Introduction Human periodontal diseases encompass a wide spectrum of conditions in addition to gingival diseases and periodontitis. Some of these are related to plaque biofilm while others arise independently of biofilm accumulation and may either be modified by the biofilm or be uninfluenced by it. It was the remit of working group 3 of the 2017 World Workshop to review and update the 1999 classification on periodontal manifestations of systemic diseases and developmental and acquired conditions, and to develop case definitions and diagnostic considerations. Periodontal manifestations of systemic diseases and conditions There are rare systemic disorders, such as Papillon–Lefèvre syndrome, that result in the early presentation of severe periodontitis. They have a major impact on the loss of periodontal tissues by influencing periodontal inflammation. Such conditions are grouped together as “periodontitis as a manifestation of systemic disease” and classification is based on the primary systemic disease (using ICD-10 codes). There are more common systemic diseases – such as diabetes mellitus – that are important modifiers of the course of periodontitis. However, diabetes-associated periodontitis should not be regarded as a distinct diagnosis – diabetes is now included in the new clinical classification of periodontitis as a descriptor in the grading process. In a similar way, smoking – now regarded as nicotine dependence and as a chronic relapsing medical disorder with major negative effects on the periodontium – is now also included as a descriptor in the grading process. Other systemic conditions, such as neoplastic diseases, can affect the periodontal tissues independently of biofilm-induced inflammation. They are also classified based on the primary systemic disease (using ICD-10 codes) and are now grouped together as “systemic diseases or conditions that affect the periodontal supporting tissues.”
A case of “periodontitis” in a patient with uncontrolled
diabetes mellitus. This is not a case of “periodontitis as a direct manifestation of systemic disease”
Systemic and other periodontal conditions
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Guidance for clinicians
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