Classification of Periodontal Diseases in Infants, Children, Adolescents, and Individuals with Special Health Care Needs


The American Academy of Pediatric Dentistry (AAPD) recognizes that although the prevalence of destructive forms of periodontal disease is low among children and adolescents, this population can develop several forms of periodontal diseases and conditions most frequently associated with an underlying systemic or immunologic disorder.1-4 In addition, current and early studies show that gingivitis occurs in half of the population by age of four or five years and peaks nearly to 100 percent at puberty.3 The prevalence of gingivitis can be similar to or greater than dental caries during childhood.1 Nevertheless, when compared to dental caries, gingivitis in children has received much less attention in understanding the long-term impact that chronic inflammation of the periodontal tissues in childhood may have on overall health of the periodontium throughout life.1 Therefore, it is critical that pediatric dental patients receive a periodontal assessment as part of their routine dental visits. Early diagnosis ensures the greatest opportunity for successful treatment, primarily by reducing etiological factors, establishing appropriate therapeutic measures, and developing an effective periodic maintenance protocol.2

In 2017, the American Academy of Periodontology and the European Federation of Periodontology co-sponsored the World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions. The objective of the workshop was to update the previous disease classification established at the 1999 International Workshop for Classification of Periodontal Diseases and Conditions.5 One of the major highlights included the recategorization of three forms of periodontitis, the development of a multidimensional staging and grading system for periodontitis, and the new classification for peri-implant diseases and conditions.6

The intent of this best practices document is to present an abbreviated overview of the new classification of periodontal and peri-implant diseases and conditions, including gingivitis. In addition, this document aims to emphasize the key role dentists have in diagnosing, treating and/or referring pediatric patients and those medically compromised or with special health care needs affected by periodontal problems. A comprehensive review of the 2017 World Workshop on the Classification of Periodontal and Peri-implant Diseases and Conditions including the rationale, criteria, and implementation of the new classifications, is available in the June 2018 Journal of Periodontology (Table 1 - see PDF).6-28