{"title":"Periodontitis Modified by Systemic Factors","authors":"Denis F. Kinane Dr.","doi":"10.1902/annals.1999.4.1.54","DOIUrl":"10.1902/annals.1999.4.1.54","url":null,"abstract":"<p>Microbial dental plaque is the initiator of periodontal disease but whether it affects a particular subject, what form the disease takes, and how it progresses, are all dependent on the host defenses to this challenge. Systemic factors modify all forms periodontitis principally through their effects on the normal immune and inflammatory defenses. Some good examples of this effect exist such as when there is a reduction in number or function of polymorphonuclear leukocytes (PMNs) that may result in an increased rate and severity of periodontal destruction. Many other systemic factors are much less clear cut and are difficult to causally link to periodontitis. In many cases the literature is insufficient to make definite statements on links between systemic factors and periodontitis. It is also at times dif- ficult to be precise regarding the causative agent in systemic exposures such as smoking and even prescribed drug therapy. The possible role of systemic diseases and systemic exposures in initiating or modifying the progress of periodontal disease is clearly a complex issue. It is however generally agreed that several conditions may give rise to an increased prevalence, incidence, or severity of gingivitis and periodontitis. The categorization of the systemic modifying factors causing periodontitis and the evidence to support the role of these factors are the focus of this review. An attempt has been made to consider the conditions under broad headings, but it will be clear that many conditions fall within more than one category and that for several conditions only case reports exist whereas in other areas an extensive literature is present. <i>Ann Periodontol 1999;4:54-63.</i></p>","PeriodicalId":79473,"journal":{"name":"Annals of periodontology","volume":"4 1","pages":"54-63"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1902/annals.1999.4.1.54","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21707030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Necrotizing Ulcerative Periodontitis","authors":"M. John Novak Dr.","doi":"10.1902/annals.1999.4.1.74","DOIUrl":"10.1902/annals.1999.4.1.74","url":null,"abstract":"<p>In patients with no known systemic disease or immune dysfunction, necrotizing periodontitis (NUP) appears to share many of the clinical and etiologic characteristics of necrotizing ulcerative gingivitis (NUG) except that patients with NUP demonstrate loss of clinical attachment and alveolar bone at affected sites. In these patients, NUP may be a sequela of a single or multiple episodes of NUG or may be the result of the occurrence of necrotizing disease at a previously periodontitis-affected site. The existence of immune dysfunction may predispose patients to NUG and NUP, especially when associated with an infection of microorganisms frequently associated with periodontal disease such as <i>Treponema</i> and <i>Selenomonas</i> species, <i>Fuscobacterium nucleatum, Prevotella intermedia</i>, and <i>Porphyromonas gingivalis</i>. The role of immune dysfunction is exemplified by the occasionally aggressive nature of necrotic forms of periodontal disease seen in patients with HIV infection or malnutrition, both of which may impact host defenses. Clinical studies of HIV infected patients have shown that patients with NUP are 20.8 times more likely to have CD4+ cell counts below 200 cells/mm<sup>3</sup>. However, these same studies have demonstrated that most patients with CD4+ cell counts below 200 cells/mm do not have NUP,<sup>3</sup> suggesting that other factors, in addition to immunocompromisation, are involved. Further studies are needed to define the complex interactions between the microbial, or viral, etiology of necrotic lesions and the immunocompromised host. It is, therefore, recommended that NUG and NUP be classified together under the grouping of necrotizing periodontal diseases based on their clinical characteristics. <i>Ann Periodontol 1999;4:74- 77.</i></p>","PeriodicalId":79473,"journal":{"name":"Annals of periodontology","volume":"4 1","pages":"74-77"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1902/annals.1999.4.1.74","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21707032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Isao Ishikawa, Michael K. McGuire, Brian Mealey, Timothy M. Blieden, Gordon L. Douglass, William W. Hallmon, Myron Nevins, Giovan Paolo Pini Prato, Alan M. Polson, Robert G. Schallhorn, Jan L. Wennström
{"title":"Consensus Report: Occlusal Trauma","authors":"Isao Ishikawa, Michael K. McGuire, Brian Mealey, Timothy M. Blieden, Gordon L. Douglass, William W. Hallmon, Myron Nevins, Giovan Paolo Pini Prato, Alan M. Polson, Robert G. Schallhorn, Jan L. Wennström","doi":"10.1902/annals.1999.4.1.108","DOIUrl":"10.1902/annals.1999.4.1.108","url":null,"abstract":"","PeriodicalId":79473,"journal":{"name":"Annals of periodontology","volume":"4 1","pages":"108"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1902/annals.1999.4.1.108","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"68171388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Development of a Classification System for Periodontal Diseases and Conditions","authors":"Gary C. Armitage Dr.","doi":"10.1902/annals.1999.4.1.1","DOIUrl":"10.1902/annals.1999.4.1.1","url":null,"abstract":"<p>Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. In addition, such systems give clinicians a way to organize the health care needs of their patients. The last time scientists and clinicians in the field of periodontology and related areas agreed upon a classification system for periodontal diseases was in 1989 at the World Workshop in Clinical Periodontics.<sup>1</sup> Subsequently, a simpler classification was agreed upon at the 1<sup>st</sup> European Workshop in Periodontology.