of
Should we still distinguish primary from secondary occlusal trauma in relation to treatment?
The presence of traumatic occlusal forces may be indicated by one or more of the following characteristics: free. Occlusal trauma is a lesion in the periodontal ligament, cementum and adjacent bone caused by traumatic occlusal forces.
DENTAL PROSTHESES AND TOOTH‐
Secondary occlusal trauma is defined as an injury that results in tissue changes due to normal or traumatic occlusal forces applied to a tooth or teeth with reduced support. Because some signs and symptoms of traumatic occlusal forces and occlusal trauma may also be associated with other conditions, appropriate differential analysis should be performed to rule out other etiological factors.
REL ATED FACTORS
Current periodontal therapies are primarily directed at etiology; in this context, traumatic occlusal forces. Traumatic occlusal force is defined as any occlusal force that results in damage to the teeth and/or the periodontal attachment.
What is the biologic width?
A reduced periodontium is meaningful only when the mobility is progressive, indicating that the forces acting on the tooth exceed the adaptability of the person or site. These were historically defined as excessive forces to indicate that the forces exceed the adaptive capacity of the individual person or place.
Is infringement of restorative margins within the supracrestal connective tissue attachment associated
The group considered the term reduced periodontium related to secondary occlusal trauma and agreed that there were problems in defining "reduced periodontium".
Are changes in the periodontium caused by infringement of restorative margins within
For subgingival indirect dental restorations, design, manufacture, materials and delivery are associated with gingival inflammation and/or loss of periodontal supporting tissues. Optimal repair margins located within the gingival sulcus do not cause gingival inflammation if patients comply with self-per‐.
Are fixed dental prostheses associated with
Are removable dental prostheses associated with periodontitis or loss of periodontal supporting tissues?
Can tooth‐related factors enhance plaque
Can adverse reactions to dental materials occur?
What is altered passive eruption?
Occlusal trauma
Localized tooth‐related factors that modify or predispose to plaque‐induced gingival diseases/periodontitis
Localized dental prosthesis‐related factors
Hand-to-mouth: a systematic review and meta-analysis of the association between rheumatoid arthritis and periodontal disease. Periodontal Manifestations of Systemic Diseases and Developmental and Acquired Conditions: Consensus Report of Working Group 3 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions.
Staging and grading of periodontitis: Framework and proposal of a new classification and case definition
INTRODUCTION: THE 1999
CL ASSIFICATION OF PERIODONTITIS
SUMMARY AND INTERPRETATION OF EVIDENCE FROM CURRENT WORKSHOP
Authors’ interpretation of current evidence reviews
INTEGR ATING CURRENT KNOWLEDGE TO ADVANCE CL ASSIFICATION OF
Clinical definition of periodontitis
Definitions of periodontitis based on marginal radiographic bone loss have serious limitations as they are not specific enough and do not detect mild to moderate periodontitis.27 Definitions of periodontitis based on radiographic bone loss should be limited to mixed dentition and eruption stages, when the clinical confirmation is the measurement of the level according to the CEJ is impractical.28 In such cases periodontitis assess‐.
Objectives of a periodontitis case definition system
Definition of a patient as a periodontitis case
Identification of the form of periodontitis
The differential diagnosis is based on the history and specific signs and symptoms of necrotizing periodontitis and the presence or absence of an unusual systemic disease that permanently alters the host implant. The vast majority of clinical cases of periodontitis do not have the local features of necrotizing periodontitis or the systemic features of a rare immune disorder with a secondary manifestation.
Additional elements proposed for inclusion in the classification of periodontitis
Necrotizing periodontitis is characterized by a history of pain, presence of ulceration in the gingival margin and/or fibrin de‐. Current evidence that effective treatment of certain cases of periodontal disease may favorably affect systemic diseases or their surrogates, although limited, is intriguing and should be definitively evaluated.
FR AMEWORK FOR DEVELOPING A
Modest-sized periodontitis treatment studies of uncontrolled type II diabetes have shown value in reducing hyperglycemia, al-. If the patient has severe systemic disease, as indicated by their American Society of Anesthesiologists (ASA) status, this can lead to the cli‐.
