New Classification of Periodontitis
Dental professionals now have access to a new classification system for periodontal disease and peri-implant diseases and conditions. This classification is the outcome of the 2017 World Workshop, which was co-sponsored by the American Academy of Periodontology (AAP) and the European Foundation of Periodontology (EFP), and was held in November 2017 in Amsterdam. 1
The new guidelines provide a framework with which these diseases can be diagnosed with more consistency across clinicians. This classification system is similar to that which medical professionals use for staging cancer and other diseases. This new structure will also enable us to more clearly communicate the level of disease and risk to our patients, which could potentially lead to improved treatment acceptance and compliance.
There have been several versions of periodontal disease classifications. Previously, periodontitis was recognized to have numerous distinct clinical presentations, rates of progression and ages of onset. Based on these characteristics, periodontitis was categorized as pre-pubertal, juvenile, adult, and rapidly progressive. Later, these categories were changed to adult and early onset periodontitis. Periodontitis was reclassified in 1999 as chronic, aggressive, necrotizing, and as a manifestation of systemic disease. 2
In the interim since the last workshop in 1999, ongoing research has illuminated considerable new information and propelled the development of this new classification.
Central to the new system is a framework for staging and grading the disease. Staging relates to the severity of disease progression as well as the complexity of disease management. The extent of the disease is also a deciding factor in staging periodontitis. The severity of the disease is measured by interdental clinical attachment loss or radiographic evidence of bone loss. The complexity of managing the disease is measured by factors such as probing depths, boney defects, furcation involvement, masticatory dysfunction, and tooth loss due to periodontal disease.3
Grading adds additional information about extenuating factors such as the rate of disease progression, estimation of future risk of further progression, expected poor outcomes of treatment, and a determination of the risk that the disease may have an adverse affect on the patient’s overall health.3
Grading includes three levels: low risk, moderate risk, and high risk, and evaluates other issues related to general health status, especially blood glucose control in patients with diabetes and tobacco use. Another very important factor is the phenotype, or physical appearance, of the oral cavity, including the amount and type of deposits evident upon examination. Considering all of these individual factors is essential for understanding the complexities of case management.3
This new structure will enable more personalized patient care as well as more standardized diagnosis and treatment planning. Implementation of these new guidelines is the first step in aligning all clinicians in proper diagnosis of periodontal disease. For questions or assistance with implementation, feel free to reach out to the author at Kathryn@periolinks.com. Learn more at the American Association of Oral Systemic Health Scientific Session on November 9-11, 2018 at the Red Rock Resort in Las Vegas, NV. https://aaosh.org/aaosh-2018-scientific-session/
The downloadable resource “Chairside Guide to Periodontitis Staging and Grading” can be accessed here: http://perio.org/2017wwdc
The downloadable resource “Three Steps to Staging and Grading a Patient” can be accessed here: http://perio.org/sites/default/files/files/Three%20Steps%20to%20Staging%20and%20Grading%20a%20Patient.pdf
The AAP and EFP considered multiple other issues related to periodontitis, peri-implant disease and conditions during the workshop, and created many other guidelines. For more information, click here: http://perio.org/2017wwdc
- Armitage GC. Development of a classification system for periodontal diseases and conditions. Ann Periodontol. 1999;4:1–6.
- Berglundh, T., Armitage, G., Araujo, M. G., Avila-Ortiz, G., Blanco, J., Camargo, P. M., . . . Zitzmann, N. (2018). 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 of Periodontology, 89. doi:10.1002/jper.17-0739.
- Tonetti, Greenwell, Kornman. J Periodontol2018;89 (Supp 1): S159-S172 Accessed: http://perio.org/sites/default/files/files/Staging%20and%20Grading%20Periodontitis.pdf
Kathryn Gilliam, BA, RDH, FAAOSH is a practicing clinician, author, speaker and coach who empowers dental professionals to elevate their standard of care and their standard of caring with protocols based on sound scientific principles. She can be reached at firstname.lastname@example.org.