<sup>2</sup> These classification systems have been widely used by clinicians and research scientists throughout the world. Unfortunately, the 1989 classification had many shortcomings including: 1) considerable overlap in disease categories, 2) absence of a gingival disease component, 3) inappropriate emphasis on age of onset of disease and rates of progression, and 4) inadequate or unclear classification criteria. The 1993 European classification lacked the detail necessary for adequate characterization of the broad spectrum of periodontal diseases encountered in clinical practice. The need for a revised classification system for periodontal diseases was emphasized during the 1996 World Workshop in Periodontics.<sup>3</sup> In 1997 the American Academy of Periodontology responded to this need and formed a committee to plan and organize an international workshop to revise the classification system for periodontal diseases. The proceedings in this volume are the result of this reclassification effort. The process involved development by the Organizing Committee of an outline for a new classification and identification of individuals to write state-of-the-science reviews for each of the items on the outline. The reviewers were encouraged to depart from the preliminary outline if there were data to support any modifications. On October 30–November 2, 1999, the International Workshop for a Classification of Periodontal Diseases and Conditions was held and a new classification was agreed upon (Fig. 1). This paper summarizes how the new classification for periodontal diseases and conditions presented in this volume differs from the classification system developed at the 1989 World Workshop in Clinical Periodontics.<sup>1</sup> In addition, an analysis of the rationale is provided for each of the modifications and changes. <i>Ann Periodontol 1999;4:1-6.</i></p>","PeriodicalId":79473,"journal":{"name":"Annals of periodontology","volume":"4 1","pages":"1-6"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1902/annals.1999.4.1.1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21706498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Mucogingival Deformities","authors":"Giovan Paolo Pini Prato Dr.","doi":"10.1902/annals.1999.4.1.98","DOIUrl":"10.1902/annals.1999.4.1.98","url":null,"abstract":"<p>The presence of mucogingival deformities often have an impact on patients in terms of esthetics and function. The variety of the conditions makes it difficult to place gingival and alveolar mucosa deformities under a single definition. Mucogingival deformities, as defined in this paper, may be congenital, developmental, or acquired defects. These may occur around natural teeth or implants and in edentulous ridges. They may be localized to soft tissues or be associated with defects in the underlying bone. They may show different degrees of severity and extension. A classification of mucogingival deformities should provide a method for identifying the different conditions in order to improve diagnosis, etiologic identification, research, treatment, and insurance evaluation. <i>Ann Periodontol 1999;4:98-100.</i></p>","PeriodicalId":79473,"journal":{"name":"Annals of periodontology","volume":"4 1","pages":"98-100"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1902/annals.1999.4.1.98","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21706900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jan Lindhe, Richard Ranney, Ira Lamster, Allan Charles, Chong-Pyoung Chung, Thomas Flemmig, Denis Kinane, Max Listgarten, Harald Löe, Robert Schoor, Gregory Seymour, Martha Somerman
{"title":"Early-Onset Periodontitis","authors":"Maurizio S. Tonetti Dr., Andrea Mombelli","doi":"10.1902/annals.1999.4.1.39","DOIUrl":"10.1902/annals.1999.4.1.39","url":null,"abstract":"<p>In 1993, the 1<sup>st</sup> European Workshop on Periodontology explicitly recognized that there was insufficient knowledge to differentiate truly different forms of periodontal disease from differences in the presentation/severity of the same disease. In spite of recent progress in our understanding of periodontal diseases, the issue is far from having been resolved. Classification of periodontal diseases, therefore, remains based upon the definition of specific clinical syndromes. Early-onset periodontitis (EOP) is one such syndrome and comprises a group of pathological conditions leading to loss of periodontal tissues early in life. The notion that classifies periodontitis syndromes as “early-onset” or “adult” is primarily epidemiological in nature and is based on the observation that periodontitis is rather infrequent in children and young adults. Nevertheless, considerable epidemiological evidence indicates that periodontitis does affect children and young adults to a level of severity that may lead to premature exfoliation of primary and/or permanent teeth. Clinical presentation of periodontitis early in the life of an individual is thought to indicate that the etiologic agents have been able to cause considerable tissue damage over a relatively short period of time. It also implies either infection with highly virulent bacteria and/or a highly susceptible subject. The purpose of this review is to discuss the criteria generally utilized to classify EOP, provide the rationale to designate EOP as a distinct disease entity, and to review the evidence justifying a subclassification into particular subgroups of EOP. <i>Ann Periodontol 1999;4:39-52.</i></p>","PeriodicalId":79473,"journal":{"name":"Annals of periodontology","volume":"4 1","pages":"39-52"},"PeriodicalIF":0.0,"publicationDate":"1999-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1902/annals.1999.4.1.39","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21707028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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