Examples of systemic conditions include: (1) sex steroid hormones (e.g., puberty, pregnancy, menstrual cycle, oral contraceptives); (2) hyperglycemia; (3) leukemia; (4) malnutrition; and (5) smoking.11,22, Elevations in sex steroid hormones, especially, during puberty and pregnancy may modify the gingival inflammatory response and result in an exaggerated gingival inflammation in the presence of even relatively small amounts of plaque. Periodontal phenotype can be assessed by measuring the gingival thickness through the use of a periodontal probe. This paper was developed under the direction of the Task Force to Update the Classification of Periodontal Diseases and Conditions and approved by the Board of Trustees of the American Academy of Periodontology in April 2015. Tobacco use by adolescents: The role of the oral health professional in evidence-based cessation program. Early diagnosis of periodontal diseases ensures the greatest opportunity for successful treatment, primarily by reducing etiological factors, establishing appropriate therapeutic measures, and developing an effective periodic maintenance protocol.2. Differential diagnosis is based on the history and the specific signs and symptoms of necrotizing periodontitis and the presence or absence of an uncommon systemic disease that definitively modify the host immune response.6,24,27, Evidence supports necrotizing periodontitis as a separate disease entity based on (1) distinct pathophysiology characterized by prominent bacterial invasion and ulceration of epithelium; (2) rapid and full thickness destruction of the marginal soft tissue resulting in characteristic soft and hard tissue defects; (3) obvious symptoms; and (4) faster resolution in response to specific antimicrobial treatment.27 This painful and infectious condition should be diagnosed primarily basedon its typical clinical features, which includes necrosis and ulceration in the interdental papilla, gingival bleeding, pseudomembrane formation, and halitosis.18,24 In severe cases, bone sequestrum also may occur.58 Pain and halitosis are observed less often among children, while systemic conditions such as fever, adenopathy, and sialorrhea (hypersalivation) are observed more frequently.18,59 Necrotizing periodontal diseases are strongly associated with impairment of the host immune system. Periodontal problems in children and adolescents. However, the role of vitamin C (ascorbic acid) in supporting periodontal tissues due to its essential function in collagen synthesis is well-documented.10,19 Vitamin C deficiency, or scurvy, compromises antioxidant micronutrient defenses to oxidative stress and collagen synthesis leading to weakened capillary blood vessels, consequently increasing the predisposition to gingival bleeding.48 Nevertheless, gingival inflammation due to vitamin C deficiency may be difficult to detect clinically and indistinguishable from plaque-induced gingivitis.22 Scurvy may occur in certain populations of pediatric interest such as infants and children from low socioeconomic families.22, One major change in the 2017 classification of dental plaque-induced gingival diseases was to simplify the system for the clinician and condense the catalog to include only conditions affecting the gingiva that could be clinically identified. The primary signs associated with EPL are deep periodontalpockets reaching or close to the apex and/or negative or altered response to pulp vitality tests. Peri-implant mucositis. Dental plaque biofilm-induced gingivitis usually is regarded as a localized inflammation initiated by microbial biofilm accumulation on teeth and considered one of the most common human inflammatory diseases (Table 2 - see PDF).6,19 When dental plaque is not removed, gingivitis may initiate as a result of loss of symbiosis between the biofilm and the host’s immuneinflammatory response. Available at: “http://www.lung.org/stop-smoking/”. 594 December 2000, Vol. The clinician uses the clinical and radiographic data gathered and classifies the patient into one of the four Case Types. In: Nowak, AJ, Christensen JR, Mabry TR,Townsend JA, Wells MH, eds. J Periodontol 2018;89(Suppl1):S159-S172.28. root anatomy;iv. 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. J Periodontol 2003;74(11):1696-704.5. American Dental Association Classifications (based primarily on attachment loss) Case Type I: Gingivitis: no attachment loss, bleeding may or may not be present Case Type II: Early Periodontitis: pocket depths or attachment loss 3 - 4 mm BOP may be present localized areas of recession possible class I … Periodontol 2000 2013;61(1):125-59.35. Accessed June 22, 2018. J Periodontol 2018;89(Suppl 1):S223-S236.14. Tobacco addiction: Diagnosis and treatment. The current classification of non-dental plaque-induced gingival conditions is based on the etiology of the lesions. (Archived by WebCite® at: “http://www.webcitationorg/74HGmCmHS”), 211 East Chicago Avenue, Suite 1600Chicago, IL 60611(312) 337-2169. Oral manifestations include gingival enlargement/bleeding, petechiae, oral