The 2018 AAP/EFP Classification of Periodontal & Peri-implant Diseases
Other Conditions Affecting the Periodontium

In addition to the major categories of gingivitis and periodontitis included in the new classification, it was recognized that there are also a variety of diseases and conditions that can negatively affect the integrity of the periodontium that can result in periodontal disease. These conditions include: (i) periodontal manifestations of systemic diseases and conditions; (ii) mucogingival conditions around natural teeth; (iii) traumatic occlusal forces and occlusal trauma; and (iv) dental and tooth related factors.

As indicated in the periodontitis category, periodontal manifestations of systemic disease are primarily comprised of uncommon systemic diseases such as Papillon-Lefevre syndrome, leukocyte adhesion deficiency, etc. that alter the host response enough to have a major effect on the course of periodontal disease. The primary diagnosis for such periodontal conditions should be classified under the specific systemic disease they fall under on the world Health Organization’s International Classification of Disease (ICD).¹²

Although substantial evidence has accumulated since the 1999 classification in support of the role of periodontal disease in increasing the overall systemic inflammatory burden and thus the individual’s susceptibility to diseases such as coronary artery disease, stroke and Type II diabetes, there is little direct interventional evidence that periodontal therapy improves overall health.¹⁶ The only exception is Type II Diabetes, where demonstrable effects have been shown in reducing a patient’s HbA1c levels by controlling oral inflammation due to periodontitis.¹⁸ Since diabetes is recognized as being one of only two currently identified risk factors for periodontal disease, its presence is captured in the “Grading” of Periodontitis cases. In the new Classification, you will find “periodontal manifestations of systemic diseases and conditions” under the 3rd classification category entitled “Other Conditions Affecting the Periodontium.”