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Fast Facts: Perio Edition AAP 2017 Classification System - Clinical Spectrum of Health

Fast Facts

Fast Facts - Perio Edition Episode 35

[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. On this week's episode, we begin the dialog around the 2017 AAP classification systems by talking about periodontal health. In 2017, the American Academy of Periodontology proposed that there were four distinctive levels of periodontal health, depending on the state of the periodontium itself. So level one is pristine periodontal oral health. The structures around that periodontium are sound and the periodontium itself is not inflamed.
The second level is a well maintained clinical periodontal health. Structurally and clinically. We have an intact periodontium. The third and fourth levels we will be discussing next week, these are areas where we've experienced what's considered to be a reduced periodontium. There is attachment loss in these cases, however these patients are in a state of disease, stability or disease remission. This week, we're going to look at levels one and two, a pristine periodontal health and are well-maintained, clinical periodontally healthy patients. And in order to identify this, we need to take a look at a World Health Organization statement from the 1940s indicating health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. It means from a holistic standpoint, that when we take a look at our patients as a whole, a practical definition of periodontal health is a patient whose periodontium is in a state free from an inflammatory burden. Histologically we've looked at the differences between inflamed tissue and non inflamed tissue, and this requires us to understand the cellular composition of our connective tissue.
A clinically sound or healthy patient will not present with high levels of lymphocytes in their connective tissue. These are individuals that will demonstrate accurate and high level stability from a physiological standpoint. And clinically, we can observe these patients as, for example, having a minimal subgingival biofilm associated with gingivitis and periodontitis. These are patients, for example, that are going to have an optimized oral hygiene status. And moreover, as we continue to identify patients that would be termed as clinically healthy, we should be noting that these individuals present with an absence of inflammation, noting minimal, if any, bleeding upon gentle stimulation or provoked stimulation of the marginal gingiva.
We also, for example, identify that these are particular patients in which radiologically we have a normal, intact periodontium and we have a gorgeous intact lamina dura that denotes the lateral alveolar crest, no evidence of bone loss into furcation areas and an optimal alveolar bone crust. If there is any mobility noted in the clinical charting of these patients, that mobility would likely be due to a widened periodontal ligament, as noted when there is occlusal trauma. Nevertheless, patients that are in a state of periodontal health are patients in which we continue to expect an optimal outcome with respect to their periodontal health. We expect that these are individuals who, for the most part, have been able to control their bleeding. Their gingival sulcus depth is optimal, their bone heights are high level. In addition, they're modifying their risk factors as well as their tooth centric or predisposing factors are stable. Patients that are in pristine periodontal health, nevertheless, are patients in which there's no bleeding on probing, no anatomical loss of periodontal structures, and these patients are patients that have well controlled their risk factors.
Thank you for joining me today as we looked at periodontal disease stability. Join me next week as we look at a clinical gingival health. However, these are going to be patients that present with a reduced periodontium.  Have a wonderful 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 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 We'll see you next week for another Fast Fact!

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