Staging and grading

Question 1

what is the staging and grading system based on

Answer 1

For periodontitis and is based on bone loss and classifies the disease into

• 4 stages based on severity (I,II,III or IV)
• 3 grades based on disease susceptibility (A,B or C)

Question 2

how to work out staging

Answer 2

• find worse site of interproximal bone loss
• measure from the CEJ

Question 3

what is stage 1

Answer 3

interproximal bone loss at worst site <15% or 2mm

Question 4

what is stage 2

Answer 4

interproximal bone loss at worst site coronal third of root

Question 5

what is stage 3

Answer 5

interproximal bone loss at worst site mid third of root

Question 6

what is stage 4

Answer 6

interproximal bone loss at worst site apical third of root

Question 7

if someone is known to have lost teeth due to perio already what stage are they

Answer 7

stage 4

Question 8

what does the staging system allow

Answer 8

to look at complexity and severity

Question 9

how do you work out grading

Answer 9

• A = max bone loss less than half patient age
• B = everything else
• C = max bone loss more than patient age

Question 10

regardless of patient age, if someone has lost >2mm over 5years what grade is this

Answer 10

C

Question 11

how do you work out extent

Answer 11

• localised (<30% of teeth)
• generalised (>30% of teeth)
• molar incisor pattern

Question 12

what is included in a periodontitis diagnosis statement

Answer 12

• Extent
• periodontitis
• stage
• grade
• stability
• risk factors

Question 13

give an example of a periodontitis diagnosis statement

Answer 13

Generalised periodontitis Stage 3 Grade B, currently unstable, risk(s): smoker 15/day

Question 14

what is a stable periodonitis pt

Answer 14

• BoP <10%
• PPD≤4mm
• No BoP at 4mm sites

Question 15

what is a periodontitis patient who is currently in remission

Answer 15

• BoP ≥10%
• PPD ≤4mm
• No BoP at 4mm sites

Question 16

what is a currently unstable peridontitis patient

Answer 16

• PPD ≥5mm or PPD ≥4mm and BoP

Question 17

What action to take on recording BPE 3

Answer 17

• initial treatment
  
  • remove calculus
  • give OHI
  • monitor plaque scores
  • evaluate pt
  • treat pockets if they are there
• 6PPC for that sextant only, and only after initial treatment

Question 18

why is the 4mm threshold important

Answer 18

it determines periodontal disease stability at non-bleeding sites following successful periodontal therapy. A higher probing depth of 5mm or 6mm in the absence of bleeding may not always represent active disease - in particular soon after periodontal treatment. Thereofre clinicians need to exercise clinical judgements when considering the need or lack of need for additional treatment such as re-instrumentation or surgery for such sites