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Fast Facts: Perio Edition – AAP 2017 Classification System – Grade A

Fast Facts: Perio Edition Episode 54

[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. Okay, everybody, now that you are experts in introduction to grading and current grading parameters, let’s take a look shall we, at how we identify Grade A for a patient. And I want to be very clear. We grade patients who have active periodontal disease. Some clinicians do get in the habit of grading all patients. That is not necessarily a requirement from the AAP, but some of our colleagues have started to integrate grading our patients that have gingivitis based on other overt risk factors that may elevate the propensity that the patient may experience gingivitis moving into periodontitis in a faster progression.
Nevertheless, let’s take a look shall we? Grade A: this is considered a slow rate of the disease process, meaning the patient has active periodontitis, yet the disease process itself is very slow moving. And here’s the criteria we look at. First, from a direct evidence standpoint, this patient has not experienced any radiologic bone loss or clinical attachment loss over the past five years. In addition, we can also take a look at things like indirect evidence, meaning the amount of bone loss based on the patient’s age is minimal. If you take the amount of bone loss and you divide it by the patient’s age, it should be less than .25. So to really think about this, this should be a patient who, based on their age, is not experiencing overt bone loss.
Their case phenotype. These are patients that will likely present with high biofilm concentrations. They have plaque everywhere, and when you debride that plaque and underneath where you should see tons of attachment loss, you should see tons of overt bone loss. What you actually see is low destruction. When patients present with heavy biofilm, but low destruction. It indicates that from a risk factor standpoint, we may not necessarily experience a very quick or very overt reaction of the body to the presence of biofilm.
From a grade modifier standpoint, this is a non-tobacco user and a non-diabetic patient. I want to be very clear. The moment the patient is a diabetic or is a tobacco user, the patient will automatically move into a Grade B or grade C based on the identifiers of how much they smoke or in the diabetic case, what their hemoglobin A1C rating is.
One final piece that I will share is that as we’re looking at systemic impact, patients that are considered a grade A slow rate will have a low concentration in their high sensitivity C reactive proteins: less than 1mg per liter. And this, of course, is identified in the practices that are a bit more progressive and are measuring these systemic inflammatory markers.
Stay tuned next week as we talk about Grade B, moderate rate and progression of the disease process.

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!

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