第三章 牙周病分类

1、第三章 牙周病分类牙周疾病的分类 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（Schmutz pyorrhea） 由口腔卫生不良所致变性或萎缩 弥漫性牙槽萎缩（diffuse alveolar atrophy) 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（paradental pyorrhea) Orban 分类（1949） 炎症状态(inflammatory conditi

2、ons) 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(degenerative conditions) 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(atrophic conditions) 牙周萎缩 牙周创伤(periodontal traumatism) 原发性 继发性 牙龈增生(gingival hyperplasia) 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(prep

3、ubertal periodontitis, PPP) 弥漫型局限型 II. 青少年牙周炎(juvenile periodontitis, JP)III. 快速进展性牙周(rapidly progresive periodontitis, RPP)IV. 成人牙周炎(adult periodontitis, 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（adult periodontitis,AP） II.早发性牙周炎 (early-onset periodontitis, EOP) 青春前期 (prepubertal periodontitis,PPP) 局

4、限型或广泛型 青少年 (juvenile periodontitis, JP) 局限型或广泛型 快速进展性（rapidly progressive periodontitis, RPP） III. 伴有全身疾病的牙周炎 （periodontitis associated with systemic diseases） IV. 坏死溃疡性牙周炎（necrotizing ulcerative periodontitis） V. 顽固性牙周炎 (refractory periodontitis) （1989）分类 的不足：在疾病范畴上存在着某些重复。缺乏牙龈病分类。过分强调了疾病的始发年龄及进展速度

5、。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） 1999 international workshop for a classification of periodontal diseases and conditions . 牙龈病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵袭性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 坏死性牙周病 (

6、necrotizing periodontal diseases) . 牙周脓肿 (abscesses of the periodontium) 伴牙髓病变的牙周炎 (periodontitis associated with endodontic lesions) . 发育或获得性异常和状况 (developmental or acquired deformities and conditions) 牙周疾病和状况的国际新分类（1999） 1999 international workshop for a classification of periodontal diseases and

7、conditions . 牙龈病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵袭性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 坏死性牙周病 (necrotizing periodontal diseases) . 牙周脓肿 (abscesses of the periodontium) 伴牙髓病变的牙周炎 (periodontitis associated with en

8、dodontic lesions) . 发育或获得性异常和状况 (developmental or acquired deformities and conditions). 慢性牙周炎 Chronic Periodontitis成人牙周炎adult periodontitis取消“成人牙周炎adult periodontitis”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chronic periodontitis”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） 1999 intern

9、ational workshop for a classification of periodontal diseases and conditions . 牙龈病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵袭性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 坏死性牙周病 (necrotizing periodontal diseases) . 牙周脓肿 (abscesse

10、s of the periodontium) 伴牙髓病变的牙周炎 (periodontitis associated with endodontic lesions) . 发育或获得性异常和状况 (developmental or acquired deformities and conditions). 侵袭性牙周炎Aggressive Periodontitis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Aggressive Periodontitis”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

11、牙周炎localized juvenile periodontitis” ，“局限型侵袭性牙周炎Localized Aggressive Periodontitis” “广泛型青少年牙周炎generalized juvenile periodontitis”。“广泛型侵袭性牙周炎 Generalized Aggressive Periodontitis” 牙周疾病和状况的国际新分类（1999） 1999 international workshop for a classification of periodontal diseases and conditions . 牙龈病 (gingiv

12、al diseases) . 慢性牙周炎 (chronic periodontitis) . 侵袭性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 坏死性牙周病 (necrotizing periodontal diseases) . 牙周脓肿 (abscesses of the periodontium) 伴牙髓病变的牙周炎 (periodontitis associated with endodontic lesions) . 发育或获

13、得性异常和状况 (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 associated with hematological disorders B. 遗传病 associated with genetic disorders C. 不明确Not otherwise specified (NOS) IV. 反映全身疾病的牙周炎 血液病 associated with hematolog

14、ical disorders 1. 获得性中性白细胞减少症 acquired neutropenia 2. 白血病 leukemia 3. 其它 other IV. 反映全身疾病的牙周炎 B. 遗传病 associated with genetic disorders 1. 家族性周期性中性白细胞减少症 familial and cyclic neutropenia 2. Down综合征 Down syndrome 3. 白细胞粘附缺陷综合征 leukocyte adhesion deficiency syndrome 4. 掌跖角化牙周破坏综合征 Papillon-Lefevre syndr

15、ome 5. Chediak-Higashi syndrome 6. 组织细胞增多综合征 histocytosis syndrome 牙周疾病和状况的国际新分类（1999） 1999 international workshop for a classification of periodontal diseases and conditions . 牙龈病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵袭性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as

16、a manifestation of systemic diseases) . 坏死性牙周病 (necrotizing periodontal diseases) . 牙周脓肿 (abscesses of the periodontium) 伴牙髓病变的牙周炎 (periodontitis associated with endodontic lesions) . 发育或获得性异常和状况 (developmental or acquired deformities and conditions) V. 坏死性牙周病 Necrotizing Periodontal Diseases A. 坏死性

17、溃疡性龈炎 Necrotizing ulcerative gingivitis (NUG): (limited to the gingiva) B. 坏死性溃疡性牙周炎 Necrotizing ulcerative periodontitis (NUP): (including the attachment apparatus) V. 坏死性牙周病 专家们建议将 “坏死性溃疡性龈炎 Necrotizing Ulcerative gingivitis (NUG)” 和 “坏死性溃疡性牙周炎Necrotizing Ulcerative Periodontitis (NUP)”集中称为“坏死性牙周病

18、 Necrotizing Periodontal Diseases”，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） 1999 international workshop for a classification of periodontal diseases a

19、nd conditions . 牙龈病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵袭性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 坏死性牙周病 (necrotizing periodontal diseases) . 牙周脓肿 (abscesses of the periodontium) 伴牙髓病变的牙周炎 (periodontitis associated with

20、 endodontic lesions) . 发育或获得性异常和状况 (developmental or acquired deformities and conditions) VI. 牙周脓肿 Abscesses of the Periodontium A. 牙龈脓肿 Gingival abscess B. 牙周脓肿 Periodontal abscess C. 冠周脓肿 Pericoronal abscess 牙周疾病和状况的国际新分类（1999） 1999 international workshop for a classification of periodontal diseas

21、es and conditions . 牙龈病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵袭性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 坏死性牙周病 (necrotizing periodontal diseases) . 牙周脓肿 (abscesses of the periodontium) 伴牙髓病变的牙周炎 (periodontitis associated

22、with endodontic lesions) . 发育或获得性异常和状况 (developmental or acquired deformities and conditions)VII伴牙体牙髓病损的牙周炎 Periodontitis Associated With Endodontic Lesions 牙周牙髓联合病损 combined periodontal-endodontic lesion 牙周疾病和状况的国际新分类（1999） 1999 international workshop for a classification of periodontal diseases an

23、d conditions . 牙龈病 (gingival diseases) . 慢性牙周炎 (chronic periodontitis) . 侵袭性牙周炎 (aggressive periodontitis) . 反映全身疾病的牙周炎 (periodontitis as a manifestation of systemic diseases) . 坏死性牙周病 (necrotizing periodontal diseases) . 牙周脓肿 (abscesses of the periodontium) 伴牙髓病变的牙周炎 (periodontitis associated with endodontic lesions) . 发育或获得性异常和状况 (developmental or acquired deformities and conditions) VIII. 发育或获得性异常和状况 Developmental or Acquired D