牙周疾病的分類

.,牙周疾病的分類（ClassificationofPeriodontalDiseases）,.,牙周疾病的分類,分類原則1.按病理學(xué)分類2.按臨床表現(xiàn)分類3.按病因分類4.混合性分類（病因與臨床表現(xiàn)，病因與病理）發(fā)展史隨著人類對疾病的病因、病理的進(jìn)一步認(rèn)識和深入研究，牙周病的分類不斷演變和改進(jìn)。,.,Gottlieb分類(1928)炎癥性不潔性膿漏（Schmutzpyorrhea）由口腔衛(wèi)生不良所致變性或萎縮彌漫性牙槽萎縮（diffusealveolaratrophy)由全身或代謝性原因所致（為青少年牙周炎最早的名稱）牙周膿漏（paradentalpyorrhea),.,Orban分類（1949）炎癥狀態(tài)(inflammatoryconditions)牙齦炎：急性或慢性；潰瘍性或化膿性；局限性或全身性等。牙周炎：單純性（由牙齦炎發(fā)展而來）復(fù)雜性（由牙周變性而來）變性狀態(tài)(degenerativeconditions)牙齦變性（gingivosis）：全身原因牙周變性（periodontosis）：主要為全身原因萎縮狀態(tài)(atrophicconditions)牙周萎縮牙周創(chuàng)傷(periodontaltraumatism)原發(fā)性繼發(fā)性牙齦增生(gingivalhyperplasia)感染內(nèi)分泌失調(diào)藥物性特發(fā)性,.,Page&Schroeder分類(1982)I.青春前期牙周炎(prepubertalperiodontitis,PPP)彌漫型局限型II.青少年牙周炎(juvenileperiodontitis,JP)III.快速進(jìn)展性牙周(rapidlyprogresiveperiodontitis,RPP)IV.成人牙周炎(adultperiodontitis,AP),.,牙周疾病分類（1989）世界臨床牙周病學(xué)專題討論會I.成人牙周炎（adultperiodontitis,AP）II.早發(fā)性牙周炎(early-onsetperiodontitis,EOP)青春前期(prepubertalperiodontitis,PPP)局限型或廣泛型青少年(juvenileperiodontitis,JP)局限型或廣泛型快速進(jìn)展性（rapidlyprogressiveperiodontitis,RPP）III.伴有全身疾病的牙周炎（periodontitisassociatedwithsystemicdiseases）IV.壞死潰瘍性牙周炎（necrotizingulcerativeperiodontitis）V.頑固性牙周炎(refractoryperiodontitis),.,（1989）分類的不足：在疾病范疇上存在著某些重復(fù)。缺乏牙齦病分類。過分強(qiáng)調(diào)了疾病的始發(fā)年齡及進(jìn)展速度。缺乏分類標(biāo)準(zhǔn)，或分類標(biāo)準(zhǔn)不夠明確。,.,牙周疾病和狀況的國際新分類（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditions.牙齦病(gingivaldiseases).慢性牙周炎(chronicperiodontitis).侵襲性牙周炎(aggressiveperiodontitis).反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases).壞死性牙周病(necrotizingperiodontaldiseases).牙周膿腫(abscessesoftheperiodontium)伴牙髓病變的牙周炎(periodontitisassociatedwithendodonticlesions).發(fā)育或獲得性異常和狀況(developmentaloracquireddeformitiesandconditions),.,牙周疾病和狀況的國際新分類（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditions.牙齦病(gingivaldiseases).慢性牙周炎(chronicperiodontitis).侵襲性牙周炎(aggressiveperiodontitis).反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases).壞死性牙周病(necrotizingperiodontaldiseases).牙周膿腫(abscessesoftheperiodontium)伴牙髓病變的牙周炎(periodontitisassociatedwithendodonticlesions).發(fā)育或獲得性異常和狀況(developmentaloracquireddeformitiesandconditions),.,.慢性牙周炎ChronicPeriodontitis成人牙周炎adultperiodontitis,取消“成人牙周炎adultperiodontitis”的名稱，因?yàn)檫@種牙周炎發(fā)生的年齡范圍廣，可見于乳牙和恒牙牙列。雖然該病最常見于成人，但也可見于兒童和青少年。“慢性牙周炎chronicperiodontitis”這一名稱較成人牙周炎受年齡的限制少些。,.,牙周疾病和狀況的國際新分類（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditions.牙齦病(gingivaldiseases).慢性牙周炎(chronicperiodontitis).侵襲性牙周炎(aggressiveperiodontitis).反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases).壞死性牙周病(necrotizingperiodontaldiseases).牙周膿腫(abscessesoftheperiodontium)伴牙髓病變的牙周炎(periodontitisassociatedwithendodonticlesions).發(fā)育或獲得性異常和狀況(developmentaloracquireddeformitiesandconditions),.,.侵襲性牙周炎AggressivePeriodontitis,取消“青少年牙周炎、快速進(jìn)展型牙周炎”的名稱，“侵襲性牙周炎AggressivePeriodontitis”較少受年齡的限制。牙周炎的分類系統(tǒng)不應(yīng)基于患者的就診年齡，而應(yīng)根據(jù)臨床、X線表現(xiàn)、病史和實(shí)驗(yàn)室發(fā)現(xiàn)來制定。,.,“局限型青少年牙周炎localizedjuvenileperiodontitis”，“局限型侵襲性牙周炎LocalizedAggressivePeriodontitis”“廣泛型青少年牙周炎generalizedjuvenileperiodontitis”?！皬V泛型侵襲性牙周炎GeneralizedAggressivePeriodontitis”,.,牙周疾病和狀況的國際新分類（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditions.牙齦病(gingivaldiseases).慢性牙周炎(chronicperiodontitis).侵襲性牙周炎(aggressiveperiodontitis).