ulcerations/infections, and cervical lymphadenopathy. St. Louis, Mo. Dr. Charlie Czerepak Interviewed by WGN-TV’s Living Healthy Chicago, Oral Health Policies & Recommendations (The Reference Manual of Pediatric Dentistry), Treating Tooth Decay: How to Make the Best Restorative Choices for Children’s Health, 2020, Pain Management in Infants, Children, Adolescents and Individuals with Special Health Care Needs, Good News in COVID Relief Package and Final FY 2021 Appropriations Bill, Pediatric Oral Health Advocacy Conferences. Copyright © 2021 American Academy of Pediatric Dentistry All Rights Reserved. WHO: World Health Organization. BoP: Bleeding on probing. Hyposalivation interferes with plaque removal, thereby increasing the risk of caries, halitosis, and gingival inflammation among other oral conditions. Stability is the major treatment goal for periodontitis; however, remission/control may be the more realistically achievable therapeutic goal when it is not possible to fully control for modifying factors.11,19,22,28. Mean annual attachment, bone level and tooth loss: A systematic review. Gingival healthGingival health (GH) is usually associated with an inflammatory infiltrate and host response in relatively stable equilibrium.21 GH in a patient with intact periodontium is diagnosed by (1) no probing attachment loss, (2) no radiographic bone loss (RBL), (3) <3 mm of PPD, and (4) <10 percent BoP.11 GH can be restored following treatment of gingivitis and periodontitis. Prevalence of periodontal disease in insulin-dependent diabetes mellitus (juvenile diabetes). : Elsevier/Saunders; 2017:371-8.4. genetics.3. There are broadly two categories of gingival disease and conditions: dental plaque biofilminduced gingivitis and non-dental plaque-induced gingival disease. Trombelli L, Farina R, Silva CO, Tatakis DN. J Dent Res 2015;94(4):540-6.58. Albert DA, Severson HH, Andrews JA. Mission Statement. Created by Meks. System is primarily based on the severity of attachment loss. GH: Gingival health. When data did not appear sufficient or were inconclusive, recommendations were based upon expert and/or consensus opinion by experienced researchers and clinicians. If the hypersensitivity does not resolve with adequate measures of plaque control, additional treatment may be required, including removal of material or appliance. Gingivitis inter menstrualis. Classification of Periodontal Diseases and Conditions, American Dental Association Classifications (ADA), American Dental Association Classifications (ADA)-1989. American Academy of Periodontology, SUNSTAR Announce 2018 Innovation Grant Recipients; World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions; Best Evidence Consensus Meeting on Cone-Beam Computed Tomography (CBCT) American Academy of Periodontology Installs New President, Officers in Boston Smoking is a major lifestyle and behavioral risk factor for periodontitis mostly attributed to alterations in the microflora and/or host response.11,22 Increased pocket depth measurements, attachment loss, and alveolar bone loss are more prevalent in smokers than non-smokers.49 Tobacco use is no longer classified as a habit but as a dependence to nicotine and a chronic relapsing medical disorder.50 Smoking and smokeless tobacco use almost always are initiated and established in adolescence.51-57 The most common tobacco products used by middle school and high school students are reported to be e-cigarettes, cigarettes, cigars, smokeless tobacco, hookahs, pipe tobacco, and bidis (unfiltered cigarettes from India).52 However, the exposure to cannabis (marijuana) among children and adolescents has increased in the United States due to its legalization in many states.55 Frequent cannabis use has been associated with deeper probing depths, more CAL, and increased risk of severe periodontitis.55 Periodontitis, visible plaque, and gingival bleeding also have been reported among crack cocaine users.56 Clinical signs associated with smokeless tobacco may include increased gingival recession and attachment loss, particularly at the sites adjacent to mucosal lesion associated with the habit.55 Health professionals who treat adolescents and young adults should be aware of the signs of tobacco use and be able to provide counseling (or referral to an appropriate provider) regarding the serious health consequences of tobacco and drug use, as well as use brief interventions for encouragement, support, and positive reinforcement for cessation when the habit is identified. Löe H. The gingival index, the plaque index and the retention index systems. Abscesses of the Periodontium Peri-implant diseases and conditionsThe 2017 World Workshop members developed a new classification for peri-implant health, peri-implant mucositis and peri-implantitis. Many factors are determined controllable (e.g., removal of overhangs, smoking cessation, good diabetes control) while others are not (e.g., genetics, immune status, use of critical medications).21. Available at: “http://www.who.int/about/mission/en/”. 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