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

Fast Facts

Fast Facts: Perio Edition Episode 51

[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 Fact: Perio Edition. You guys, we almost did it. Here we are concluding the conversation about staging periodontitis. Last week we looked at stage three periodontal cases and identified that these are patients in which we are experiencing several different clinical modalities. Of note, we looked at stage three periodontal cases in which patients are experiencing deep periodontal lesions that extend into the middle portion of the root and beyond. These are patients in which there is complex management required in order to stabilize the patient's existence of this disease.
And so patients are going to experience things like advanced probing depths of 6 mm or above, vertical bone loss, furcation involvements of class two or three, and moderate ridge defects. Radiologically the bone loss extends into the middle third of the root and beyond. Why is that important? Because a stage four periodontal case experiences all of those complexities however, in a stage four case and this is the only major difference, the patient has or will lose five or more teeth due to the periodontal disease process.  Meaning they've either lost the teeth already or doctor has deemed these teeth as having hopeless prognosis and requiring extraction of five or more teeth.
When this occurs, there is complex rehabilitation that is needed because the patient likely is experiencing things like masticatory dysfunction. Perhaps the patient is experiencing a situation where multi rooted teeth have been extracted and so single rooted teeth are performing the function of multi rooted teeth. Perhaps they are experiencing mesial drifting, tipping, or super eruption. And in situations like this, we will typically see other types of clinical modalities manifesting. These could be things like secondary occlusal trauma, they could have severe ridge defects, their bite could be collapsed or drifted, or there could be flaring or in extreme cases, the patient may have less than 20 remaining teeth.
This masticatory dysfunction results from the considerable damage of periodontally supported tissues, and it should be very clear that in these situations the Academy identifies that in the absence of proper control of periodontitis and adequate rehabilitation, the remaining dentition is at risk of being lost. Meaning we do need to consider that rehabilitation with some type of a device to repair the missing tissues. This could be a fixed prosthetic, like a bridge. This could be a removable prosthetic like a partial or a full denture, a dental implant, an all on four or an all on six case.
It is imperative to understand that this adequate rehabilitation is being done in order to preserve the remaining dentition. This case management requires stabilization or restoration of masticatory function. And of course, it's very clear that this complication for most patients is due to the sequelle of tooth loss affiliated with the activity of periodontal disease to begin with. With that we've done it. We've discussed all there is to know about staging of periodontitis. Stay tuned next week as we begin discussing grading, the newest parameter coming down from the AAP.
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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