This classification of periodontal disease is carried out for the case when the primary cause of periodontal disease is unknown or ignored. In this case, there are no effective prevention and treatment, which leads to the constant progression of periodontitis. In the case when the primary cause of periodontitis is taken into account and exploited, the treatment and prevention of periodontitis can eliminate the appearance of any symptoms of periodontal disease at any age and for any period. In this case, the classification in the proposed form is not needed, since there is no mass symptomatology of periodontitis and the periodontal is in homeostasis at any time. In this case, the classification can be made with an optimistic background, when the symptoms are not considered in the process of deterioration, but in the process of improving the state or stabilizing the state. The classification demonstrates severe pessimism in the situation with the prevention and treatment of periodontal disease. In the classification there is no mention of the connection of periodontal diseases with many other diseases.

Thank you very much. I will read the publication again under the light of your comments.

Now I see that it covers peri-implant diseases as well.

What does the actual result of the absence of all the symptoms of periodontitis at the age of 51 have? Incomplete application of evidence can lead to a comprehensive result? How can a misunderstanding of the development of periodontal disease help in the correct diagnosis of periodontal disease? The classification contains a description of all destructive results, how can it help to prevent such a result? What is the usefulness of the classification? In that classification recorded a catastrophic state of affairs in periodontology? How to get out of this situation? What is the result of a practice based on incorrect assumptions?

I am also trying to get the usefullness of the new classification.

Biofilm is not the cause of gingivitis. Systemic diseases are not the cause of periodontal diseases, but, on the contrary, periodontal diseases are the cause of systemic diseases. Genetic vulnerability is not a cause of periodontal disease. The immune response is not the cause of bone loss and gum recession. The term necrotizing gingivitis is used - how and why do necrotic processes arise in a parodont in a healthy organism? Who will answer this question? Periodontitis is not a multifactorial disease, but a single-factor disease. Why does the natural oral microflora suddenly become pathogenic? Is the patchwork gum repair a gum treatment or plastic surgery? Systemic diseases are not the cause of loss of periodontal attachment, periodontitis is a single-factor disease. Plaque is not the cause of periimplantitis. Dental plaque control is not a means of avoiding periodontitis. The whole classification is a set of conclusions and descriptions that have little to do with the fundamental processes that occur in parodont.

Flu can cause bacterial damage. You can classify the symptoms of a bacterial lesion with the flu. But will it be a classification of the flu as a disease? After all, it is known that the flu is caused by a virus. With flu, we treat a symptom - a bacterial lesion, and the body itself copes with the virus. In periodontitis, bacterial damage and atrophic processes are the symptoms of periodontitis and the classification presented is a classification of the symptoms of periodontitis, but not periodontitis. The treatment of the symptoms of periodontitis is not the treatment of periodontitis, as periodontitis and the symptoms of periodontitis are fundamentally different processes. How different is the process of viral damage from a bacterial lesion. The peculiarity of periodontitis is that trying to eliminate the symptoms of periodontitis, you do not eliminate periodontitis as a process. If during flu infection the body itself eliminates the main process - a viral lesion, then with periodontitis the body can not do anything without external help. That is why, after implantation, periodontitis continues to develop. Bone loss and bacterial damage continue to develop.

I've read your comments with great interest. Thank you very much.

I also have difficulty with this classification for many reasons (like what dr Vasil Grigoriev wrote ) but one of the reasons is that many general dentists who refer cases to me do not like it at all, they think it is just a glorification for the standard old classification ( mild-moderate or severe periodontitis. they feel this classification (mild-moderate and severe ) was quite acceptable to them and can be explained to the patient easily and that most of the new classification like biofilm is not necessary or at least confusing .

I also know many general dentists are up on the new classification but I find also many general dentists want the old classification so they can communicate the in a short period the diagnosis, let's hope another easy classification can come out

sincerely

Dr.K.A.Galil.Professor of Medicine and Professor of Dentistry DDS.,D.Oral & Maxillofacial Surgery ,PH.D,FAGD.,FADI.,Cert.Periodontist(Uof Michigan) (Royal College Dent Surg.Ont) Departments of Periodontics,Orthodontics and Clinical Anatomy Schulich School Of Medicine and Dentistry. University of Western Ontario, London,Ontario.

www.drgalil.ca

Dear Professor,

Thank you for your contribution to the discussion.

We would like to hear more from Dr. Vasil Grigoriev about his contradictions on the pathogenesis of periodontal disease. I would also welcome any article supporting his view. Thanks

The development of periodontitis can be divided into two stages. The main process in which there are no irreversible changes. And a secondary process in which there are irreversible tissue changes and there are symptoms of periodontitis, which are characteristic of the secondary process of periodontitis. The new classification appears to be an attempt to improve treatment outcomes through administrative reclassification measures, without broadening the understanding of the etiology and pathogenesis of periodontitis. The new and old classification "sees" only the secondary process and is based on the symptomatic theory, in which the symptoms act as the cause of the disease. In the new and old classifications, the symptomatic theory is the theoretical basis. Classifications consider the associated processes of periodontitis as the main ones. In many diseases, bacterial damage is a secondary process that occurs against the background of the main process. In periodontitis, a change in the bacterial composition of the biofilm or a change in numbers among some bacterial species is a secondary process. A biofilm is a non-pathogenic formation and can accumulate products of process disturbances. In the case of periodontitis, the biofilm can accumulate products generated by the underlying process of periodontitis. Modification of the classification is meaningless if it is based on a symptomatic theory in which the symptom is the cause of the disease. It is necessary to go beyond the secondary process. It is necessary to master the understanding of the basic process of periodontitis in order to obtain a positive result. The fundamental theory of periodontitis allows you to manage periodontitis at the main stage of periodontitis development. At the main stage of periodontitis, all changes are reversible. The application of the fundamental theory makes it possible to exclude the appearance of all the symptoms of periodontitis that appear at the stage of the secondary process. In the case of a fundamental theory, a fundamentally different classification is used, which can be defined as a classification of the stage of reversible changes. The "old" and "new" classifications can be defined as the classification of the stage of irreversible changes without taking into account and without understanding the main stage of periodontitis.

Dear Dr Vasil, Grigoriev.

your answer makes sense to me and to those who are involved and immersed in periodontology, but I am concerned about my patient and my general dentist colleague who has no time to explain to the patient the new classification . Patients want things simplified, add to this when a patient visits us he or she knows they have a disease called periodontal disease and it has systemic effects so they want the process simplified so that they can understand. How many of us talked to the patient about Oral hygiene and saw the patient roll up his or her eyes and or the insurance company doesn't consider it important and won't pay for it. How many times does a dentist hear the word doctor I hate going to the dentist but I don't hate you personally, according to many psychologists this has many connotations and I won't delve into this because it is a big topic, but you get the point so we need to make the classification easy to swallow by the patient and easy to be delivered by the general dentist and the periodontist and the hygienist to the patient. Hopefully, we can work on that.

sincerely

Dr.K.A.Galil.Professor of Medicine and Professor of Dentistry DDS.,D.Oral & Maxillofacial Surgery ,PH.D,FAGD.,FADI.,Cert.Periodontist(Uof Michigan) (Royal College Dent Surg.Ont) Departments of Periodontics, Orthodontics and Clinical Anatomy Schulich School Of Medicine and Dentistry. University of Western Ontario, London, Ontario.

www.drgalil.ca

Vasil Grigoriev Thanks for the detailed explanation.