Week 5- Periodontal Staging and Grading Flashcards
what are the stages of severity of disease based on clinical attachment level
- slightL 1-2mm
- moderate: 3-4mm
- severe: greater than or equal to 5 mm
what is the gold standard for categorizing the severity of disease
clinical attachment level
AAP formed a task force in 2015 to identify alternative criteria including:
- radiographic bone loss
- probing depth
why is probing depth not considered diagnostic
- inflammation has effect on penetration of probe into tissue
- inflammation may move gingival margin coronally - psuedopocket
what is the recommendation for using these factors to measure severity of disease
- use interproximal attachment los - 2 or more non-adjacent teeth
- use probing depth as a complexity factor
what is the 2017 classification of periodontal and peri-implant diseases and conditions
-3 dimensional adaptive system:
- severity/extent: number of teeth affected rather than sites
- prognosis: affects no teeth up to 4 teeth, 5 or more teeth
- progression: grading
the 2017 AAP classification’s rationale for change is to:
- recognize and monitor systemic influences inflowing to periodontal disease such as smoking and diabetes
- control inflammatory and microbial influences from periodontal disease outflowing to systemic targets to decrease the co-morbid effect of the periodontal disease
what are the periodontal diseases and condition
- necrotizing diseases
- periodontitis as a manifestation of systemic diseases
- periodontitis
according to the CDC and prevention approximately _____ of adults over 30 years old have periodontitis
47%
what is the primary cause of tooth loss in adults over 30 years old
periodontitis
what is the goal of new system of staging and grading
- easy to use
- should promote better communication with patient, referring dentists, hygienists, other health care professionals
- identify response to treatment
what are the 3 steps to staging and grading a patient
- step 1: initial case overview to assess disease
- step 2: establish stage
- step 3: establish grade
what do you screen in step 1 of staging and grading in a patient
- full mouth probing depths
- full mouth radiographs
- missing teeth
mild to moderate periodontitis will either be:
stage I or stage II
severe to very severe periodontitis will be:
stage III or Stage IV
for staging and grading every patient categorized based on:
the worst periodontal site and specific factors that may impact long term management
staging is divided into
- severity
- complexity
- extend and distribution
staging considers:
- CAL using the worst site
- amount and % of bone loss
- probing depth
- presence/extent of ridge defects and furcation involvement
- tooth mobility
- tooth loss due to periodontitis
what are the criteria for defining periodontitis
- interdental CAL at 2 or more non adjacent teeth OR
- buccal or oral CAL greater than or equal to 3mm with pocketing greater than 3mm on 2 or more teeth
what is the interproximal CAL for each stage of the new system
- stage I: 1-2mm
- stage II: 3-4mm
- stage III: greater than or equal to 5mm
- stage IV: greater than or equal to 5mm
ensure the problem cannot be attributed to non-periodontal causes such as:
- gingival recession due to trauma- toothbrush trauma/toothpaste abrasion
- dental caries extending to or below the gingival margin
- defect on distal on 2nd molars caused by malposition or extraction of a 3rd molar
- endodontic lesion draining through marginal periodontium - deep probing depth
- vertical root fracture- isolated deep probing depth
what does the staging and grading system also take into consideration
- overall probing depths
- evaluates radiographic bone loss, horizontal and vertical
- evaluates furcation involvements, number of missing teeth, function
describe stage I with complexity factors
- max probing depth less than 4mm
- mostly horizontal bone loss
describe stage II with complexity factors
- max probing depth less than 5mm
- mostly horizontal bone loss
describe stage III with complexity factors
- in addition to stage II complexity:
- probing depths greater than or equal to 6mm
- vertical bone loss greater than or equal to 3mm
- class II or III furcation involvements
- moderate ridge defects
describe stage IV with complexity factors
- in addition to stage III complexity need for complex rehabilitation due to:
