| S221
JEPSEN et al .
KEYWORDS anatomy, attachment loss, bruxism, classification, dental prostheses, dental restorations, diagnosis, genetic disease, gingival inflammation, gingival recession, gingival thickness, gingivitis, mucogingival surgery, occlusal trauma, periodontal disease, periodontitis, plastic periodontal surgery, systemic disease, tooth
A variety of systemic diseases and conditions can affect the course of periodontitis or have a negative impact on the periodontal attach‐ ment apparatus. Gingival recessions are highly prevalent and often associated with hypersensitivity, the development of caries and non‐ carious cervical lesions on the exposed root surface and impaired esthetics. Occlusal forces can result in injury of teeth and peri‐ odontal attachment apparatus. Several developmental or acquired conditions associated with teeth or prostheses may predispose to diseases of the periodontium. The objectives of Workgroup 3 were to revisit the 1999 AAP classification for periodontal diseases and conditions, evaluate the updated evidence with regard to epidemiology and etiopathogen‐ esis and to propose a new classification system together with case definitions and diagnostic considerations. In preparation, four posi‐ tion papers were provided, that had been accepted for publication. Discussions were based on these four reviews covering 1) periodon‐ tal manifestions of systemic diseases and conditions; 1 2) mucogin‐ gival conditions around natural teeth; 2 3) traumatic occlusal forces and occlusal trauma; 3 and 4) dental prostheses and tooth‐related factors. 4 This consensus report is based on the results of these re‐ views and on expert opinions of the participants. SYSTEMIC DISEASES AND CONDITIONS THAT AFFECT THE PERIODONTAL SUPPORTING TISSUES Is it possible to categorize systemic diseases and conditions based on the underlying mechanisms of their effect on the periodontal supporting tissues? Systemic diseases and conditions that can affect the periodontal supporting tissues can be grouped into broad categories as listed in Albandar et al., 1 for example genetic disorders that affect the host immune response or affect the connective tissues, metabolic and endocrine disorders, and inflammatory conditions. In the future, it is anticipated that further refinement of these categories will be possible. Are there diseases and conditions that can affect the periodontal supporting tissues? There are many diseases and conditions that can affect the peri‐ odontal tissues either by 1) influencing the course of periodontitis or 2) affecting the periodontal supporting tissues independently of dental plaque biofilm‐induced inflammation. These include:
1a. Mainly rare diseases that affect the course of periodontitis (e.g., Papillon Lefevre Syndrome, leucocyte adhesion deficiency, and hypophosphatasia). Many of these have a major impact resulting in the early presentation of severe periodontitis. 1b. Mainly common diseases and conditions that affect the course of periodontitis (e.g., diabetes mellitus). The magnitude of the effect of these diseases and conditions on the course of peri‐ odontitis varies but they result in increased occurrence and se‐ verity of periodontitis. 2. Mainly rare conditions affecting the periodontal supporting tis‐ sues independently of dental plaque biofilm‐induced inflamma‐ tion (e.g., squamous cell carcinoma, Langerhans cell histiocytosis). This is a more heterogeneous group of conditions which result in breakdown of periodontal tissues and some of which may mimic the clinical presentation of periodontitis. The full list of these diseases and conditions is presented in Table 1, adapted from Albandar et al. 1 Particularly relating to those common conditions identified in 1b) above: Should diabetes‐associated periodontitis be a distinct diagnosis? Given the current global diabetes epidemic and the challenges with timely identification and/or achieving glycemic goals in a large per‐ centage of affected individuals, this disease is of particular impor‐ tance. 5 Because of differences in prevalence between type 1 and type 2 diabetes most of the evidence for its adverse effects on periodontal tissues is from patients with type 2 diabetes. 6 The level of hyperglycemia over time, irrespective of the type of diabetes, is of importance when it comes to the magnitude of its effect on the course of periodontitis. 7 There are no characteristic phenotypic features that are unique to periodontitis in patients with diabetes mellitus. On this basis diabetes‐associated periodontitis is not a distinct disease. Nevertheless, diabetes is an important modifying factor of peri‐ odontitis, and should be included in a clinical diagnosis of peri‐ odontitis as a descriptor. According to the new classification of periodontitis, 8,9 the level of glycemic control in diabetes influences the grading of periodontitis. There is mounting evidence of specific mechanistic pathways in the pathogenesis of periodontitis in patients with diabetes. 10 In a more etiologically driven classification this should require further consideration in the future.
Made with FlippingBook Annual report