PERIODONTITIS STAGING AND GR ADING SYSTEM
Grading can be achieved by refining each individual's stage definition with an A, B, or C scale, in which increasing grades will refer to those with direct or indirect evidence of varying degrees of periodontal fracture.
Grade of periodontitis
Integrating biomarkers in a case definition system
Integrating knowledge of the interrelationship between periodontal health and general health in a
INCORPOR ATION OF STAGING AND GR ADING IN THE CASE DEFINITION
Such a multidimensional view of periodontitis would create the potential to transform our view of periodontitis. And the powerful result of the multidimensional view is the ability to communicate better with patients, other professionals.
Stage of periodontitis (Table 3)
It is recognized that in the application of clinical practice some clinicians may prefer to use diagnostic quality radiographic images as an indirect and somewhat less sensitive assessment of periodontal decay. Likewise, if posterior bite collapse is present, then stage IV would be the appropriate stage diagnosis since com‐.
Grade of periodontitis (Table 4)
This element has been placed in the table to draw attention to this dimension of the biology of periodontitis. An update of the evidence on the potential impact of periodontal therapy on diabetes outcomes.
Acute periodontal lesions (periodontal abscesses and
David Herrera 1 | Belén Retamal‐Valdes 2 | Bettina Alonso 1 | Magda Feres 2
Acute lesions in the periodontium are among the few clinical situations in periodontology in which patients may seek emergency care, mainly because of the associated pain. Details about the electronic search methods and included studies, flow charts showing the selection of articles for each condition assessed in this review, and study designs-.
1.1 | Clinical presentation
In addition, and in contrast to most other periodontal conditions, rapid destruction of periodontal tissues can occur during the course of these lesions, thus emphasizing The current review and update focuses on two acute conditions (periodontal abscesses and necrotizing periodontal disease); and in endo‐.
1.2 | Etiology: pathophysiology, microbiology and histological features
1.2.1 | Pathophysiology
1.2.2 | Microbiology
1.2.3 | Histopathology
1.3 | Etiology: risk factors
1.3.1 | Periodontal abscess in periodontitis patients
1.3.2 | Periodontal abscess in non‐
It has been reported that orthodontic factors, such as inadequate orthodontic forces or a crossbite, promote the development of PA.
1.4 | Assessment and diagnosis
1.5 | Proposed changes to the current 1999 classification
DISEASES
2.1 | Clinical presentation
2.2 | Etiology and risk factors
2.2.1 | Human immunodeficiency virus
2.2.2 | Other systemic conditions
2.2.3 | Malnutrition
2.2.4 | Psychological stress and insufficient sleep
2.2.5 | Inadequate oral hygiene, pre‐existing gingivitis, and previous history of NPD
2.2.6 | Tobacco and alcohol consumption
2.2.7 | Young age and ethnicity
2.2.8 | Seasonal variations
2.2.9 | Other factors
2.3 | Pathophysiology and histological features
2.4 | Assessment and diagnosis
2.4.1 | Differential diagnosis
67.9% Mobility of teeth (46.43%); sialorrhea (42.86%) CobbUSACaseHIV16 NUP series Advanced generalized alveolar bone loss (100%) y, years; na, not available; HIV, human immunodeficiency virus; ANUG, acute necrotizing ulcerative gingivitis; NUG, necrotizing ulcerative gingivitis; NG, necrotizing gingivitis; NUP, necrotizing ulcerative periodontitis.
2.5 | Proposed changes to the current 1999 classification
3.1 | Clinical presentation
3.2 | Etiology and risk factors 3.2.1 | Primary etiology
The periodontal condition has an important influence on the prognosis of EPL due to the striking changes in the oral ecol-. The most common lesions in this category were: (1) root/pulp chamber/furcation perforation (eg, due to root canal instrumentation or for tooth preparation for post-retained restorations)98;.
3.2.2 | Microbiology
Converting this ecology to a healthy state is challenging,96,97 especially in patients with severe periodontitis and in teeth with deep pockets, as in the case of EPL.