- masticatory dysfunction
- secondary occlusal trauma greater than or equal to 2 mobility
- bite collapse, drifting, flaring less than 10 opposing pairs remaining teeth
- severe ridge defects
what is the prognosis of each stage
- stage I or II: no tooth loss likely
- stage III: risk of tooth loss up to 4
- stage IV: risk of loss of arch or dentition (greater than 5 teeth_
describe stage 1
1-2mm CAL
- less than 15% bone loss around root
- no tooth loss due to periodontal disease
- probing depth 4mm or less
- mostly horizontal BL
describe stage II
- moderate
- 3-4mm CAL
- 15-33% bone loss
- no tooth loss due to periodontal disease
- probing depth 5mm or less
- mostly horizontal bone loss
describe stage III
- severe with potential for additional tooth loss
- 5mm or more CAL
- bone loss beyond 33%
- tooth loss of four teeth or less due to perio disease
- with complex issues such as probing depth 6mm or more
- vertical BL 3mm or more
- class II-III furcations
- moderate ridge defects
describe stage IV
- severe with potential for loss of dentition
- encompasses all of stage III with additional features that will require the need for complex rehabilitation due to masticatory dysfunction
- secondary occlusal trauma
- severe ridge defects
- bite collapse
- pathologic migration of teeth
- less than 20 remaining teeth - 10 opposing pairs
what is the purpose of staging of periodontitis
classify the severity and extent of a patients disease based on the measureable amount of destroyed and/or damaged tissue as a result of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management
how many complexity factors shift the stage to a higher level
one or more
what should the initial stage be determined using
CAL. if not available use RBL
what number of tooth loss is each stage
- no tooth loss= stage I or II
- less than or equal to 4 teeth: stage III
- greater than or equal to 5 teeth: stage IV
if lost any teeth due to periodontitis then what stage is it automatically
stage III or IV
what furcation involvement puts patient into periodontitis stage 3 or 4
grade 2 or 3
what is localized BL
BL involved less than 30% of teeth
what is generalized bone loss
more than 30% of teeth
what is molar-incisor BL
BL is found around molar - usually first- and anterior incisors
molar/incisor pattern generally applies to old classifications of:
localized aggressive periodontitis which was known before that as localized juvenile periodontitis
what is molar/incisor pattern stage and grade
stage III grade C
what does grading consider
- rate of disease progression
- risk of further advancement
- potential threats to general health - smoking, DM
- response to standard therapy
what are the grades
- A: low risk of progression
- B: moderate risk of progression
- C: high risk of progression
initially what grade do you assume
grade B
what group tends to have more rapid attachment loss
children
what is considered direct evidence for grading
- historical radiographic bone loss
- CAL
what is considered indirect evidence
- % bone loss/patient age
- case phenotype (soft tissue thickness, bone thickness)
- heavy plaque accumulation but minimal destruction vs minimal plaque but major destruction
what are the grades using direct evidence
- grade A: no loss over 5 years
- grade B: less than 2mm loss over 5 years
- grade C: greater than 2mm over 5 years
what is the calculation for bone loss
percentage / age
what are the risk factors smoking and diabetes in grade A
- slow rate
- nonsmoker
- nondiabetic
what are the risk factors smoking and diabetes in grade B
- moderate rate
- less than 10 cigs per day
- diabetic with HBA1c less than 7%
what are the risk factors for smoking and diabetes for grade C
- rapid rate
- greater than or equal to 10 cigs a day
- diabetic with HBA1C greater than or equal to 7%
what is the goal of grading in periodontitis
to indicate the rate of periodontitis progression, responsiveness to standard therapy and potential impact on systemic health
what are the other names for periodontitis
- chronic periodontits
- aggressive periodontitis
what is another term for periodontal biotype
periodontal phenotype
what is another term for excessive occlusal force
traumatic occlusal force
what is another term for biologic width
supracrestal attached tissue
what is biologic width made of
supracrestal connective tissue and JE
