牙周疾病的分类

*,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,牙周疾病的分类,（,Classification of Periodontal Diseases,）,牙周疾病的分类,分类原则,1.,按病理学分类,2.,按临床表现分类,3.,按病因分类,4.,混合性分类（病因与临床表现，病因与病理）,发展史,随着人类对疾病的病因、病理的进一步认识和深入研究，牙周病的分类不断演变和改进。,Gottlieb,分类,(1928),炎症性,不洁性脓漏,（,Schmutz,pyorrhea,）,由口腔卫生不良所致,变性或萎缩,弥漫性牙槽萎缩（,diffuse alveolar atrophy),由全身或代谢性原因所致,（为青少年牙周炎最早的名称）,牙周脓漏,（,paradental,pyorrhea),Orban,分类,（,1949,）,炎症状态,(inflammatory conditions),牙龈炎,：,急性或慢性；溃疡性或化脓性；局限性或全身性等。,牙周炎：,单纯性（由牙龈炎发展而来）,复杂性（由牙周变性而来,）,变性状态,(degenerative conditions),牙龈变性（,gingivosis,）,：,全身原因,牙周变性（,periodontosis,）,：,主要为全身原因,萎缩状态,(atrophic conditions),牙周萎缩,牙周创伤,(periodontal traumatism),原发性 继发性,牙龈增生,(gingival hyperplasia),感染 内分泌失调 药物性 特发性,Page & Schroeder,分类,(1982),I.,青春前期牙周炎,(,prepubertal,periodontitis, PPP),弥漫型,局限型,II.,青少年牙周炎,(juvenile,periodontitis, JP),III.,快速进展性牙周,(rapidly,progresive,periodontitis, RPP),IV.,成人牙周炎,(adult,periodontitis, AP),牙周疾病分类（,1989,）,世界临床牙周病学专题讨论会,I.,成人牙周炎（,adult,periodontitis,AP,）,II.,早发性牙周炎,(early-onset,periodontitis, EOP),青春前期,(,prepubertal,periodontitis,PPP,),局限型或广泛型,青少年,(juvenile,periodontitis, JP),局限型或广泛型,快速进展性（,rapidly progressive,periodontitis, RPP,）,III.,伴有全身疾病的牙周炎,（,periodontitis associated with systemic diseases,）,IV.,坏死溃疡性牙周炎（,necrotizing ulcerative periodontitis,）,V.,顽固性牙周炎,(refractory periodontitis),（,1989,）分类 的不足：,在疾病范畴上存在着某些重复。,缺乏牙龈病分类。,过分强调了疾病的始发年龄及进展速度。,缺乏分类标准，或分类标准不够明确。,牙周疾病和状况的国际新分类（,1999,）,1999 international workshop for a classification of,periodontal diseases and conditions,.,牙龈病,(g,ingival diseases,) .,慢性牙周炎,(chronic,periodontitis,) .,侵袭性牙周炎,(aggressive periodontitis) .,反映全身疾病的牙周炎,(periodontitis as a manifestation of systemic diseases) .,坏死性牙周病,(necrotizing periodontal diseases) .,牙周脓肿,(abscesses of the periodontium) ,伴牙髓病变的牙周炎,(periodontitis associated with endodontic lesions) .,发育或获得性异常和状况,(developmental or acquired deformities and conditions),牙周疾病和状况的国际新分类（,1999,）,1999 international workshop for a classification of,periodontal diseases and conditions,.,牙龈病,(g,ingival diseases,),.,慢性牙周炎,(c,hronic,periodontitis,),.,侵袭性牙周炎,(aggressive,periodontitis,) .,反映全身疾病的牙周炎,(,periodontitis,as a manifestation of systemic diseases) .,坏死性牙周病,(necrotizing periodontal diseases) .,牙周脓肿,(abscesses of the,periodontium,) ,伴牙髓病变的牙周炎,(,periodontitis,associated with endodontic lesions) .,发育或获得性异常和状况,(developmental or acquired deformities and conditions),.,慢性牙周炎,Chronic Periodontitis,成人牙周炎,adult,periodontitis,取消“,成人牙周炎,adult,periodontitis,”,的名称，因为这种牙周炎发生的年龄范围广，可见于乳牙和恒牙牙列。虽然该病最常见于成人，但也可见于儿童和青少年。“,慢性牙周炎,chronic,periodontitis,”,这一名称较成人牙周炎受年龄的限制少些。