牙周疾病的分类

牙周疾病的分类（ClassificationofPeriodontalDiseases）牙周疾病的分类分类原则1.按病理学分类2.按临床 表 关于同志近三年现实表现材料材料类招标技术评分表图表与交易pdf视力表打印pdf用图表说话 pdf 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 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，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(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)VI.牙周脓肿AbscessesofthePeriodontiumA.牙龈脓肿GingivalabscessB.牙周脓肿PeriodontalabscessC.冠周脓肿Pericoronalabscess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)VII．伴牙体牙髓病损的牙周炎PeriodontitisAssociatedWithEndodonticLesions牙周牙髓联合病损combinedperiodontal-endodonticlesion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)VIII.发育或获得性异常和状况DevelopmentalorAcquiredDeformitiesandConditionsA．促进菌斑性龈病/牙周炎的局部牙因素localizedtooth-relatedfactorsthatmodifyorpredisposetoplaque-inducedgingivaldiseases/periodontitisB.膜龈异常和状况mucogingivaldeformitiesandconditionsaroundteethC．无牙嵴膜龈异常和状况MucogingivaldeformitiesonedentulousridgesD．咬合创伤OcclusalTraumaVIII.发育或获得性异常和状况D．咬合创伤occlusaltrauma1.原发性咬合创伤Primaryocclusaltrauma2.继发性咬合创伤SecondaryocclusaltraumaD．咬合创伤occlusaltrauma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。 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