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Fast Facts: Perio Edition - AAP 2017 Classification System - Stage I Periodontitis
Fast Facts: Perio Edition Episode 48
[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. [Singing] "Let's talk about Stage Baby. Let's talk about"... Okay, I'll spare you guys and not sing! I'm here today because we're going to begin the conversation around AAP staging and grading, beginning with discussing stage one periodontitis. Now, stage one periodontitis is tough for clinicians because I want to be very clear, according to the American Academy of Periodontology, stage one periodontitis is considered the borderland between gingivitis and periodontitis, and so because of that, sometimes we'll have patients that kind of sit on that teeter totter in-between "Is this 4mm pocket gingivitis or is this 4mm pocket periodontitis?" And so it's important for us to understand when we discuss specifically stage one periodontitis that the AAP classifies stage one perio as the earliest stages of attachment loss. Patients with stage one periodontitis have developed this early onset periodontitis in response to persistent inflammation. So again, these are going to be patients that of likely presented with reversible gingivitis before, and that persistent inflammation has now created the earlier stages of attachment loss as well as biofilm dysbiosis, which is just a fancy term for an imbalance between health and disease producing bacteria.
So typically, when these patients present with clinical attachment loss, I want to be very clear, the AAP in their framework indicates a patient with stage one periodontitis as a patient who has a pocket depth maximum anywhere in the mouth of 4mm. And I want to be very clear when we talk about a 4mm periodontal pocket what we're specifically talking about is the fact that we have forgiven a biological sulcus or collar of gum tissue around the neck of the tooth. Remember, we typically forgive anywhere between 1mm to 3 mm as a healthy sulcus or gingival pocket. And so if we are presenting with a 4mm pocket and that it's a true 4mm pocket in that we're not seeing that 4 mm due to hyperplasia tissue overgrowth or fibrosis, but rather we're starting to see the early break in 1mm to 2 mm around that CEJ, and we're starting to see that apical migration of the junctional epithelium. This is when we begin to understand that the patient is now beginning to present with early onset clinical attachment loss.
First and foremost, I want to be very clear.The patient will present with maximum anywhere in the mouth of a 4mm periodontal pocket. In addition, if the patient does present with radiologic bone loss, it's going to be less than 15%, which is oftentimes very difficult to observe on a radiograph. The patient, if they do present with any radiologic bone loss, it will be mostly horizontal in nature.
I want to conclude by sharing that this patient has not lost any teeth due to the periodontal disease process and our Academy indicates that stage one periodontally diseased patients have an opportunity for early intervention and monitoring.
Stay tuned next week as we talk about stage two periodontitis.
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!