In dentistry, numerous types of classification schemes have been developed to describe the teeth and gum tissue in a way that categorizes various defects. All of these classification schemes combine to provide the periodontal diagnosis of the aforementioned tissues in their various states of health and disease.
In 1983, Seibert classified alveolar crestal defects: Class I: buccolingual loss of tissue with normal apicocoronal ridge height Class II: apicocoronal loss of tissue with normal buccolingual ridge width Class III: combination-type defects
Furcation defect
Gingival recession
The magnitude of a receding gumline, commonly referred to as the measurement of gingival recession, is most often described using Miller's classification: A new classification has been proposed to classify gingival and palatal recessions. The new classification system gives a comprehensive depiction of recession defect that can be used to include cases that cannot be classified according to earlier classifications. A separate classification system for palatal recessions is also proposed. The new classification system is more detailed, informative and tries to overcome the limitations of Miller's classification system. A wide array of cases which cannot be classified by application of Miller's classification, can be classified by application of Kumar & Masamatti's Classification.
Tooth mobility
As a general rule, mobility is graded clinically by applying firm pressure with either two metal instruments or one metal instrument and a gloved finger.
The first step to a successful diagnosis is careful history taking. Listen carefully to the patient. Ask key questions: “Do your gums bleed on brushing?” “Are any of your teeth loose?” “Do you smoke?” Then, a Williams probe with 1, 2, 3, 5, 7, 8, 9 and 10mm markings to measure the pocket depths around all the teeth. A six point or a four point pocket depth charting can be done. It should also be noted if any of the pockets bleed on probing. Bleeding will be a measure of inflammation; no bleeding on probing suggests health, except in smokers, who don’t usually bleed on probing. The probe will help us determine the distance from the base of the gingival crevice to the cemento-enamel junction – this is attachment loss. This is the best way to monitor the patient’s condition long term but it is difficult to determine the position of the cemento-enamel junction. If there is attachment loss, and no other systemic condition, then the diagnosis will be periodontitis. Using the periodontal six/four point chart, if more than 30% of sites are involved then a diagnosis of generalised disease is given. If less than 30% of sites are involved, then the type of periodontitis is localised. To finish off the diagnosis, the extent of the disease must be assessed. This is deemed mild, moderate or severe depending on the amount of attachment loss present. Radiographs such as bitewings, intra-oral periapicals or panoramics can be done to help assess the bone loss and aid in diagnosis.
Periodontal health, gingival diseases and conditions
Periodontitis
Other conditions affecting the periodontium.
In periodontal health, gingival diseases and conditions, there are 3 sub-types: I) Periodontal health and gingival health a. Gingival health on an intact periodontium b. Gingival health on a reduced periodontium i. Stable periodontitis patient ii. Non periodontitis patient II) Gingivitis - dental biofilm induced a. Associated with the dental biofilm alone b. Mediated by systemic or local risk factors c. Drug influenced gingival enlargement III) Gingival diseases - non dental biofilm induced a. Genetic/developmental disorders b. Specific infections c. Inflammatory and immune conditions d. Reactive processes e. Neoplasms f. Endocrine, nutritional and metabolic diseases g. Traumatic lesions h. Gingival pigmentation In the second part of the new classification system, periodontitis, there are again three sub-types I) Necrotizing periodontal diseases II) Periodontitis III) Periodontitis as a manifestation of systemic disease In the third division, Other conditions affecting the periodontium, there is again further breakdown. I) Systemic diseases or conditions affecting the periodontal supporting tissues II) Periodontal abscesses and endodontic-periodontal lesions III) Mucogingival deformities and conditions IV) Traumatic occlusal forces V) Tooth and prosthesis related factors
