Person with periodontitis There were several attempts to introduce an agreed-upon classification system for periodontal diseases: in 1989, 1993, 1999, and 2017. 1999 classification The 1999 classification system for periodontal diseases and conditions listed seven major categories of periodontal diseases, of which 2–6 are termed destructive periodontal disease, because the damage is essentially irreversible. The seven categories are as follows: * Gingivitis * Chronic periodontitis * Aggressive periodontitis * Periodontitis as a manifestation of systemic disease * Necrotizing ulcerative gingivitis/periodontitis * Abscesses of the periodontium * Combined periodontic-endodontic lesions Moreover, terminology expressing both the extent and severity of periodontal diseases are appended to the terms above to denote the specific diagnosis of a particular person or group of people. Severity The "severity" of disease refers to the amount of periodontal ligament fibers that have been lost, termed "clinical attachment loss". According to the 1999 classification, the severity of chronic periodontitis is graded as follows: * Slight: of attachment loss * Moderate: of attachment loss * Severe: ≥ of attachment loss Extent The "extent" of disease refers to the proportion of the dentition affected by the disease in terms of percentage of sites. Sites are defined as the positions at which probing measurements are taken around each tooth and, generally, six probing sites around each tooth are recorded, as follows: * Mesiobuccal * Mid-buccal * Distobuccal * Mesiolingual * Mid-lingual * Distolingual If up to 30% of sites in the mouth are affected, the manifestation is classified as "localized"; for more than 30%, the term "generalized" is used. 2017 classification The 2017 classification of periodontal diseases is as follows: Periodontal health, gingival disease and conditions * Periodontal health and gingival health * Clinical gingival health on an intact periodontium * Clinical gingival health on an intact periodontium * Stable periodontitis * Non periodontitis person *Gingivitis - Dental biofilm induced *Associated with the dental biofilm alone *Mediated by systemic and local risk factors *Drug induced gingival enlargement. *Gingival diseases - Non dental biofilm induced *Genetic/developmental disorders *Specific infections *Inflammatory and immune conditions *Reactive processes *Neoplasms *Endocrine, nutritional and metabolic *Traumatic lesions *Gingival pigmentation. Periodontitis *Necrotizing periodontal diseases *Necrotizing Gingivitis *Necrotizing Periodontitis *Necrotizing Stomatitis * Periodontitis as a manifestation of systemic disease * Periodontitis Other conditions affecting the periodontium (Periodontal Manifestations of Systemic Diseases and Developmental and Acquired Conditions) * Systemic disease of conditions affecting the periodontal support tissues * Other Periodontal Conditions * Periodontal abscesses * Endodontic- periodontal lesions *Mucogingival deformities and conditions *Gingival Phenotype *Gingival/Soft Tissue Recession *Lack of Gingiva *Decreased Vestibular Depth *Aberrant Frenum/muscle position *Gingival Excess *Abnormal Color *Condition of the exposed root surface *Traumatic occlusal forces *Primary Occlusal Trauma *Secondary Occlusal Trauma * Tooth and prosthesis related factors * Localized tooth-related factors * Localized dental prostheses-related factors Peri-implant diseases and conditions * Peri-implant health *Peri-implant mucositis *Peri-implantitis * Peri-implant soft and hard tissue deficiencies Staging The goals of staging periodontitis is to classify the severity of damage and assess specific factors that may affect management. According to the 2017 classification, periodontitis is divided into four stages; after considering a few factors such as: * Amount and percentage bone loss radiographically * Clinical attachment loss, probing depth * Presence of furcation * Vertical bony defects * History of tooth loss related to periodontitis * Tooth hypermobility due to secondary occlusal trauma Grading According to the 2017 classification, the grading system for periodontitis consists of three grades: *Grade A: Slow progression of disease; no evidence of bone loss over last five years *Grade B: Moderate progression; < 2mm of bone loss over last five years *Grade C: Rapid progression or future progression at high risk; ≥ 2mm bone loss over five years Risk factors affecting which grade a person is classified into include: *Smoking * Diabetes
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