Page 51 - Dental Practice Vol 17 No.5_

pathogens can significantly increase the risk of a heart attack or ically proven to reduce and inhibit bacteria and biofilm is an easy
stroke. They understand the importance of a complete periodontal first step. Recent research demonstrates some stabilized stannous flu-
examination however, “from a cardiovascular standpoint, there must oride formulas are clinically proven to neutralize plaque bacteria and
be an objective assessment of high-risk pathogen burden as part of toxins and the SnF2 bacteriostatic properties enable it to keep work-
the definition of periodontal disease.” ing for 12 hours. Or suggesting they switch from using a manual
Salivary diagnostics has been around for many years and can be a toothbrush to an electric brush. The data shows oscillation/rotation
valuable risk assessment tool. There are several PCR DNA-based oral electric toothbrush users had significantly lower progression of prob-
pathogen tests available. These tests give you a snapshot of the ing depth (22.0%), clinical attachment loss (21.0%), and
client’s pathogenic load which can guide you in your treatment rec- decayed/missing/filled surfaces (17.7%) compared to manual tooth-
ommendations. brush users.
Salivary testing is vital when clients have symptoms (halitosis, Ask yourself as a dental health professional, am I doing enough?
increased bone loss or bleeding), but they are missing the “typical” What can I change or implement to provide my clients with the oral
plaque, biofilm and/or calculus deposit we normally associate with systemic care they deserve? Now more than ever, we need to connect
disease progression. Every time I see a client, I try to link how their with our clients, improve our assessments, and go the extra mile.
oral condition relates to their systemic health. I feel there is a void Let’s make sure we improve the quality of life for our clients by shar-
within dentistry that needs to be filled. We spend most of our time ing our knowledge, education and understanding about the oral sys-
talking about problems such as broken teeth, periodontal pockets temic link. I know if I do my job to the best of my ability my clients
and caries but we don't often get to the root cause of the problem. may not realize the benefits of my care, but I know I am making a dif-
The cause of the problem could be specific bacteria and exacerbated ference.
by an undiagnosed systemic condition.
If our clients have systemic risk factor or uncontrolled disease we STAGING AND GRADING PERIODONTITIS
must review their homecare routine at every visit. Select an appro- The 2017 World Workshop on the Classification of Periodontal and
priate interdental biofilm cleaning tool and technique, mouth rinse, Peri-Implant Diseases and Conditions resulted in a new classification
toothpaste and toothbrush. Consider adding disclosing to your pro- of periodontitis characterized by a multidimensional staging and
tocols. We need talk to them about their home care routine and grading system. The charts below provide an overview. Please visit
Staging and Grading Periodontitis
make evidence-based recommendations for a proactive approach. Perio.org/2017wwdc for the complete suite of reviews, case defini-
Simple suggestions like using a therapeutic dentifrice that is clin- tion papers, and consensus reports.
The 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions resulted in a new
classification of periodontitis characterized by a multidimensional staging and grading system. The charts below provide an
overview. Please visit perio.org/2017wwdc for the complete suite of reviews, case definition papers, and consensus reports.
Table 2: PERIODONTITIS: STAGING
Staging intends to classify the severity and extent of a patient’s disease based on the measurable amount of destroyed and/or damaged tissue
PERIODONTITIS: STAGING
as a result of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management. Initial stage
Staging intends to classify the severity and extent of a patient’s disease based on the measurable amount of destroyed and/or damaged tissue as a result
should be determined using clinical attachment loss (CAL). If CAL is not available, radiographic bone loss (RBL) should be used. Tooth loss
of periodontitis and to assess the specific factors that may attribute to the complexity of long-term case management.
due to periodontitis may modify stage definition. One or more complexity factors may shift the stage to a higher level.
Initial stage should be determined using clinical attachment loss (CAL). If CAL is not available, radiographic bone loss (RBL) should be used. Tooth loss due to
periodontitis may modify stage definition. One or more complexity factors may shi the stage to a higher level. See perio.org/2017wwdc for additional information.

Periodontitis Stage I Stage II Stage III Stage IV
Interdental CAL
1 – 2 mm 3 – 4 mm ≥5 mm ≥5 mm
(at site of greatest loss)
Severity Coronal third Coronal third Extending to middle Extending to middle
RBL
(<15%) (15% - 33%) third of root and beyond third of root and beyond
Tooth loss
No tooth loss ≤4 teeth ≥5 teeth
(due to periodontitis)
Local • Max. probing depth • Max. probing depth In addition to In addition to
≤4 mm ≤5 mm Stage II complexity: Stage III complexity:
• Mostly horizontal • Mostly horizontal • Probing depths • Need for complex
bone loss bone loss ≥6 mm rehabilitation due to:
• Vertical bone loss – Masticatory dysfunction
≥3 mm – Secondary occlusal trauma
Complexity
• Furcation involvement (tooth mobility degree ≥2)
Class II or III – Severe ridge defects
• Moderate ridge defects – Bite collapse, dri ing, flaring
– < 20 remaining teeth
(10 opposing pairs)
Add to stage as For each stage, describe extent as:
Extent and descriptor • Localized (<30% of teeth involved);
distribution • Generalized; or
• Molar/incisor pattern

Dental Practice // May-June 2021 // Vol 17 No 5 51