3.2.3 | Risk factors
3.3 | Pathophysiology and histological features
3.4 | Assessment and diagnosis
If one or more of these events are identified, detailed clinical and radiographic examinations should be performed to determine the presence of perforations, fractures and fissures, or external root resorption. Accurate radiographic assessment and clinical examination of the root anatomy are very important at this stage to assess the integrity of the root and aid in dif.
3.5 | Proposed changes to the current 1999 classification
The first steps in diagnosis should be to assess the patient's history and clinical or radiographic examination. If perforations and fractures are not identified, the diagnosis should proceed to a second phase consisting of full-mouth periodontal assessment.
OBSERVATIONS AND DISCUSSION
Quality of the available evidence
Pending topics for the proposed classification
The extent of the effect of these diseases and conditions on the course of the peri‐. A case with gingival recession presents with an apical shift of the gingival margin (recession depth).
Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: Case definitions and
Manifestations of systemic diseases and conditions affecting the periodontal attachment apparatus: case definitions and. Finally, we describe conditions that can cause periodontal attachment destruction independently of plaque-induced periodontitis.
Literature search strategies
The issue of providing accurate case definitions for all these conditions is difficult, as a case will generally be defined as periodontal breakdown in the presence of the specific systemic condition. What is the strength of the evidence of the reported association between the identified disorders/medication and loss of perio‐.
Screening and selection criteria of studies
Most of these factors are determined by the genetic profile of the host and can be modified by the environment. In addition, we did not include conditions that may affect the gingival tissues but have not been shown to contribute to periodontal breakdown (such as the leuk‐. mias).
Strength of associations and quality of evidence
A MA JOR IMPACT ON THE LOSS OF PERIODONTAL TISSUE BY INFLUENCING
1.1 | Genetic disorders
1.1.1 | Diseases associated with immunologic disorders (Table 2)
Among the primary immunodeficiency diseases, some studies have reported severe periodontitis in individuals with chronic granuloma. Individuals with CGD have gene mutations that cause defects in the intracellular killing of phagocytosed microorganisms in leukocytes.12 H-IgE is due to mutations in signal transducer and activator of trans-.
1.1.2 | Diseases affecting the oral mucosa and gingival tissue (Table 3)
There is evidence that mutations in the ELANE gene encoding neutrophil elastase are more important in the pathogenesis of peri‐. In individuals with Cohen syndrome, there is a higher prevalence and severity of bone loss than in age- and sex-matched controls.13,14.
1.1.3 | Diseases affecting the connective tissues (Table 3)
Flow cytometry shows low CD18 or CD15 expression on neutrophils (< 5% of normal) • Genetic testing for mutations in the beta-2 integrin (ITGB2) gene. Disorder Strength of Association Evidence Quality Biological Mechanisms Case Definitions Diagnostic Considerations - Cyclic Neutropenia Weak Case Reports, Narrative Reviews Lack of immune response due to intermittent low neutrophil count.
Diabetes mellitus (DM) and chronic hyperglycemia
Glucocerebrosidase enzyme assay to assess enzyme activity in peripheral leukocytes • Genetic testing for mutations in the gene encoding glucocerebrosidase (GCD) HypophosphatasiaSignificantCase Reports, Animal Models, Narrative Reviews. Mutations in the alkaline phosphatase (ALPL) gene are associated with decreased bone and tooth mineralization and defects in root cementum, resulting in compromised periodontal attachment and reduction in alveolar bone height.
Obesity
To date, there is little evidence that the clinical features of periodontitis in patients with DM differ from periodontitis in individuals who do not have DM. It has been suggested that dental and periodontal abscesses may be a common complication of DM.61 A recent study in Saudi Arabia (where the reported prevalence of DM is 23.9%) found that 58.6% of patients in whom periodontal abscesses were diagnosed, HbA1c ≥6.5%.62 Overall, however, an increased prevalence of periodontal abscesses in DM-associated periodontitis compared to periodontitis in individuals who do not have DM is not well documented.
