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Fast Facts: Perio Edition - Periodontitis - AAP 2017 Classification System

Fast Facts

Fast Facts: Perio Edition Episode 46
[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 continue the dialog around the AAP 2017 classification system. And this week we're going to start looking at periodontitis. In previous episodes, we looked at the clinical spectrum of health, we looked at health on a reduced periodontium. We looked at gingivitis, both biofilm and non-dental biofilm induced and last week we looked at necrotizing periodontal diseases. This week, as we continue to focus on periodontitis, it's important for us to understand that periodontitis has kind of been through a makeover. Periodontitis previously was described as either chronic or aggressive perio. So we remember, for example, that chronic perio was really kind of that slow, progressive, destructive form of periodontitis versus aggressive perio, where we saw that in some cases we had this high progression, this rapid progression, early onset perio or highly destructive forms of periodontitis. And it's important to note that in 2017, the American Academy of Periodontology took a step back and said these are not two different types of diseases. Moreover, that periodontitis itself is characterized as a chronic, multifactorial inflammatory disease. And this particular disease is associated with dysbiotic plaque biofilms and characterized by progressive destruction of the tooth supporting apparatus. OK, let's unpack that. Perio is chronic. Chronic meaning that it is a slow or subsequently progressive condition. But this is a condition that is going to require complex rehabilitation and maintenance. It is multifactorial, meaning we're not just talking about bacteria alone, but the fact that periodontitis can be associated with other types of factors that can contribute to or exacerbate the disease process. Periodontitis is inflammatory, meaning we begin to see a reaction from the host. The presence of biofilm, in addition to the exacerbation of risk factors, creates a situation where the body begins to create an inflammatory response. The liver begins to release C reactive proteins, our mast cells begin to release inflammatory cytokines and the body goes into inflammatory mode. This disease process is associated with dysbiotic plaque biofilms, which is a fancy term for an imbalance in this biofilm. This biofilm is not simply a biofilm that presents with high concentrations of health producing bacteria.
We're seeing an imbalance where now the highest concentration of bacteria discovered in the biofilm itself is pathogenic bacteria, bacteria that is disease producing or onset of disease. And subsequently, this type of an inflammatory condition is characterized by progressive destruction. The attachment apparatus that supports the tooth structure becomes destroyed.
It's important for us to understand what this definition means, because within the scaffolding of this definition, we understand that primary features of periodontal disease can include loss of periodontal tissue support as seen in clinical attachment loss and or radiographically assessed movement of alveolar bone levels, as well as the presence of advanced periodontal pocketing and gingival bleeding.
We continue to see that periodontitis accounts for an incredible amount of edentulous patients, as well as masticatory dysfunction. And we begin to see as well that periodontal disease now being categorized as periodontitis alone, is also being classified or rather characterized by a stage and a grade.
The next few programs that we're going to be taking a look at are going to unpack what we know about staging and grading patients that present with active periodontal disease. Thank you for tuning in today. Have a wonderful week and we'll see you next week as we discuss an introduction to staging periodontal disease.
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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