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The 2018 AAP/EFP Classification of Periodontal & Peri-implant Diseases

Course Number: 610

Necrotizing Periodontal Diseases

Patients falling under this category present with three typical clinical features: necrosis of the papilla, bleeding; and pain. This condition is associated with an impairment of the host immune response.17 Table 6 illustrates the key features of this classification.

Photo showing necrotizing periodontal diseases

Image Courtesy of Dr. C. Cobb.

Table 6. Classification of Necrotizing Periodontal Diseases.

Patient Category of Necrotizing Periodontal DiseasePatientsPredisposing ConditionsClinical Condition
Severely & Chronically CompromisedAdult- HIV+/AIDS with CD4 counts <200 & detectable viral load
- Other severe systemic conditions that cause immunosuppression
Necrotizing Gingivitis (NG)
Necrotizing Periodontitis (NP)
Necrotizing Stomatitis (NS)
Possible progression
Child- Severe malnourishments
- Extreme living conditions
- Severe viral infections
Temporarily or Moderately CompromisedGingivitis Patient

Periodontitis Patient
- Uncontrolled factors: stress, nutrition, smoking, habits
- Previous NPD (residual craters)
Generalized NG
Possible progression to NP
Local Factors: root proximity, tooth malpositionLocalized NG
Possible progression to NP
Common Predisposing FactorsNG Infrequent Progression
NP infrequent progression

Adapted from Papapanou et al. 2018.17