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PAPAPANOU et al .
Correspondence Dr. Panos N. Papapanou, Division of Periodontics, Section of Oral, Diagnostic and Rehabilitation Sciences, Columbia University College of Dental Medicine, 630 West 168th Street, PH‐7E‐110, New York, NY 10032, USA. Email: pp192@cumc.columbia.edu Sources of Funding : The workshop was planned and conducted jointly by the American Academy of Periodontology and the European Federation of Periodontology with financial support from the American Academy of Periodontology Foundation, Colgate, Johnson & Johnson Consumer Inc., Geistlich Biomaterials, SUNSTAR, and Procter & Gamble Professional Oral Health. The proceedings of the workshop were jointly and simultaneously published in the Journal of Periodontology and Journal of Clinical Periodontology .
Abstract A new periodontitis classification scheme has been adopted, in which forms of the disease previously recognized as “chronic” or “aggressive” are now grouped under a single category (“periodontitis”) and are further characterized based on a multi‐di - mensional staging and grading system. S taging is largely dependent upon the severity of disease at presentation as well as on the complexity of disease management, while grading provides supplemental information about biological features of the disease including a history‐based analysis of the rate of periodontitis progression; assessment of the risk for further progression; analysis of possible poor outcomes of treatment; and assessment of the risk that the disease or its treatment may negatively affect the general health of the patient. Necrotizing periodontal diseases, whose characteristic clinical phenotype includes typical features (papilla necrosis, bleeding, and pain) and are associated with host im - mune response impairments, remain a distinct periodontitis category. Endodontic‐periodontal lesions, defined by a pathological communication between the pulpal and periodontal tissues at a given tooth, occur in either an acute or a chronic form, and are classified according to signs and symptoms that have direct impact on their prognosis and treatment. Periodontal abscesses are defined as acute lesions characterized by localized ac - cumulation of pus within the gingival wall of the periodontal pocket/sulcus, rapid tissue destruction and are associated with risk for systemic dissemination. KEYWORDS acute periodontal conditions, endo‐periodontal lesion, necrotizing gingivitis, necrotizing periodontitis, periodontal abscess, periodontal disease, periodontitis
Periodontitis is a chronic multifactorial inflammatory disease associ - ated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth‐supporting apparatus. Its primary features include the loss of periodontal tissue support, manifested through clinical attachment loss (CAL) and radiographically assessed alveolar bone loss, presence of periodontal pocketing and gingival bleeding. Periodontitis is a major public health problem due to its high prev - alence, as well as because it may lead to tooth loss and disability, negatively affect chewing function and aesthetics, be a source of social inequality, and impair quality of life. Periodontitis accounts for a substantial proportion of edentulism and masticatory dysfunction, results in significant dental care costs and has a plausible negative impact on general health. According to the latest internationally accepted classification scheme (Armitage 1 1999), periodontitis is further subdivided as follows: • Chronic periodontitis , representing the forms of destructive periodontal disease that are generally characterized by slow progression • Aggressive periodontitis , a diverse group of highly destructive forms of periodontitis affecting primarily young individuals,
including conditions formerly classified as “early‐onset periodon - titis” and “rapidly progressing periodontitis” • Periodontitis as a manifestation of systemic disease , a heteroge - neous group of systemic pathological conditions that include peri - odontitis as a manifestation • Necrotizing periodontal diseases , a group of conditions that share a characteristic phenotype where necrosis of the gingival or peri - odontal tissues is a prominent feature • Periodontal abscesses , a clinical entity with distinct diagnostic fea - tures and treatment requirements Although the above classification has provided a workable framework that has been used extensively in both clinical prac - tice and scientific investigation in periodontology during the past 17 years, the system suffers from several important short - comings, including substantial overlap and lack of clear patho - biology‐based distinction between the stipulated categories, diagnostic imprecision, and implementation difficulties. The ob - jectives of workgroup 2 were to revisit the current classification system of periodontitis, incorporate new knowledge relevant to its epidemiology, etiology and pathogenesis that has accumu - lated since the current classification's inception, and propose a
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