,牙周疾病和状况的国际新分类（,1999,）,1999 international workshop for a classification of,periodontal diseases and conditions,.,牙龈病,(g,ingival diseases,),.,慢性牙周炎,(,chronic,periodontitis,),.,侵袭性牙周炎,(,aggressive,periodontitis,),.,反映全身疾病的牙周炎,(,periodontitis,as a manifestation of systemic diseases) .,坏死性牙周病,(necrotizing periodontal diseases) .,牙周脓肿,(abscesses of the,periodontium,) ,伴牙髓病变的牙周炎,(,periodontitis,associated with endodontic lesions) .,发育或获得性异常和状况,(developmental or acquired deformities and conditions),.,侵袭性牙周炎,Aggressive Periodontitis,取消“青少年牙周炎、快速进展型牙周炎,”,的名称， “侵袭性牙周炎,Aggressive Periodontitis”,较少受年龄的限制。牙周炎的分类系统不应基于患者的就诊年龄，而应根据临床、,X,线表现、病史和实验室发现来制定。,“,局限型青少年牙周炎,localized juvenile,periodontitis,”,，,“,局限型侵袭性牙周炎,Localized Aggressive,Periodontitis,”,“,广泛型青少年牙周炎,generalized juvenile,periodontitis,”,。,“,广泛型侵袭性牙周炎,Generalized Aggressive,Periodontitis,”,牙周疾病和状况的国际新分类（,1999,）,1999 international workshop for a classification of,periodontal diseases and conditions,.,牙龈病,(g,ingival diseases,) .,慢性牙周炎,(c,hronic,periodontitis,) .,侵袭性牙周炎,(,aggressive,periodontitis,),.,反映全身疾病的牙周炎,(,periodontitis,as a manifestation of systemic diseases),.,坏死性牙周病,(,necrotizing periodontal diseases,) .,牙周脓肿,(,abscesses of the,periodontium,),伴牙髓病变的牙周炎,(,periodontitis,associated with endodontic lesions),.,发育或获得性异常和状况,(,developmental or acquired deformities and conditions),IV.,反映全身疾病的牙周炎,Periodontitis as a Manifestation of,Systemic Diseases,A.,血液病,associated with hematological,disorders,B.,遗传病,associated with genetic disorders,C.,不明确,Not otherwise specified (NOS),IV.,反映全身疾病的牙周炎,血液病,associated with hematological,disorders,1.,获得性中性白细胞减少症,acquired,neutropenia,2.,白血病,leukemia,3.,其它,other,IV.,反映全身疾病的牙周炎,B.,遗传病,associated with genetic disorders,1.,家族性周期性中性白细胞减少症,familial and,cyclic,neutropenia,2.,Down,综合征,Down syndrome,3.,白细胞粘附缺陷综合征,leukocyte adhesion,deficiency syndrome,4.,掌跖角化牙周破坏综合征,Papillon-Lefevre,syndrome,5.,Chediak,-Higashi syndrome,6.,组织细胞增多综合征,histocytosis,syndrome,牙周疾病和状况的国际新分类（,1999,）,1999 international workshop for a classification of,periodontal diseases and conditions,.,牙龈病,(g,ingival diseases,) .,慢性牙周炎,(c,hronic,periodontitis,) .,侵袭性牙周炎,(,aggressive,periodontitis,) .,反映全身疾病的牙周炎,(,periodontitis,as a manifestation of systemic diseases),.,坏死性牙周病,(necrotizing periodontal diseases),.,牙周脓肿,(abscesses of the,periodontium,) ,伴牙髓病变的牙周炎,(,periodontitis,associated with endodontic lesions),.,发育或获得性异常和状况,(developmental or acquired deformities and conditions),V.,坏死性牙周病,Necrotizing Periodontal Diseases,A.,坏死性溃疡性龈炎,Necrotizing ulcerative gingivitis (NUG):,(,limited to the,gingiva,),B,.,坏死性溃疡性牙周炎,Necrotizing ulcerative,periodontitis,(NUP):,(,including the attachment apparatus),V.,坏死性牙周病,专家们建议将 “坏死性溃疡性龈炎,N,ecrotizing Ulcerative gingivitis (NUG)”,和 “坏死性溃疡性牙周炎,Necrotizing Ulcerative Periodontitis (NUP)”,集中称为“坏死性牙周病,Necrotizing Periodontal Diseases,”,，,因为,NUG,和,NUP,可能是同一种感染的不同阶段,。