American Academy of Periodontology
The American Academy of Periodontology classification system was established to identify distinct types of periodontal diseases by taking into consideration factors such as age of onset, clinical appearance, rate of disease progression, pathogenic microbial flora and systemic influences. The two major categories are Gingivitis and Periodontitis. Within each category there are specific types of diseases identified. Gingivitis Subdivisions are listed below: Plaque-Associated Gingivitis (illustrated)
o Chronic Gingivitis o Acute Necrotizing Ulcerative Gingivitis o Gingivitis Associated with Systemic Conditions or Medications  Hormone-Induced Gingival Inflammation  Drug-Influenced Gingivitis (illustrated)  Linear Gingival Erythema (LGE) Gingival Manifestations of Systemic Diseases and Mucocutaneous Lesions
o Bacterial, Viral or Fungal o Blood Dyscrasias (for example Acute Monocytic Leukemia) o Mucocutaneous Diseases (Lichen Planus, Cicatricial Pemphigoid) American Academy of Periodontology: Current Procedural Terminology for Periodontics and Insurance Reporting Manual, 7th Edition Plaque-Associated Gingivitis:
This slide illustrates a patient who presents clinical findings
representative of Plaque Associated Gingivitis:
Gingival redness, edema, bleeding upon probing, enlargement
and tenderness.
Radiographic evaluation shows no signs of bone loss.
Acute Necrotizing Ulcerative Gingivitis
Patients diagnosed with Acute Necrotizing Ulcerative Gingivitis may present with the following
clinical findings: Papillary necrosis, bleeding, pain and fetor oris (odor).
Hormone-Induced Gingival Inflammation
Changes in the levels of circulating estrogen and progesterone can cause gingival hyperplasia,
this can occur at puberty or during pregnancy. Clinical findings of patients diagnosed with
Hormone-Induced Gingival Inflammation may include the following:
Gingival redness, bleeding upon probing, edema and gingival
enlargement associated with proliferation of blood vessels.
Drug-Influenced Gingivitis
Patients that take medications such as Dilantin, Cyclosporin or
Procardia often present with gingival overgrowth.
This case illustrates a patient who is taking the medication
Cyclosporin for treatment of a kidney transplant.
Clinical findings include: Fibrotic gingival response,
pseudopockets and bleeding upon probing.
Linear Gingival Erythema (LGE)
Patients that are HIV+ may exhibit this type of gingival response.
Bacterial, Viral or Fungal
Two examples of cases in this gingivitis category include patients with Acute Herpetic
Gingivostomatitis or Candida Albicans.
Blood Dyscrasias
Patients with a history of blood disorders, such as Acute Monocytic Leukemia, commonly leads
to a compromised or reduction of the host immune response. Clinical Findings often include;
spontaneous bleeding upon probing or by simply touching the gingival tissues.
Mucocutaneous Diseases
Examples of gingival diseases in this category include; Lichen Planus, Pemphigus Vulgaris and
Desquamative Gingivitis.
Periodontitis Subdivisions are listed below: Adult Periodontitis - Plaque-Associated (illustrated) o Prepubertal o Juvenile Periodontitis o Rapidly Progressive (illustrated) Periodontitis Associated with Systemic Diseases (illustrated) American Academy of Periodontology: Current Procedural Terminology for Periodontics and Insurance Reporting Manual, 7th Edition
Adult Periodontitis (Plaque-Associated)
Adult Periodontitis is the most common chronic form of periodontitis. The presence of local factors such as plaque is usually comparable with the disease progression. This slide illustrates a patient with active periodontal disease associated with the presence of plaque and calculus. Early-Onset Periodontitis
Localized Juvenile Periodontitis This case illustrates a patient diagnosed with Localized Juvenile Periodontitis. In these patients, local factors are minimal, there is rapid loss of attachment, bilateral symmetry is common, destruction of bone is often localized to first permanent molars, permanent incisors but can be generalized destruction, and mild to moderate inflammatory response. Prepubertal Periodontitis A rare periodontal disease, onset is often during or immediately following eruption of the decidous dentition. Clinical findings include generalized severe and rapid destruction of bone. Other medical conditions are usually present. This case is a young female diagnosed with Rapidly Progressive Periodontitis. In these type of cases, clinical manifestations of inflammation may be present, local factors are minimal, generalized severe and rapid bone destruction occurs. Periodontitis Associated with Systemic Diseases
With certain systemic conditions the inflammatory response is altered in the presence of local
irritants thereby, accelerating the progression of periodontal disease. The patient in this case has a history of Diabetes. Necrotizing Ulcerative Periodontitis
Necrotizing Ulcertative Periodontitis can be described similar to Acute Necrotizing Ulcerative
Gingivitis. Findings may include erythema, ulceration and necrosis of the gingival margin, with
destruction of the supporting bone. The deep interdental osseous craters are distinctive when
compared to other types of bony defects found in periodontal diseases.
These type of cases normally do not respond to "well-executed" periodontal therapy.
This is a new category established by the AAP. Patients in this category have implants that
exhibit a "periodontitis-like-process" similar to natural teeth.

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