21. Classification Of Periodontal Disease: Periodontitis

Question 1

LOs

Answer 1

Question 2

What codes in a BPE indicate health or gingivitis?
What do the codes mean

Answer 2

Question 3

What to do once you’ve decided the BPE code for codes 3,4?

Answer 3

Question 4

Disease extent categories

Answer 4

• Localised (<30% teeth affected)
• Generalised (>30% teeth)
• Molar-incisor pattern

Question 5

What is staging?

What information do we need to collect to complete staging?

What are the different stage categories?

How are roots divided?

Answer 5

Question 6

What do we do if we can’t take a radiograph to determine the stage number?

Answer 6

• measure the clinical attachment loss in mm from gingival crevice to cemento enamel junction

Question 7

What is grading?

Answer 7

Rate of progression - susceptibility of periodontitis

Question 8

How to calculate the grades?

What are they?

What do they mean?

Answer 8

Question 9

Current disease status and risk factor assessment

Answer 9

Question 10

What elements to consider when making a diagnosis?

Answer 10

• Include elements of:
o staging/
o grading/
o extent/
o current disease status and
o risk factor assessment

• E.g. Generalised periodontitis Stage IV Grade C; currently unstable
Risk factors: poorly controlled diabetes.

Question 11

Example case 1
Disease extent? (Localised or generalised)
Staging?
Grade?

Answer 11

Question 12

Example case 2
Disease extent? (Localised or generalised)
Staging?
Grade?
Risk factors?

Answer 12

Question 13

Summary of classifying periodontal disease/ diagnosis steps?

Answer 13

• Be familiar with the BPE system, screening tool for a provisional periodontal diagnosis

• BPE codes 0/1/2
→ Health or Gingivitis on Intact/ Reduced periodontium

• BPE code 3 and 4→Periodontitis
↳ require radiographs and pocket charts
↳ Extent
↳ Staging
↳ grading
↳ current disease status
↳ risk factor assessment
= Definitive diagnosis

Question 14

Further reading

Answer 14

Further reading
Guidance documents from the British society of Periodontology

• https://www.bsperio.org.uk/assets/downloads/BSP_BPE_Guidelines_2019.pdf

• https://www.bsperio.org.uk/assets/downloads/111_153050_bsp-flowchart-implementing-the-2017-
classification.pdf

Periodontal diagnosis in the context of the 2017 classification system of periodontal diseases and conditions – Implementation in Clinical Practice, T. Dietrich, P. Ower, M. Tank, N. X. West, C. Walter, I. Needleman, F. J. Hughes, R. Wadia, M. R. Milward, P. J. Hodge, I. L. C. Chapple & on behalf of the British Society of Periodontology, BDJ volume 226, pages 16–22
https://pubmed.ncbi.nlm.nih.gov/30631188/