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Fast Facts - AAP 2017 Classification System - Clinical Gingival Health on a Reduced Periodontium

Fast Facts

Fast Facts: Perio Edition Episode 36

[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 of Fast Facts: Perio Edition, we are continuing the convo around the 2017 AAP classification system. Last week we looked at the clinical spectrum of health and we discussed the first two of the major categories when it comes to diagnosing or identifying periodontal health as pristine periodontal health and a well maintained clinically periodontally healthy case. This week we're continuing the dialog by looking specifically at our patients that present with a gingival healthy status, but they present with a reduced periodontium. I will begin by saying this is relatively new for us. Picture it. You have your periodontal maintenance patient, they've had active periodontal treatment in the past and now they've been seeing you every three or four months and their tissues are in a state of stability. They have perfect coral pink tissue, they have high level keratinization and for the most part you have a resulted minimal bleeding upon probing and optimal pocket depth numbers. This is a patient, however, who has experienced the disease process. And so this particular patient is considered a patient that is in a periodontal disease stability state. This is a patient that although their gingiva may be clinically healthy, there is a presence of a reduced periodontium. These are patients that may have some clinical attachment loss or destruction from a history of the disease process, but these are patients that are in a state in which their periodontitis has been successfully treated. We have been able to control local or systemic factors. And so these are patients that do have minimal bleeding on probing, optimal pocket depth sites, stable attachment levels and a lack of progression of the destructive process. Are these patients that if we do not maintain these modifying factors, could readily enter back into active periodontal disease? Absolutely. And so these individuals, patients that are in a state of periodontal disease remission or control, are considered patients that are periodontal patients in a stable on a reduced periodontium status.
On the other side of the coin, we can also have patients that present with some type of clinical attachment loss, yet their periodontal status, from a gingival observation, is in a state of stability. So these are patients that may have some attachment loss, they may have some recession, and this would be due to non periodontal factors. These could be things, for example, like patients that have had clinical crown lengthening done. So, yeah, they're going to have recession. They're going to maybe even have exposed root surfaces in some areas. But these are patients that have that exposed surface because a doctor performed clinical crown lengthening on them. This could also be a patient, for example, that has an apparent frontal pull or maybe some iatrogenic challenge. Maybe the patient had a tongue ring, for example. And so the sequelae, the loss of attachment in some of those areas is due not specifically to the disease process itself, but due to some other extenuating circumstance.
These are patients that are considered non periodontitis patients that do present with still a reduced periodontium. The key indicator here is that it is imperative for us as the treating clinician to identify, does our patient truly present with pristine health of the periodontium, where there's no clinical attachment loss whatsoever, or does the patient have a healthy gingival status yet we're seeing some attachment loss? The American Academy of Periodontology very much supports us as clinicians in understanding and identifying the various factors that can contribute to changes in our patients periodontal status.
Stay tuned as next week we continue the conversation in introducing the various layers of gingivitis as identified by the AAP in 2017. Thank you for joining in and 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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