1、医学课件园 ,牙周疾病的分类（Classification of Periodontal Diseases）,2018/10/29,医学课件园 ,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。,医学课件园 ,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
2、周炎最早的名称） 牙周脓漏（paradental pyorrhea),医学课件园 ,Orban 分类（1949）炎症状态(inflammatory conditions)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
3、 hyperplasia) 感染 内分泌失调 药物性 特发性,医学课件园 ,Page & Schroeder 分类 (1982)I. 青春前期牙周炎(prepubertal 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),医学课件园 ,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
4、,AP）II.早发性牙周炎 (early-onset periodontitis, EOP)青春前期 (prepubertal periodontitis,PPP) 局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
5、(refractory periodontitis),医学课件园 ,（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。 缺乏分类标准，或分类标准不够明确。,医学课件园 ,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 (aggressi
6、ve 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),
7、医学课件园 ,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 (necrotizing
8、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),医学课件园 ,. 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
9、，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。,医学课件园 ,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
10、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),医学课件园 ,. 侵袭性牙周炎Aggressive
11、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。,医学课件园 ,“局限型青少年牙周炎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 Aggres
12、sive Periodontitis”,医学课件园 ,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) .
13、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),医学课件园 ,IV. 反映全身疾病的牙周炎 Periodontitis as a Manifestation of Systemic DiseasesA. 血液病 associa
14、ted with hematological disordersB. 遗传病 associated with genetic disordersC. 不明确Not otherwise specified (NOS),医学课件园 ,IV. 反映全身疾病的牙周炎 血液病 associated with hematological disorders1. 获得性中性白细胞减少症 acquired neutropenia 2. 白血病 leukemia 3. 其它 other,医学课件园 ,IV. 反映全身疾病的牙周炎 B. 遗传病 associated with genetic disorders1
15、. 家族性周期性中性白细胞减少症 familial and cyclic neutropenia2. Down综合征 Down syndrome3. 白细胞粘附缺陷综合征 leukocyte adhesiondeficiency syndrome4. 掌跖角化牙周破坏综合征 Papillon-Lefevresyndrome5. Chediak-Higashi syndrome 6. 组织细胞增多综合征 histocytosis syndrome,医学课件园 ,牙周疾病和状况的国际新分类（1999） 1999 international workshop for a classification
16、 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 (abscesses of the periodontium) 伴牙髓病变的牙周炎 (per
17、iodontitis associated with endodontic lesions) . 发育或获得性异常和状况 (developmental or acquired deformities and conditions),医学课件园 ,V. 坏死性牙周病Necrotizing Periodontal DiseasesA. 坏死性溃疡性龈炎 Necrotizing ulcerative gingivitis (NUG):(limited to the gingiva)B. 坏死性溃疡性牙周炎Necrotizing ulcerative periodontitis (NUP):(incl
18、uding the attachment apparatus),医学课件园 ,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 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
19、现.,医学课件园 ,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。,医学课件园 ,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
20、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),医学课件园 ,VI. 牙周脓肿 Abscesse
21、s of the PeriodontiumA. 牙龈脓肿 Gingival abscessB. 牙周脓肿 Periodontal abscessC. 冠周脓肿 Pericoronal abscess,医学课件园 ,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 period
22、ontitis) . 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),医学课件园 ,VI
23、I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,医学课件园 ,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 (aggress
24、ive 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)
25、,医学课件园 ,VIII. 发育或获得性异常和状况 Developmental or Acquired Deformities and ConditionsA促进菌斑性龈病/牙周炎的局部牙因素localized tooth-related factors that modify or predisposeto plaque-induced gingival diseases/ periodontitisB. 膜龈异常和状况 mucogingival deformities and conditions around teeth C无牙嵴膜龈异常和状况 Mucogingival deformit
26、ies on edentulous ridgesD咬合创伤 Occlusal Trauma,医学课件园 ,VIII. 发育或获得性异常和状况 D咬合创伤 occlusal trauma1. 原发性咬合创伤 Primary occlusal trauma 2. 继发性咬合创伤 Secondary occlusal trauma,医学课件园 ,D咬合创伤 occlusal trauma 咬合创伤:合力导致的损伤使附着装置发生组织学改变。 原发性咬合创伤:过大的牙合力作用于有健康支持组织的牙齿，造成损伤，发生组织学改变。可发生在：1）正常骨高度，2）正常附着水平，和3）过大牙合力。 2. 继发性咬合创伤：正常的或过大的牙合力作用于牙周支持组织减少的牙齿而造成损伤，发生组织学改变。可发生在：1）骨吸收，2）附着丧失，和3）“正常”/过大牙合力。,医学课件园 ,国际新分类（1999） 1989分类牙龈病 牙龈病 慢性牙周炎 成人牙周炎 侵袭性牙周炎 青少年牙周炎 快速进展性牙周炎反映全身疾病的牙周炎 伴有全身疾病的牙周炎X 顽固性牙周炎 坏死性牙周病 急性坏死性溃疡性牙周炎牙周脓肿 牙周脓肿 伴牙髓病变的牙周炎 牙周牙髓联合病变 发育或获得性异常和状况 牙龈退缩 X 根分叉病变,
