Periodontal pathology

Parodontopathy is generally divided into 2 main groups, which are gingivitis and periodontitis. The other group of periodontal diseases is periodontal atrophy, which is however only accepted in the Czech Republic.

 For more information see Gingivitis.

 For more information see Parodontitis.

Manifestations of periodontopathies - in general

The basic manifestations of periodontopathies include inflammation of the gingiva and the development of parodontal caries.

Sulcus gingivalis

Parodontal pockets

A gingival sulcus that is deeper than 3 mm is called a socket or pocket. Pockets can be of two types: fake and real.

Fake periodontal pockets

Fake periodontal pocket is characterized by deepening of the gingival sulcus without loss of the dentogingival connection, thus the connecting epithelium tendon is in place, only the gingival margin is shifted coronally due to the increase in its volume.

True periodontal pockets

In the true periodontal pocket there is already a loss of the epithelial attachment and its shift apically.

Classification of periodontopathies

According to the December 1999 Annals of Periodontology classification of periodontal disease.

A. Diseases of the gingiva

PLAQUE-INDUCED GINGIVAL DISEASE

1. Gingivitis associated only with the presence of plaque
   • No other local factors;
   • With other local factors.
2. Gingival disease modified by overall factors:
   • associated with the endocrine system:
     • Gingivitis in puberty;
     • Gingivitis associated with the menstrual cycle;
     • Gingivitis and pyogenic granuloma in pregnancy;
     • Gingivitis in diabetes mellitus.
   • Associated with blood diseases:
     • Gingivitis in leukemia;
     • ...
3. Medically modulated gingival disease:
   • Drug-modulated gingival disease;
     • Drug-induced gingival hyperplasia;
     • Drug-induced gingivitis;
     • Gingivitis associated with oral contraceptive use;
     • ...
4. Gingival disease modified by malnutrition:
   • Gingivitis in vitamin C deficiency;
   • ...

GINGIVAL LESIONS WITHOUT PLAQUE INVOLVEMENT

1. Gingival lesions of specific bacterial origin
   • Infection with Neisseria gonorrhoeae
   • Infection with Treponema pallidum
   • Streptococcal infections
   • ...
2. Gingival lesions of viral origin
   • Infection with herpetic viruses
     • Primary herpetic gingivostomatitis
     • Recurrent oral herpes
     • Infection with varicella-zoster
     • ...
3. Gingival disease of mycotic origin:
   • candidal infections;
     • Generalized gingival candidiasis;
     • Linear gingival erythema;
     • Histoplasmosis;
     • Other,
4. Gingival lesions of genetic origin:
   • Hereditary fibromatosis of the gingiva;
   • ...
5. Gingival manifestations of general conditions:
   • Diseases affecting mucous membranes and skin;
     • Lichen planus;
     • Pemphigoid;
     • Pemphigus vulgaris;
     • Erythema multiforme;
     • Lupus erythematosus;
     • Drug-induced;
     • ...
   • Allergic reactions
     • Dental materials;
       • Mercury;
       • Nickel;
       • Acrylic;
       • ...
     • Reactions attributed to:
       • To toothpaste;
       • To mouthwashes;
       • Chewing gum additives;
       • Food and its additives;
       • ...
6. Traumatic lesions:
   • Chemical damage;
   • Physical damage;
   • Thermal damage.
7. Reaction to foreign tissue
8. Other unspecified

B. Chronic periodontitis

1. Localized
2. Generalized

C. Aggressive periodontitis

1. Localized
2. Generalized

D. Periodontitis as a manifestation of general disease

1. Associated with haematological diseases:
   • Acquired neutropenia;
   • Leukemia;
   • ...
2. Associated with genetically linked diseases:
   • Familial and Cyclic neutropenia;
   • Down syndrome;
   • Leukocyte Adhesion Deficiency Syndrome;
   • Papillon-Lefévre syndrome;
   • Chediak-Higashi syndrome;
   • Histiocytosis;
   • Glycogen storage diseases;
   • Infantile genetic agranulocytosis;
   • Cohen syndrome;
   • Ehlers-Danlos syndrome;
   • Hypophosphatasia;
   • ...
3. Other unspecified'

E. Necrotizing periodontal disease

1. Necrotizing ulcerative gingivitis (NUG)
2. Necrotizing ulcerative periodontitis (NUP)

F. Periodontal abscess

1. Gingival abscess
2. Parodontal abscess
3. Pericoronal abscess

G. Periodontitis associated with endodontic lesions

1. Combined periodontal-endodontic lesions

H. Developmental and acquired deformities

1. Local factors on teeth that modify or predispose to plaque-induced gingivitis or periodontitis:
   • Anatomical abnormalities on the teeth;
   • Fillings on teeth and prosthetic structures;
   • Root fractures;
   • Cervical root resorption and cement pearls.
2. Mucogingival deformities and conditions around teeth:
   • Gingival recessions:
     • Vestibular or oral surfaces;
     • Interproximal space.
   • Lack of keratinized gingiva;
   • Reduced vestibular depth;
   • Aberrant position of the frenulum;
   • Excess gingival tissue;
     • Fake pockets;
     • Variable gingival margin;
     • Excessive gingival manifestations;
     • Gingival hyperplasia;
   • Abnormal color.
3. Mucogingival deformities of the edentulous arch:
   • Vertical and/or horizontal arch defect;
   • Lack of gingival keratinized tissue;
   • Gingival/soft tissue enlargement;
   • Aberrant frenulum position;
   • Reduced vestibule depth;
   • Abnormal color.
4. Occlusal trauma:
   • Primary occlusal trauma;
   • Secondary occlusal trauma..

Sources

Related articles

• Anatomy of the periodontium

Source

• POLENÍK, Pavel. Patologie parodontu [lecture for subject Preventivní zubní lékařství, specialization Zubní lékařství, LFP UK]. Plzeň. 19.12.2008. 

Bibliography

• POLENÍK, Pavel. Subgingivální ošetření v praxi zubního lékaře. 1. edition. Quintessenz, 2008. ISBN 978-80-8679-04-5.

• LINDHE, Jan – KARRING, Thorkild – LANG, Niklaus Peter. Clinical Periodontology and Implant Dentistry. 4. edition. 2003. ISBN 1-4051-0236-5.