近来尚无足够的资料可将它们区分为不同的疾病范畴，仅有的区别在于前者感染局限于牙龈，后者累及所有的牙周组织。坏死性牙周病的分类主要基于临床表现,.,坏死性溃疡性牙周炎：,此种感染的特点为牙龈组织、牙周膜和牙槽骨的坏死。常见于患有系统性疾病的人，但并不局限于,HIV,感染、严重营养不良和免疫抑制性疾病。,牙周疾病和状况的国际新分类（,1999,）,1999 international workshop for a classification of,periodontal diseases and conditions,.,牙龈病,(g,ingival diseases,) .,慢性牙周炎,(c,hronic,periodontitis,) .,侵袭性牙周炎,(,aggressive,periodontitis,) .,反映全身疾病的牙周炎,(,periodontitis,as a manifestation of systemic diseases),.,坏死性牙周病,(necrotizing periodontal diseases),.,牙周脓肿,(abscesses of the,periodontium,),伴牙髓病变的牙周炎,(,periodontitis,associated with endodontic lesions),.,发育或获得性异常和状况,(developmental or acquired deformities and conditions),VI.,牙周脓肿,Abscesses of the,Periodontium,A.,牙龈脓肿,Gingival abscess,B.,牙周脓肿,Periodontal abscess,C.,冠周脓肿,Pericoronal,abscess,牙周疾病和状况的国际新分类（,1999,）,1999 international workshop for a classification of,periodontal diseases and conditions,.,牙龈病,(g,ingival diseases,) .,慢性牙周炎,(c,hronic,periodontitis,) .,侵袭性牙周炎,(,aggressive,periodontitis,) .,反映全身疾病的牙周炎,(,periodontitis,as a manifestation of systemic diseases) .,坏死性牙周病,(necrotizing periodontal diseases) .,牙周脓肿,(abscesses of the,periodontium,),伴牙髓病变的牙周炎,(,periodontitis,associated with endodontic lesions),.,发育或获得性异常和状况,(developmental or acquired deformities and conditions),VII,伴牙体牙髓病损的牙周炎,Periodontitis Associated With Endodontic Lesions,牙周牙髓联合病损,combined periodontal-endodontic lesion,牙周疾病和状况的国际新分类（,1999,）,1999 international workshop for a classification of,periodontal diseases and conditions,.,牙龈病,(g,ingival diseases,) .,慢性牙周炎,(c,hronic,periodontitis,) .,侵袭性牙周炎,(,aggressive,periodontitis,) .,反映全身疾病的牙周炎,(,periodontitis,as a manifestation of systemic diseases),.,坏死性牙周病,(,necrotizing periodontal diseases,) .,牙周脓肿,(,abscesses of the,periodontium,),伴牙髓病变的牙周炎,(,periodontitis,associated with endodontic lesions),.,发育或获得性异常和状况,(developmental or acquired deformities and conditions),VIII.,发育或获得性异常和状况,Developmental or Acquired Deformities and Conditions,A,促进菌斑性龈病,/,牙周炎的局部牙因素,localized tooth-related factors that modify or predispose,to plaque-induced gingival diseases/,periodontitis,B.,膜龈异常和状况,mucogingival,deformities and conditions around teeth,C,无牙嵴膜龈异常和状况,Mucogingival,deformities on edentulous ridges,D,咬合创伤,Occlusal,Trauma,VIII.,发育或获得性异常和状况,D,咬合创伤,occlusal,trauma,1.,原发性咬合创伤,P,rimary,occlusal,trauma,2.,继发性咬合创伤,Secondary,occlusal,trauma,D,咬合创伤,occlusal,trauma,咬合创伤,:,合力导致的损伤使附着装置发生组织学改变。,原发性咬合创伤,:,过大的牙合力作用于有健康支持组织的牙齿，造成损伤，发生组织学改变。可发生在：,1,）正常骨高度，,2,）正常附着水平，和,3,）过大牙合力。,2.,继发性咬合创伤：,正常的或过大的牙合力作用于牙周支持组织减少的牙齿而造成损伤，发生组织学改变。可发生在：,1,）骨吸收，,2,）附着丧失，和,3,）“正常”,/,过大牙合力。,国际新分类（,1999,）,1989,分类,牙龈病,牙龈病,慢性牙周炎,成人牙周炎,侵袭性牙周炎,青少年牙周炎,快速进展性牙周炎,反映全身疾病的牙周炎,伴有全身疾病的牙周炎,X,顽固性牙周炎,坏死性牙周病,急性坏死性溃疡性牙周炎,牙周脓肿,牙周脓肿,伴牙髓病变的牙周炎,牙周牙髓联合病变,发育或获得性异常和状况,牙龈退缩,X,根分叉病变,