Odontologia

Periodontology 2000, Vol. 34, 2004, 9±21 Printed in Denmark. All rights reserved

Copyright # Blackwell Munksgaard 2004

PERIODONTOLOGY 2000

Periodontal diagnoses and classi®cation of periodontal diseases
Gary C. Armitage What is a periodontal diagnosis?
A periodontal diagnosis is an important label that clinicians place on a patient's periodontal condition or disease. In the currentpractice of periodontics it is primarily derived from information obtained from the patient's medical and dental histories combined with ®ndings from a thorough oral examination. The entire constellation of signs and symptoms associated with the disease or condition is taken into account before arriving at a diagnosis. In some instances additional information provided by laboratory tests is useful inthe overall decision-making process. Under the best of circumstances a periodontal diagnosis is a clinician's best guess as to what condition or disease the patient has. Assignment of a diagnosis carries with it the implication that the clinician has ruled out other possible diseases that the patient might have had. Since diagnostic deductions (i.e. reasonable guesses) are made on the basis ofincomplete knowledge of a patient's actual condition, it is important to realize that the assigned diagnosis might be wrong. Because there is always some uncertainty, experienced clinicians routinely develop a differential diagnosis that is a listing of the possible diagnoses of a patient's condition ranked from most likely to least likely. A differential diagnosis is important because it providesthe clinician with other diagnostic options if the initial diagnosis subsequently proves to be wrong. A carefully considered periodontal diagnosis is of major importance in the subsequent management of a patient's periodontal disease. An accurate diagnosis is often a ®rst step toward development of a welldesigned and appropriate treatment plan that when implemented leads to resolution of thepatient's periodontal infection. An incorrect diagnosis often leads to an ill-conceived treatment approach that ultimately fails to resolve the patient's periodontal problem. The diagnostic label captures, in a few words, a clinician's entire past experience with a disease or condition. It is a summary term that helps guide the clinician toward answering questions that are important to both the dentistand patient:  What is the cause of the disease or condition?  Is referral to another, more experienced, clinician appropriate?  What will happen if the disease or condition is not treated?  What are the treatment options?  What is the best treatment?  What is the expected outcome of treatment (i.e. prognosis)?  What are the anticipated side effects of treatment?  Will the treatment bepainful?  Will the treatment result in esthetic problems?  How long will treatment take?  How much will the treatment cost? Importantly, most patients will want these questions addressed before treatment has started. It should be emphasized that from the perspective of many patients a ``healthy'' periodontium is one that is comfortable and free from functional and esthetic problems. Therefore, itis always a good practice to establish a diagnosis and discuss its implications with the patient prior to starting any therapeutic procedures.

Current classification system ± what are possible periodontal diagnoses?
Plaque-induced periodontal diseases have traditionally been divided into three general categories: health, gingivitis, or periodontitis. In this context,

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thediagnosis of health implies that there is an absence of plaque-induced periodontal disease. Plaque-induced gingivitis is the presence of gingival in¯ammation without loss of connective tissue attachment (7). Plaque-induced periodontitis is the presence of gingival in¯ammation at sites where there has been apical migration of the epithelial attachment onto the root surfaces accompanied by loss of...