Table 5)
1.3 | Inflammatory diseases (Table 6)
2. | OTHER SYSTEMIC DISORDERS THAT MAY CONTRIBUTE TO PERIODONTAL
Abdominal pain, fever, diarrhea and weight loss • Colonoscopy showing polypoid mucosal changes, ulcerations and inflammatory changes. • Increased prevalence and severity of periodontal disease and loss of periodontal attachment and alveolar bone. Joint pain, swelling, stiffness, redness and limited movement • Increased risk of loss of periodontal attachment and alveolar bone.
RESULT IN LOSS OF PERIODONTAL TISSUE INDEPENDENT OF PERIODONTITIS
There is no convincing evidence that hypertension is associated with an increased prevalence of periodontal disease or the severity of at-. Certain drugs, particularly cytotoxic chemotherapeutics, can cause neutropenia, either transient or long-lasting, and may therefore be associated with an increased risk of periodontitis, but few studies are available.
3.1 | Neoplasms
The clinical features of many of these conditions that may raise suspicion and suggest the need for biopsy are listed in Tables 9 and 10. Given the destructive nature of most of these conditions, it is usually not possible to speculate on the potential for periodontal healing after treatment. , as tooth loss is usually performed as part of the treatment.
3.2 | Other disorders that may affect periodontal tissue (Table 10)
Enlargement of the PDL and single or multiple osteolytic lesions (brown tumors) in the jaw that may mimic bone loss due to periodontal disease. The influence of glycated hemoglobin on the cross-sensitivity between type 1 diabetes mellitus and periodontal disease.
Classification and diagnosis of aggressive periodontitis
In this review, we focus in particular on LAgP and we suggest that it needs to be redefined; where possible, we distinguish this type from GAgP. After our extensive review of the literature, we have reached two conclusions: 1) there is a huge interest in AgP, which has expanded exponentially probably due to the broader definition given in 1999, and 2) it is time for a new look at the way we classify AgP, especially LAgP (see Figure 2).
LITER ATURE REVIEW Epidemiology
Relevant findings
Critical evaluation
Knowledge gaps and suggestions for resolution
Microbiology Relevant findings
In most studies, except for the cohort studies, the older age of the subjects and the lack of pre-disease microbial analysis weakened the conclusions about the relationship between microbial factors and disease initiation. Although it appears that A. actinomycetemcomitans is import‐ . in some cases, different combinations of bacteria occurring in different ethnic populations can show similar clinical patterns of destruction.4 Thus, although the composition of a microbial con‐ . sortium can vary from case to case and from population to population. ulation, metabolic end products that may challenge the host may be similar.39.
Host response elements Relevant findings
Data suggest that in a subset of African and Middle Eastern individuals, A. actinomycetemcomitans may occur in the early stages of the disease. It seems as if specific virulence factors of A. actinomycetemcomitans can suppress the host response, allowing the overgrowth of a "toxic" combination of "other" bacteria in the local environment.
Genetic factors Relevant findings
Generalized aggressive periodontitis
DISCUSSION
Features unique to LAgP
Is LAgP a distinct entity?
Therefore chromosome position, imm_number or polymorphism is given fCombination of minor alleles for both genes also appears to be associated with AgP g. The non-parametric approach shows five markers; the possible role of IL-4-STR, IL-2, SEPS already highlighted by logistic regression, is confirmed by Multifactor Dimensionality Reduction algorithm analysis. Furthermore, a significant involvement of FCGR2A and IL-6 variants was also identified hHaplotype tagging SNP for the significantly associated haplotype rs20417.
Roadblocks toward a better understanding
Generally, periodontal disease is defined as an inflammatory disease of the supporting tissues surrounding the teeth, which can cause irreversible loss of periodontal ligament, alveolar bone, tooth mobility, and ulti. From a pathophysiological point of view, both LAgP and CP have a common end result: bone loss and disorientation of the AT.
CONSIDER ATIONS WHEN REDEFINING AGGRESSIVE PERIODONTITIS
In general, however, it is clear that LAgP exhibits a unique phe‐ . notype, but a more in-depth understanding of the differences between events leading to bone loss in LAgP compared to CP has to await a more demanding definition of early events. The definition of disease beyond age could include; a) the location of the lesion and the stage or extent of the disease (one, two or three or more teeth).
