The American Academy of Periodontology, or AAP, read with interest Dr. DiBenedetto’s plea for a nosology for periodontal diseases that would enable epidemiologists to track disease patterns with accuracy; scientists to consistently research the diseases, potential treatments and links to overall health; and practitioners to monitor quality of care and its impact on patient outcomes.
While a perfect, universal nosology for dentistry does not exist to accommodate these functions simultaneously, it is important to recognize the tools currently available to accomplish these activities.
The 1999 International Workshop for a Classification of Periodontal Diseases and Conditions. Prior to the 1999 International Workshop, the last time periodontal scientists and clinicians agreed on a classification system for periodontal diseases was in 1989 at the World Workshop in Periodontics, and in 1993 at the first European Workshop in Periodontology.
These classification systems had many shortcomings, including considerable overlap in disease categories, absence of a gingival disease component, inappropriate emphasis on age of onset of disease and rates of progression, and inadequate or unclear classification criteria.
The 1993 European classification lacked the detail necessary for adequate characterization of the broad spectrum of periodontal diseases encountered in clinical practice. The 1999 workshop responded to the need for a reclassification system.1 While the scheme is not perfect and is subject to criticism, it is the most comprehensive nosology available to accurately communicate about periodontal diseases and conditions. It will certainly change in the future, as our understanding of the diseases and conditions evolve over time.
AAP–Centers for Disease Control and Prevention, or CDC, Initiative to Develop Surveillance Measures for Periodontal Diseases. In 2003, the CDC initiated collaboration with the AAP to consider potential population-based measures of periodontal diseases, and make recommendations for those that can be used in state-based surveillance.
Surveillance is the first step in a four-step process to identify tactics that can combat diseases in populations, and is followed by risk factor identification (What are the causes?), intervention evaluation (What works?) and implementation (How is it done?).
We are hopeful that this collaboration will produce a surveillance system that enables the CDC to monitor periodontal diseases, so that the data can be compared to epidemiologic data available for systemic diseases to which periodontal disease may be related, resulting in the application of appropriate public health interventions.
When speaking about a system that "rigorously couples the fruits of scholarly effort and research to the everyday actions of us all," medical informatics guru L.L. Weed recognizes that "real problems in the real world—practical or theoretical problems—do not fit neatly into academic boundaries."2 This is not reason enough to abandon the search for a perfect nosology in dentistry; rather, it is a reminder that it needs to address many functions simultaneously, is likely to evolve over time, and will fall short of achieving all intended at some point during its evolution.
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