Fast Facts: Perio Edition – AAP 2017 Classification System – Stage III Periodontitis

Fast Facts: Perio Edition Episode 50
 
[Andrew Johnston, RDH]
Welcome back everyone! You are listening to another episode of Fast Facts- Perio Edition brought to you by A Tale of Two Hygienists in partnership with DentistRX. And now, please welcome your host, Katrina Sanders.
 
[Katrina Sanders, RDH]
Hello, and welcome to Fast Facts: Perio Edition as we continue the dialogue about the AAP staging entities. Last week we looked at stage two periodontal cases, and we identified that the Academy does expect that the dental community will rise to meet the needs of patients in stage two periodontitis that require bacterial removal and subsequent monitoring. Let’s move into stage three. As we look at patients in which, according to the Academy, the periodontitis has now produced a significant amount of damage to the attachment apparatus. And, we also understand [spoiler alert] that in the absence of advanced treatment, tooth loss has a likeliness to occur. In stage three periodontitis the Academy describes this as deep lesions that extend into the middle third of the root and beyond, and subsequently this management is thus complicated. Probing depth 6 mm or greater in the mouth. The patient will also likely present with some other interesting advanced modalities, things like vertical bone loss, furcation involvements of class two or class three. These patients may also experience moderate ridge defects. Now, for dental hygienists that are typically working blindly and by blindly I mean, we’re using feel more than we are our own eyeballs. Observing these moderate ridge defects can be a bit of a challenge. Although, as a periodontal hygienist who works in the surgical suite, I will tell you first and foremost, it truly is incredible to see the amount of destruction in bone following early bone loss and subsequent, of course, dysbiosis. What I mean to say, is that when patients present into a stage three radiologically, we are seeing this as radiologic bone loss extending into the middle third of the root and beyond. And unfortunately, according to several resources, now we’re beginning to understand that by the time you can see bone loss radiologically, the patient has already experienced anywhere between 30% to 50% bone loss. Meaning in most scenarios, the only time that we can see radiologic bone loss on a patient is once they have moved into stage three periodontitis.
 
My clarity around this is to describe the fact that the Academy acknowledges that there are concerns if we are waiting until the patient moves into stage three periodontal disease to pull the trigger, so to speak, in active therapy. And to note, the Academy does indicate that this complicated nature of managing stage three periodontitis may, of course, require us to also look at what these deep intra bony defects, furcation involvements, or subsequent, of course, loss of ridge in the bone could mean for our patients.
 
One final note. With stage three periodontal cases, these patients may have lost teeth due to periodontal disease. However, they’ve either lost four or less teeth due to periodontitis. Stay tuned as we discuss stage four periodontitis next week.
 
This has been another episode of Fast Facts – Perio Edition with Katrina Sanders, RDH. Please feel free to reach me on Instagram @thedentalwinegenist or on my website www.KatrinaSanders.com Cheers.
 
[Andrew Johnston, RDH]
Thank you for listening to another episode of Fast Facts – Perio Edition, brought to you in part by DentistRX makers of the InteliSonic line of power brushes. Find out more by visiting their website at www.dentistrx.com. We’ll see you next week for another Fast Fact!