CONCLUSIONS AND FUTURE DIRECTIONS
Mean annual attachment, bone level, and tooth loss
A systematic review
To investigate the evidence for progression of periodontitis, defined as change in attachment level over a period of 12 months or more – What is the evidence for different mean values of progression. Overall, the evidence does not support or refute differentiation between forms of periodontal disease based on the progression of attachment level change.
Population
Exposure
Disease determinants, risk factors, and etiologic agents
Study follow-up duration
Types of studies
Search strategy
Study selection
Unclear or missing data
Data extraction and management
Quality assessment
Data synthesis
The same approach was used to estimate the mean annual progression for each of the three age subgroups, namely age < and >50 years. If a meta-analysis seemed appropriate, it was used to provide an overall estimate of the average annual progression of 95%.
RESULTS Search
When a study only provided the relevant progression information for subgroups (e.g. gender or age groups), the mean annual progression for the study was estimated as a weighted average, with the weights being inversely proportional to the variance if the latter could be calculated or otherwise directly proportional to the frequency. For these analyzes of association, a chi-square test of heterogeneity was performed between the overall mean annual progression for each subgroup of the potential modifier (eg, men and women) to determine the effect of the factor (ie, gender, geographic location, or age group) on the average annual progression.
Study characteristics Location
Sample characteristics
Risk of bias and methodologic quality
Mean annual attachment level change
Exploration of subgroups
Distribution of highest and lowest mean annual attachment level change
NEEDLEMAN ET AL. . respective values were higher for the studies that reported on periodontitis alone; lowest quintile 0.22 mm, highest quintile 0.91 mm).
Mean annual tooth loss
30 In a rural Chinese population, comparing the 30 participants with the worst attachment loss at age 10 with the 30 people with the least attachment loss, annual tooth loss was 0.53 versus 0.18. 5 In another study, comparison of people with progressive disease (>one site of attachment loss of >2 mm) with non-progressive disease (all others) showed the same annual tooth loss of 0.07.
Mean annual bone level change
DISCUSSION Key findings
Overall completeness and applicability of the evidence
Overall quality, strength, and consistency of the evidence
In the SHIP and Gusheng cohorts, tooth loss was much more pronounced in subjects with periodontitis compared to healthy subjects, whereas no such association was found in the Java cohort. In the United States and Germany, chronic periodontitis is closely associated with tooth loss in persons aged ≥40 years.
Potential biases in the review process
Agreements and disagreements with other reviews
F I G U R E 6 Random effects meta-analysis: Mean annual change in attachment level, subgroup analysis, effect of gender. F I G U R E 7 Random effects meta-analysis: Mean annual change in attachment level, subgroup analysis, age effect.
Implications for practice and policy
Previous workshops have also struggled with such issues and accepted the considerable variability of presentation of periodontitis, including progression of attachment level change. Overall, the results of this new systematic review neither support nor refute the ongoing differentiation between forms of periodontal disease based on progression of attachment level change.
Implications for further research
A 10-year longitudinal study of the progression of destructive periodontal disease in adults and the elderly [in Chinese]. The natural history of periodontal attachment loss in the third and fourth decades of life.
Age‐dependent distribution of periodontitis in two countries
Classification criteria are not designed to characterize each individual patient with a unique set of disease manifestations, but rather to set a baseline. The evolution of classification criteria for periodontal diseases over the years has been shaped by a rich discussion in the scientific community.
Periodontal examination
Details of the SHIP-Trend methodology can be found elsewhere.11 SHIP-Trend surveyed a total of 4,420 people between 2008 and 2012.
Study variables
Statistical analysis
RESULTS
Findings from NHANES 2009 to 2014
In contrast, persons in the top 5% of the FIGURE 1 A Trend in average attachment loss, clinical recession, and pocket depth by age group, National Health and Nutrition Examination Survey (NHANES), 2009 to 2014. Persons in the youngest age group average about one missing tooth and this number in‐.
Findings from SHIP‐Trend 2008 to 2012
When similar analyzes were performed for individuals in the upper quintile in each age group separately (Figs. B to K, Appendix), it was observed that in the youngest age group.
