《牙周病學(xué)》課件7-牙周疾病分類-09

1、 2022/7/28牙周疾病的分類Classification of Periodontal Diseases3牙周疾病的分類發(fā)展史隨著人類對(duì)疾病的病因、發(fā)病機(jī)制等的進(jìn)一步認(rèn)識(shí)和深入研究牙周病的分類不斷演變和改進(jìn)分類原則1.按病理學(xué)分類2.按病因分類3.按臨床表現(xiàn)分類4.混合性分類（病因與臨床表現(xiàn)，病因與病理） Gottlieb分類 (1928)炎癥性 不潔性膿漏（Schmutz pyorrhea） 由口腔衛(wèi)生不良所致變性或萎縮 彌漫性牙槽萎縮（diffuse alveolar atrophy) 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 （paradental pyorrh

2、ea) Orban 分類（1949） 炎癥狀態(tài)(inflammatory conditions) 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：?jiǎn)渭冃裕ㄓ裳例l炎發(fā)展而來(lái)） 復(fù)雜性（由牙周變性而來(lái)） 變性狀態(tài)(degenerative conditions) 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)(atrophic conditions) 牙周萎縮 牙周創(chuàng)傷(periodontal traumatism) 原發(fā)性 繼發(fā)性 牙齦增生(gingival hyperplasia) 感染 內(nèi)分泌失調(diào) 藥物性 特發(fā)性

3、 Page & Schroeder 分類 (1982) I. 青春前期牙周炎(prepubertal periodontitis, PPP) 彌漫型局限型 II. 青少年牙周炎(juvenile periodontitis, JP)III. 快速進(jìn)展性牙周炎(rapidly progresive periodontitis, RPP)IV. 成人牙周炎(adult periodontitis, AP) 牙周疾病分類（1989） 世界臨床牙周病學(xué)專題討論會(huì) I. 成人牙周炎（adult periodontitis, AP） II.早發(fā)性牙周炎 (early-onset periodontitis

4、, EOP) 青春前期 (prepubertal periodontitis,PPP) 局限型或廣泛型 青少年 (juvenile periodontitis, JP) 局限型或廣泛型 快速進(jìn)展性（rapidly progressive periodontitis, RPP） III. 伴有全身疾病的牙周炎 （periodontitis associated with systemic diseases） IV. 壞死潰瘍性牙周炎（necrotizing ulcerative periodontitis） V. 頑固性牙周炎 (refractory periodontitis)歐洲牙周病學(xué)研討

5、會(huì)（1993）(European Workshop on Periodontology)成人牙周炎（adult periodontitis）早發(fā)性牙周炎（early-onset periodontitis）壞死性牙周炎（necrotizing periodontitis） （1989, 1993）分類的不足：缺乏牙齦病分類過(guò)分強(qiáng)調(diào)了疾病的始發(fā)年齡及進(jìn)展速度有些類型的標(biāo)準(zhǔn)和不夠明確在疾病范疇上有某些重復(fù) 牙周疾病和狀況的國(guó)際新分類（1999） 1999 international workshop for a classification of periodontal diseases and

6、conditions . 牙齦病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵襲性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 壞死性牙周病 (necrotizing periodontal diseases) . 牙周組織膿腫 (abscesses of the periodontium) 伴牙髓病變的牙周炎 (periodontitis associated with

7、endodontic lesions) . 發(fā)育或獲得性異常和狀況 (developmental or acquired deformities and conditions) 牙周疾病和狀況的國(guó)際新分類（1999） 1999 international workshop for a classification of periodontal diseases and conditions . 牙齦病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵襲性牙周炎 (aggressive periodontitis) . 反映全身疾病的

8、牙周炎 (periodontitis as a manifestation of systemic diseases) . 壞死性牙周病 (necrotizing periodontal diseases) . 牙周組織膿腫 (abscesses of the periodontium) 伴牙髓病變的牙周炎 (periodontitis associated with endodontic lesions) . 發(fā)育或獲得性異常和狀況 (developmental or acquired deformities and conditions). 慢性牙周炎 Chronic Periodonti

9、tis取消“成人牙周炎adult periodontitis”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?！奥匝乐苎譪hronic periodontitis”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(guó)際新分類（1999） 1999 international workshop for a classification of periodontal diseases and conditions . 牙齦病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) .

