牙周疾病的分类

牙周疾病的分类（ClassificationofPeriodontalDiseases）2020/2/29牙周疾病的分类分类原则1.按病理学分类2.按临床表现分类3.按病因分类4.混合性分类（病因与临床表现，病因与病理）发展史•随着人类对疾病的病因、病理的进一步认识和深入研究，牙周病的分类不断演变和改进。Gottlieb分类(1928)炎症性不洁性脓漏（Schmutzpyorrhea）由口腔卫生不良所致变性或萎缩弥漫性牙槽萎缩（diffusealveolaratrophy)由全身或代谢性原因所致（为青少年牙周炎最早的名称）牙周脓漏（paradentalpyorrhea)Orban分类（1949）炎症状态(inflammatoryconditions)牙龈炎：急性或慢性；溃疡性或化脓性；局限性或全身性等。牙周炎：单纯性（由牙龈炎发展而来）复杂性（由牙周变性而来）变性状态(degenerativeconditions)牙龈变性（gingivosis）：全身原因牙周变性（periodontosis）：主要为全身原因萎缩状态(atrophicconditions)牙周萎缩牙周创伤(periodontaltraumatism)原发性继发性牙龈增生(gingivalhyperplasia)感染内分泌失调药物性特发性Page&Schroeder分类(1982)I.青春前期牙周炎(prepubertalperiodontitis,PPP)•弥漫型•局限型II.青少年牙周炎(juvenileperiodontitis,JP)III.快速进展性牙周(rapidlyprogresiveperiodontitis,RPP)IV.成人牙周炎(adultperiodontitis,AP)牙周疾病分类（1989）世界临床牙周病学专题讨论会I.成人牙周炎（adultperiodontitis,AP）II.早发性牙周炎(early-onsetperiodontitis,EOP)青春前期(prepubertalperiodontitis,PPP)局限型或广泛型青少年(juvenileperiodontitis,JP)局限型或广泛型快速进展性（rapidlyprogressiveperiodontitis,RPP）III.伴有全身疾病的牙周炎（periodontitisassociatedwithsystemicdiseases）IV.坏死溃疡性牙周炎（necrotizingulcerativeperiodontitis）V.顽固性牙周炎(refractoryperiodontitis)（1989）分类的不足：①在疾病范畴上存在着某些重复。②缺乏牙龈病分类。③过分强调了疾病的始发年龄及进展速度。④缺乏分类标准，或分类标准不够明确。牙周疾病和状况的国际新分类（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditionsⅠ.牙龈病(gingivaldiseases)Ⅱ.慢性牙周炎(chronicperiodontitis)Ⅲ.侵袭性牙周炎(aggressiveperiodontitis)Ⅳ.反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases)Ⅴ.坏死性牙周病(necrotizingperiodontaldiseases)Ⅵ.牙周脓肿(abscessesoftheperiodontium)Ⅶ．伴牙髓病变的牙周炎(periodontitisassociatedwithendodonticlesions)Ⅷ.发育或获得性异常和状况(developmentaloracquireddeformitiesandconditions)牙周疾病和状况的国际新分类（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditionsⅠ.牙龈病(gingivaldiseases)Ⅱ.慢性牙周炎(chronicperiodontitis)Ⅲ.侵袭性牙周炎(aggressiveperiodontitis)Ⅳ.反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases)Ⅴ.坏死性牙周病(necrotizingperiodontaldiseases)Ⅵ.牙周脓肿(abscessesoftheperiodontium)Ⅶ．伴牙髓病变的牙周炎(periodontitisassociatedwithendodonticlesions)Ⅷ.发育或获得性异常和状况(developmentaloracquireddeformitiesandconditions)Ⅱ.慢性牙周炎ChronicPeriodontitis成人牙周炎adultperiodontitis取消“成人牙周炎adultperiodontitis”的名称，因为这种牙周炎发生的年龄范围广，可见于乳牙和恒牙牙列。虽然该病最常见于成人，但也可见于儿童和青少年。“慢性牙周炎chronicperiodontitis”这一名称较成人牙周炎受年龄的限制少些。牙周疾病和状况的国际新分类（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditionsⅠ.牙龈病(gingivaldiseases)Ⅱ.慢性牙周炎(chronicperiodontitis)Ⅲ.侵袭性牙周炎(aggressiveperiodontitis)Ⅳ.反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases)Ⅴ.坏死性牙周病(necrotizingperiodontaldiseases)Ⅵ.