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Fast Facts: Perio Edition – “AAP 2017 Classification System – Current Grading Parameters

Fast Facts: Perio Edition Episode 53

[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]
Welcome back, everyone. You are listening to another episode of Fast Facts Pario Edition, brought to you by a tailor to hygienist and partnership with dentist RX. And now please welcome your host, Katrina Sanders.
Hello, and welcome to Fast Facts: Perio Edition. All right, everybody, get ready to roll up your sleeves as we start looking at some of the parameters that we use currently, when we’re looking at grading guidelines. I want to be very clear this is an ever evolving topic, and so depending on when you’re listening to this, it is possible that the AAP may have even updated some of the pieces that we’re looking at with regards to grading. Of note, the AAP States that we really need to, when classifying a patient as grade A, B, or C, look at recognized risk factors.
Currently, these various types of risk factors are going to be outlined within our grading entity. First and foremost, when we take a look at grade, we look at primary criterion. This primary criterion will either be direct evidence, meaning if we can take a look at a survey of dental radiographs and periodontal charting over the past five years, we can directly identify if the patient has experienced a slow, a moderate, or a rapid rate of the disease process over those five years, and that’s great… If we have that information. We all know that if a new patient shows up in the practice without their previous charting or radiographs, or if we simply don’t have quality images or Pario charting, we can’t necessarily lean on that. So another evidentiary piece that we look at is indirect evidence. And there are two major pieces that we look at with regards to indirect evidence. The first is the percentage of bone loss over age. So essentially, we’re looking at how much destruction or bone loss has the patient experienced, and is that appropriate based on what we may expect from the patient’s age? Is it extremely advanced? For example, if we were to see an 18 year old with 50% bone loss, I think most of us would agree that would be very concerning to see somebody that young experiencing that amount of bone loss, and so that can absolutely elevate the rapid nature or the progression of the disease process for that patient. We also look at what’s called case phenotype, the amount of biofilm in the patient’s mouth, and how the patient is going to respond to that biofilm. We also look at grade modifiers, and this is where we’ve looked at recognized risk factors like cigarette smoking or the metabolic control of diabetes because we understand that these affect the rate of progression of Perio. However, we’re also looking at other emerging risk factors that may be added. Things like obesity, genetic factors, physical activity, or nutrition. Finally, the Academy has also added in two new markers as of their initial publication in 2017. The first is the risk of systemic impact, the inflammatory burden, or the concentration of high sensitivity C reactive proteins or the presence of very specific biomarkers as I identified or outlined in our saliva our gingival crevicular fluid or serum levels, which could be vast indicators of clinical attachment loss or progression of bone loss.
Stay tuned in the coming weeks as we look very specifically at what a grade A, grade B or grade C patient will look like.
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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