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Fast Facts: Perio Edition - AAP 2017 Classification System - Grade B

Fast Facts

Fast Facts: Perio Edition Episode 55

[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. Will you “B” my favorite listener today? Today we're talking about AAP grading and specifically looking at our grade B patients. Last week we looked at grade A patients, patients that present with a slow rate of progression of the disease process. And today we're going to be looking at patients that present with grade B, moderate rate of progression.
A few things I want to note. First of all, when classifying patients as a grade, remember, these are patients that have active periodontitis, and we are identifying if they are a grade A, grade B or grade C. We should start by placing all patients into grade B, and if there are modifiers that move the patient into grade A because of direct evidence, indirect evidence, risk factors, or systemic burden for example, then we move the patient down into a grade A or we move the patient up into a grade C in some instances. But most patients are going to fall in a grade B moderate progression situation. From a progression process, first and foremost, direct evidence wise, the patient will have experienced some attachment loss over the past five years, but not any greater than 2mm of clinical attachment loss. So again, this would be a longitudinal data study in which you're looking at radiographic bone loss or clinical attachment loss over the past five years. If the patient has radiologic bone loss in tandem with their age, we're looking at anywhere between .25 - 1.0 being the range for how we would identify the numerator and denominators of bone loss and age. And from a case phenotype standpoint, the amount of destruction that the patient presents with, the amount of attachment loss, the amount of bone loss, the amount of exposure, of furcatious, mobility etc. Is going to be commensurate or in alignment with their biofilm deposits, meaning you see the amount of debris they have and you see the destruction and from a clinical standpoint, the progression and evidentiary pieces that lay out are very clear that this patient's destruction makes sense with the amount of biofilm.
From a grade modifier standpoint, this could be a patient who is a tobacco smoker but smokes less than ten cigarettes a day. This patient could also be a diabetic patient. However, this diabetic patient has controlled their hemoglobin A1C under  7.0%. And finally, when looking at the risk of systemic impact of periodontitis, this could be a patient, for example, that has a high sensitivity C reactive protein marker anywhere between one to three milligrams per liter.
I want to be very clear with these patients, you are going to take whichever identifier or modifier would move the patient into the higher grade, and that is going to be the weight that you will use to identify the patient's grade. Speaking of advanced grades, stay tuned. As next week, we talk about grade C of the periodontal disease process and what this means for our patients with advanced progression of 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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