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Classification of periodontal diseases

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Classification of periodontal diseases

The 2018 World Workshop on the Classification of Periodontal Diseases8 recognised several types of periodontal condition. The British Society of Periodontology and Implant Dentistry (BSP) subsequently published their implementation of the Classification37 which aimed to be more appropriate for use in UK general dental practice, where most periodontal diseases are diagnosed and managed. The 2018 Classification system now recognises:

  • periodontal health and gingivitis;
  • periodontitis;
  • other conditions affecting the periodontal tissues.

More information on the conditions included in each category is listed below.

Periodontal health (intact periodontium)

Periodontal health (reduced periodontium*)

Gingivitis: dental biofilm-induced (intact periodontium)

Gingivitis: dental biofilm-induced (reduced periodontium*)

Gingival disease and conditions: non biofilm-induced

*Reduced periodontium due to causes other than periodontitis e.g. crown lengthening surgery, endodontic-periodontal lesions, recession due to toothbrushing, etc.

Periodontitis**

Necrotising periodontal diseases 

Periodontitis as a manifestation of systemic disease

**All patients with evidence of historical or current periodontitis should be staged/graded at initial consultation.

Systemic diseases or conditions affecting the periodontal supporting tissues

Periodontal abscesses and endodontic-periodontal lesions

Mucogingival deformities and conditions

Traumatic occlusal forces

Tooth and prosthesis related factors

Once periodontitis has been recognised in a patient, the 2018 Classification allows for a more accurate description of the disease present. Note that staging and grading only identify historical disease experience and indicate the likelihood of future disease risk. Staging and grading do not provide any information on treatment need, which is based on assessment of disease activity, probing pocket depths and bleeding on probing.

The principal differences between the updated 2018 Classification and the previous disease classification are: 

  • the removal of the terms chronic and aggressive periodontitis;
  • the incorporation of a system (STAGING) that assesses the severity of periodontal breakdown as a function of bone levels around the teeth at presentation;
  • the incorporation of a system (GRADING) that assesses the rate of periodontal breakdown;
  • the recognition of risk factors which make a patient more susceptible to disease and may make control more challenging;
  • the extent of disease is described; 
  • a descriptor of disease stability indicated by levels of bleeding on probing and periodontal probing pocket depth.