反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases).壞死性牙周病(necrotizingperiodontaldiseases).牙周膿腫(abscessesoftheperiodontium)伴牙髓病變的牙周炎(periodontitisassociatedwithendodonticlesions).發(fā)育或獲得性異常和狀況(developmentaloracquireddeformitiesandconditions),.,IV.反映全身疾病的牙周炎PeriodontitisasaManifestationofSystemicDiseasesA.血液病associatedwithhematologicaldisordersB.遺傳病associatedwithgeneticdisordersC.不明確Nototherwisespecified(NOS),.,IV.反映全身疾病的牙周炎血液病associatedwithhematologicaldisorders1.獲得性中性白細(xì)胞減少癥acquiredneutropenia2.白血病leukemia3.其它other,.,IV.反映全身疾病的牙周炎B.遺傳病associatedwithgeneticdisorders1.家族性周期性中性白細(xì)胞減少癥familialandcyclicneutropenia2.Down綜合征Downsyndrome3.白細(xì)胞粘附缺陷綜合征leukocyteadhesiondeficiencysyndrome4.掌跖角化牙周破壞綜合征Papillon-Lefevresyndrome5.Chediak-Higashisyndrome6.組織細(xì)胞增多綜合征histocytosissyndrome,.,牙周疾病和狀況的國際新分類（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditions.牙齦病(gingivaldiseases).慢性牙周炎(chronicperiodontitis).侵襲性牙周炎(aggressiveperiodontitis).反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases).壞死性牙周病(necrotizingperiodontaldiseases).牙周膿腫(abscessesoftheperiodontium)伴牙髓病變的牙周炎(periodontitisassociatedwithendodonticlesions).發(fā)育或獲得性異常和狀況(developmentaloracquireddeformitiesandconditions),.,V.壞死性牙周病NecrotizingPeriodontalDiseasesA.壞死性潰瘍性齦炎Necrotizingulcerativegingivitis(NUG):(limitedtothegingiva)B.壞死性潰瘍性牙周炎Necrotizingulcerativeperiodontitis(NUP):(includingtheattachmentapparatus),.,V.壞死性牙周病專家們建議將“壞死性潰瘍性齦炎NecrotizingUlcerativegingivitis(NUG)”和“壞死性潰瘍性牙周炎NecrotizingUlcerativePeriodontitis(NUP)”集中稱為“壞死性牙周病NecrotizingPeriodontalDiseases”，因?yàn)镹UG和NUP可能是同一種感染的不同階段。近來尚無足夠的資料可將它們區(qū)分為不同的疾病范疇，僅有的區(qū)別在于前者感染局限于牙齦，后者累及所有的牙周組織。壞死性牙周病的分類主要基于臨床表現(xiàn).,.,壞死性潰瘍性牙周炎：此種感染的特點(diǎn)為牙齦組織、牙周膜和牙槽骨的壞死。常見于患有系統(tǒng)性疾病的人，但并不局限于HIV感染、嚴(yán)重營養(yǎng)不良和免疫抑制性疾病。,.,牙周疾病和狀況的國際新分類（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditions.牙齦病(gingivaldiseases).慢性牙周炎(chronicperiodontitis).侵襲性牙周炎(aggressiveperiodontitis).反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases).壞死性牙周病(necrotizingperiodontaldiseases).牙周膿腫(abscessesoftheperiodontium)伴牙髓病變的牙周炎(periodontitisassociatedwithendodonticlesions).發(fā)育或獲得性異常和狀況(developmentaloracquireddeformitiesandconditions),.,VI.牙周膿腫AbscessesofthePeriodontiumA.牙齦膿腫GingivalabscessB.牙周膿腫PeriodontalabscessC.冠周膿腫Pericoronalabscess,.,牙周疾病和狀況的國際新分類（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditions.牙齦病(gingivaldiseases).慢性牙周炎(chronicperiodontitis).侵襲性牙周炎(aggressiveperiodontitis).反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases).壞死性牙周病(necrotizingperiodontaldiseases).牙周膿腫(abscessesoftheperiodontium)伴牙髓病變的牙周炎(periodontitisassociatedwithendodonticlesions).發(fā)育或獲得性異常和狀況(developmentaloracquireddeformitiesandconditions),.,VII伴牙體牙髓病損的牙周炎PeriodontitisAssociatedWithEndodonticLesions牙周牙髓聯(lián)合病損combinedperiodontal-endodonticlesion,.,牙周疾病和狀況的國際新分類（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditions.牙齦病(gingivaldiseases).慢性牙周炎(chronicperiodontitis).侵襲性牙周炎(aggressiveperiodontitis).反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases).壞死性牙周病(necrotizingperiodontaldiseases).牙周膿腫(abscessesoftheperiodontium)伴牙髓病變的牙周炎(periodontitisassociatedwithendodonticlesions).發(fā)育或獲得性異常和狀況(developmentaloracquireddeformitiesandconditions),.,VIII.發(fā)育或獲得性異常和狀況DevelopmentalorAcquired