Classifications of Periodontal Diseases

Table 1. Clinical Criteria Assigned to Periodontal Case Types of Health, Gingivitis, Chronic Periodontitis and Aggressive Periodontitis.1
Case Type PD (mm) BOP (Yes/No) Bone Loss (%) Mobility (Grade) Furcations (Grade) CAL (mm) Visual Inflammation
0 (Health) 0-3 No 0 None None 0 No
I (Gingivitis) 0-4 Yes 0 None None 0 Yes (localized or generalized)*
II (Slight Chronic Periodontitis) 4-5 Yes 10 I 1 1-2 Yes (localized or generalized)*
III (Moderate Chronic Periodontitis) 5-6 Yes 33 I and II 1 and 2 3-4 Yes (localized or generalized)*
IV (Severe Chronic Periodontitis) ≥ 6 Yes > 33 I, II, or III 1, 2, 3, or 4 ≥ 5 Yes (localized or generalized)*
V (Aggressive Periodontitis) (age is significant factor) ≥ 6 Yes > 33 I, II, or III 1, 2, 3, or 4 ≥ 5 Yes (localized or generalized)*
* Localized disease is defined as ≤ 30% of sites are involved; and generalized disease infers > 30% of sites are involved.
Specialty referral may be indicated for additional treatment beyond initial therapy.
Specialty referral should be considered.

The above classifications are from the American Dental Association/American Academy of Periodontology 1999. The below guidelines have been recently developed to improve the determination of classifications of periodontal disease. A new set of guidelines is scheduled to be released in 2017.

Table 2. Guidelines for Determining Severity of Periodontitis.2
Slight (Mild) Moderate Severe (Advanced)
Probing depths > 3 & < 5mm ≥ 5 & < 7mm ≥ 7mm
Bleeding on probing Yes Yes Yes
Radiographic bone loss Up to 15% of root length or ≥ 2mm & ≤ 3mm 16% to 30% or > 3mm & ≤ 5mm > 30% or > 5mm
Clinical attachment loss 1 to 2mm 3 to 4mm ≥ 5mm
deep periodontal pocket.

Upon performing the periodontal screening on Emmett, Jessica found that his periodontal pocket depths had increased from 2-3 mm to greater than 5 mm in most areas. Jessica completes her scaling and polishing of Emmett’s teeth and updates a plan for his oral health instructions that she will deliver to him after Dr. Jay does her clinical examination.

characteristics of periodontal disease.

Dr. Jay to Mr. Davis: "Emmett, I can see from the data Jessica collected, that your periodontal pockets have increased significantly, and in looking at your radiographs, you have some bone loss. This is the reason that some of your teeth are loose and your gums are bleeding and tender. Unfortunately, your condition has progressed from gingivitis to periodontal disease (periodontitis). Have you experienced any bad breath?"

Mr. Davis to Dr. Jay: "Well, yes I have. I just thought it might be something I was eating."

Dr. Jay to Mr. Davis: "Actually, bad breath can also be a sign of periodontal disease."