Week 6 Staging and Grading Flashcards
When do you suspect periodontitis?
When clinical attachment loss CAL is present or
there is recession plus pocket depth of greater than 3
If no CAL what BOP constitutes as health, localize gingivitis and generalize gingivitis?
Less than 10%
Local Gingivitis from 10-30%
Generalized Gingivitis if greater than 30%
What are local factors that could cause CAL that don’t count as periodontitis (4)?
Endo-perio lesion, Vertical root fracture, Caries or restoration Impacted wisdom tooth Gingival enlargement or overgrowth
Definition of periodontitis?
Two or more non-adjacent teeth have CAL
Or
One site involving at least two teeth has Recession of 3 mm or more and pocket depth of more than 3
Generally pocket depth of 4 or more and 1 mm recession in more than one area…
So two teeth with recession of 2 and 3 mm pockets is not perio would need more recession- want to clarify more….
If there is CAL and pocket depths are 3 or less and there is no BOP what kind of patient are they?
If there is BOP then what?
3 PPD or less with out BOP is reduced but healthy periodontium patient
If there is BOP then then they have inflammation in Periodontitis patient
When do you move on to staging and grading?
When CAL in separate sites and PPD of 4 or more
What is rated when determining stage?
Interdental CAL at site of greatest loss
RBL (radiographic bone loss)
Tooth loss due to Perio
Complexity/Local- PD, furcation, mobility
Extent and distribution
What is CAL?
Clinical attachment loss
Clinical attachment level is Distance from CEJ to bottom of pocket
There is loss if that is more that 3 mm?
Need to verify exact definition with Dr daubert
Stage 1 requirement?
CAL of 1-2 mm
RBL of less than 15%
No tooth loss
Max PD of 4 mm
Description of % of teeth involved and if it is the molar/incisor pattern
Stage II requirements?
CAL OF 3-4 mm
RBL at 15-33% of the root
No tooth loss
Max probing depth of 5 mm, mostly horizontal bone loss
And
Description of % of teeth involved and if it is the molar/incisor pattern
Stage III requirements?
CAL of 5 mm or more
RBL into the middle 1/3 of root or more
Tooth loss of up to 4 teeth
Max probing depth of 6 mm or more
Vertical bone loss of 3 mm or more
Furcation Involvement of class II or III
Moderate Ridge Defects
Description of % of teeth involved and if it is the molar/incisor pattern
Stage IV requirements?
CAL of 5 mm or more
RBL into the middle 1/3 of root or more
Tooth loss of 5 or more teeth
Max probing depth of 6 mm or more
Vertical bone loss of 3 mm or more
Furcation Involvement of class II or III
Severe Ridge Defects
Bite breakdown, occlusal trauma, mastication disfunction
Mobility of 2 or more causing teeth to drift
Less than 20 teeth remaining or 10 opposing pairs
Description of % of teeth involved and if it is the molar/incisor pattern
What does the perio grade mean?
How fast the disease is progressing
It gives us an estimate of future risk and helps judge potential impacts on systemic health
What is rated to determine the grade?
Direct evidence of bone loss or CAL over time
And or indirect evidence of
% bone loss/age
and case phenotype
These are modified by smoking and diabetes
What counts as Grade A?
No observed bone loss over 5 years
Less than .25 bone loss/age
Heavy deposits but low destruction levels
No diabetes and non-smoker
