Periodontal disease, commonly known as gum disease, is a widespread infection affecting the tissues that support teeth. These supporting structures include the gums, the periodontal ligament, and the bone surrounding the tooth roots. Like many other medical conditions, a clear and consistent classification system is necessary for accurately diagnosing and effectively treating this disease. A significant update to how periodontal disease is classified has recently been introduced.
Why a New Classification System?
The previous classification system for periodontal disease, established in 1999, had limitations in capturing its varying severity, progression, and individual risk factors. It struggled to differentiate certain forms of the disease, leading to inconsistencies in diagnosis and treatment planning. Scientific understanding of how periodontal disease develops and progresses has advanced considerably since then.
This knowledge highlighted the need for a more comprehensive system to reflect the disease’s complex nature. The goal was to provide a more accurate and personalized approach to patient care. The new classification was developed through the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions, a collaborative effort by the American Academy of Periodontology (AAP) and the European Federation of Periodontology (EFP).
Understanding the New Classification
The updated classification system for periodontitis introduces a multi-dimensional framework based on staging and grading. This framework helps dental professionals assess both the current state of the disease and its potential future behavior.
Periodontitis is now categorized into four stages (I, II, III, and IV), which primarily describe the severity and extent of damage to tooth-supporting structures. Stage I represents the earliest form with minimal attachment and bone loss, while Stage IV indicates extensive damage, often involving tooth loss and complex management needs. Staging considers factors like clinical attachment loss, radiographic bone loss, and tooth loss due to the disease. It also accounts for the complexity of managing the condition, such as deep pockets or specific bone defects.
In addition to staging, the new system introduces grades (A, B, and C) to assess the rate of disease progression and the risk of future progression. Grade A indicates a slow rate of progression, while Grade C suggests a rapid and potentially aggressive form. Grading considers evidence of past bone loss over time and the presence of risk factors such as smoking and uncontrolled diabetes. For instance, a patient who smokes heavily or has poorly controlled diabetes might be assigned a higher grade, indicating a greater likelihood of rapid progression.
The classification also includes the extent and distribution of the disease, noting whether it is localized (affecting less than 30% of teeth) or generalized (affecting 30% or more of teeth). Specific patterns, like involvement primarily of molars and incisors, are also noted. The new classification briefly includes other forms of periodontal diseases, such as necrotizing periodontal diseases and periodontitis that manifests as a symptom of systemic diseases.
Impact on Patient Diagnosis and Treatment
The updated classification system significantly impacts how dental professionals diagnose and treat periodontal disease, leading to more tailored care. Precise staging and grading allow dentists and periodontists to gain a deeper understanding of each patient’s specific condition.
This detailed assessment enables the development of treatment plans specific to the individual’s disease severity, rate of progression, and associated risk factors. For example, a patient with rapidly progressing disease (Grade C) might receive more intensive initial therapy and frequent follow-up compared to someone with a slowly progressing condition (Grade A), even if their current stage is similar. This precision helps predict the likely outlook for the patient’s oral health.
The new system also improves communication between dental professionals and patients. Using a standardized and more descriptive classification, clinicians can more clearly explain the disease’s nature, its potential course, and the rationale behind recommended treatments. Its fundamental purpose remains consistent: to help preserve natural teeth and maintain overall oral health for patients.