10、 侵襲性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 壞死性牙周病 (necrotizing periodontal diseases) . 牙周組織膿腫 (abscesses of the periodontium) 伴牙髓病變的牙周炎 (periodontitis associated with endodontic lesions) . 發(fā)育或獲得性異常和狀況 (developmental or acquired deformiti

11、es and conditions). 侵襲性牙周炎Aggressive Periodontitis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Aggressive Periodontitis”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(lái)制定。 局限型青少年牙周炎localized juvenile periodontitis 廣泛型青少年牙周炎generalized juvenile periodontitis 局限型侵襲性牙周炎localized aggressive periodontitis 廣泛型侵襲性牙周炎 g

12、eneralized aggressive periodontitis 牙周疾病和狀況的國(guó)際新分類（1999） 1999 international workshop for a classification of periodontal diseases and conditions . 牙齦病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵襲性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic dis

13、eases) . 壞死性牙周病 (necrotizing periodontal diseases) . 牙周組織膿腫 (abscesses of the periodontium) 伴牙髓病變的牙周炎 (periodontitis associated with endodontic lesions) . 發(fā)育或獲得性異常和狀況 (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 as

14、sociated with hematological disorders B. 遺傳病 associated with genetic disorders C. 不明確Not otherwise specified (NOS) IV. 反映全身疾病的牙周炎 血液病 associated with hematological disorders 1. 獲得性中性白細(xì)胞減少癥 acquired neutropenia 2. 白血病 leukemia 3. 其它 other IV. 反映全身疾病的牙周炎 B. 遺傳病 associated with genetic disorders 1. 家族性

15、周期性中性白細(xì)胞減少癥 familial and cyclic neutropenia 2. Down綜合征 Down syndrome 3. 白細(xì)胞粘附缺陷綜合征 leukocyte adhesion deficiency syndrome 4. 掌跖角化牙周破壞綜合征 Papillon-Lefevre syndrome 5. Chediak-Higashi syndrome 6. 組織細(xì)胞增多綜合征 histocytosis syndrome 牙周疾病和狀況的國(guó)際新分類（1999） 1999 international workshop for a classification of pe

16、riodontal diseases and conditions . 牙齦病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵襲性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 壞死性牙周病 (necrotizing periodontal diseases) . 牙周組織膿腫 (abscesses of the periodontium) 伴牙髓病變的牙周炎 (periodo

17、ntitis associated with endodontic lesions) . 發(fā)育或獲得性異常和狀況 (developmental or acquired deformities and conditions) V. 壞死性牙周病 Necrotizing Periodontal Diseases A. 壞死性潰瘍性齦炎 Necrotizing ulcerative gingivitis (NUG) B. 壞死性潰瘍性牙周炎 Necrotizing ulcerative periodontitis (NUP) 牙周疾病和狀況的國(guó)際新分類（1999） 1999 internationa

18、l workshop for a classification of periodontal diseases and conditions . 牙齦病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵襲性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 壞死性牙周病 (necrotizing periodontal diseases) . 牙周組織膿腫 (abscesses of

19、 the periodontium) 伴牙髓病變的牙周炎 (periodontitis associated with endodontic lesions) . 發(fā)育或獲得性異常和狀況 (developmental or acquired deformities and conditions) VI. 牙周組織膿腫 Abscesses of the Periodontium A. 牙齦膿腫 Gingival abscess B. 牙周膿腫 Periodontal abscess C. 冠周膿腫 Pericoronal abscess 牙周疾病和狀況的國(guó)際新分類（1999） 1999 inte

20、rnational workshop for a classification of periodontal diseases and conditions . 牙齦病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵襲性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 壞死性牙周病 (necrotizing periodontal diseases) . 牙周膿腫 (absces

21、ses of the periodontium) 伴牙髓病變的牙周炎 (periodontitis associated with endodontic lesions) . 發(fā)育或獲得性異常和狀況 (developmental or acquired deformities and conditions)VII伴牙體牙髓病損的牙周炎 Periodontitis Associated With Endodontic Lesions 牙周牙髓聯(lián)合病損 combined periodontal-endodontic lesion 牙周疾病和狀況的國(guó)際新分類（1999） 1999 international workshop for a classification of periodontal diseases and conditions . 牙齦病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵襲性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 壞死性牙周病 (necrotizing periodontal diseases) . 牙周