牙周脓肿(abscessesoftheperiodontium)Ⅶ．伴牙髓病变的牙周炎(periodontitisassociatedwithendodonticlesions)Ⅷ.发育或获得性异常和状况(developmentaloracquireddeformitiesandconditions)Ⅲ.侵袭性牙周炎AggressivePeriodontitis取消“青少年牙周炎、快速进展型牙周炎”的名称，“侵袭性牙周炎AggressivePeriodontitis”较少受年龄的限制。牙周炎的分类系统不应基于患者的就诊年龄，而应根据临床、X线表现、病史和实验室发现来制定。“局限型青少年牙周炎localizedjuvenileperiodontitis”，“局限型侵袭性牙周炎LocalizedAggressivePeriodontitis”“广泛型青少年牙周炎generalizedjuvenileperiodontitis”。“广泛型侵袭性牙周炎GeneralizedAggressivePeriodontitis”牙周疾病和状况的国际新分类（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditionsⅠ.牙龈病(gingivaldiseases)Ⅱ.慢性牙周炎(chronicperiodontitis)Ⅲ.侵袭性牙周炎(aggressiveperiodontitis)Ⅳ.反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases)Ⅴ.坏死性牙周病(necrotizingperiodontaldiseases)Ⅵ.牙周脓肿(abscessesoftheperiodontium)Ⅶ．伴牙髓病变的牙周炎(periodontitisassociatedwithendodonticlesions)Ⅷ.发育或获得性异常和状况(developmentaloracquireddeformitiesandconditions)IV.反映全身疾病的牙周炎PeriodontitisasaManifestationofSystemicDiseasesA.血液病associatedwithhematologicaldisordersB.遗传病associatedwithgeneticdisordersC.不明确Nototherwisespecified(NOS)IV.反映全身疾病的牙周炎A.血液病associatedwithhematologicaldisorders1.获得性中性白细胞减少症acquiredneutropenia2.白血病leukemia3.其它otherIV.反映全身疾病的牙周炎B.遗传病associatedwithgeneticdisorders1.家族性周期性中性白细胞减少症familialandcyclicneutropenia2.Down综合征Downsyndrome3.白细胞粘附缺陷综合征leukocyteadhesiondeficiencysyndrome4.掌跖角化牙周破坏综合征Papillon-Lefevresyndrome5.Chediak-Higashisyndrome6.组织细胞增多综合征histocytosissyndrome牙周疾病和状况的国际新分类（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditionsⅠ.牙龈病(gingivaldiseases)Ⅱ.慢性牙周炎(chronicperiodontitis)Ⅲ.侵袭性牙周炎(aggressiveperiodontitis)Ⅳ.反映全身疾病的牙周炎(periodontitisasamanifestationofsystemicdiseases)Ⅴ.坏死性牙周病(necrotizingperiodontaldiseases)Ⅵ.牙周脓肿(abscessesoftheperiodontium)Ⅶ．伴牙髓病变的牙周炎(periodontitisassociatedwithendodonticlesions)Ⅷ.发育或获得性异常和状况(developmentaloracquireddeformitiesandconditions)V.坏死性牙周病NecrotizingPeriodontalDiseasesA.坏死性溃疡性龈炎Necrotizingulcerativegingivitis(NUG):(limitedtothegingiva)B.坏死性溃疡性牙周炎Necrotizingulcerativeperiodontitis(NUP):(includingtheattachmentapparatus)V.坏死性牙周病专家们建议将“坏死性溃疡性龈炎NecrotizingUlcerativegingivitis(NUG)”和“坏死性溃疡性牙周炎NecrotizingUlcerativePeriodontitis(NUP)”集中称为“坏死性牙周病NecrotizingPeriodontalDiseases”，因为NUG和NUP可能是同一种感染的不同阶段。近来尚无足够的资料可将它们区分为不同的疾病范畴，仅有的区别在于前者感染局限于牙龈，后者累及所有的牙周组织。坏死性牙周病的分类主要基于临床表现.坏死性溃疡性牙周炎：此种感染的特点为牙龈组织、牙周膜和牙槽骨的坏死。常见于患有系统性疾病的人，但并不局限于HIV感染、严重营养不良和免疫抑制性疾病。牙周疾病和状况的国际新分类（1999）1999internationalworkshopforaclassificationofperiodontaldiseasesandconditionsⅠ.牙龈病(gingivaldiseases)Ⅱ.慢性牙周炎(ch