CLINICAL CLASSIFICATION OF PERIODONTITIS IN ADOLESCENTS AND YOUNG-ADULTS

THE AIM OF THIS STUDY was to determine the degree to which clinical cl assifications based on cross-sectional assessments endure in the cours e of development of early-onset periodontitis (EOP), and to introduce new criteria which might improve the clinical classification of these diseases. Subjects with EOP and a matched group without EOP were ident ified within a national probability sample examined during the 1986/87 survey of US schoolchildren. Of these, 265 subjects (mean age 16 year s) were re-examined during the 1992/93 school year. The clinical attac hment level of teeth was assessed, and the individuals were classified into localized juvenile periodontitis (LJP), generalized juvenile per iodontitis (GJP), incidental attachment loss (IAL), and no-periodontit is groups using three classification methods previously described, A f ourth method that considered the extent and severity of attachment los s and the number of missing teeth was introduced to classify the indiv iduals at baseline and at follow-up as having localized, generalized, or incidental EOP, and no-periodontitis groups, Furthermore, the indiv iduals were classified using criteria based on the rate and pattern of change in attachment loss during 6 years. The results showed low corr elations between the baseline classifications and the classifications at the 6-year follow-up examination, irrespective of the method used. In addition, the cross-sectional classifications were not predictive o f the rate of progression of periodontal disease in these subjects. In the generalized disease group, two-thirds of the individuals exhibite d moderate/rapid disease progression, while one-third had slow or no p rogression. In the localized disease group, one-half of the individual s had moderate/rapid disease progression and one-half had slow or no p rogression. In the incidental disease group one-fourth of the individu als had moderate/rapid disease progression and three-fourths had slow or no progression. We propose that the term early-onset periodontitis be used as a generic term to describe periodontal disease before its n ormal onset. In addition, we suggest that incidental, localized, and g eneralized EOP are heterogeneous groups comprising rapidly and slowly progressing forms within each classification. The findings suggest tha t a classification system in which subsets of the disease that are def ined according to a combination of cross-sectional criteria and the di sease progression may be useful in studies of EOP, Furthermore, the fi ndings suggest that clinical classifications of EOP be used as generic descriptors until a full understanding of the pathogenesis of this di sease is accomplished.