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

Fast Facts

Fast Facts: Perio Edition Episode 56

[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. You guys, we're going to talk about Grade C today. We've made it through Grade A slow rate of progression grade B moderate rate of progression in previous weeks. And this week we are talking about our patients that present with Grade C rapid rate of progression. And I want to remind you that anytime that a patient is diagnosed with active periodontitis, we are going to grade the patient as grade A,B, or C based on the progression of their disease process.
In taking a look at what we understand with regards to classifying a patient as a grade C, the first piece of evidence we will look at is the direct evidence, meaning longitudinally, have we seen any overt radiographic bone loss or clinical attachment loss? And for a patient with grade C, they have experienced either bone loss or clinical attachment loss of 2 mm or greater over the past five years. In perio, we see these patients all the time. Everything looked fantastic last year and all of a sudden this year we have a grade three furcation that would be an example of a patient who is experiencing just incredible rapid rate of progression of the disease process.
In addition, these can also be patients that have a high percentage of bone loss based on their age. An excellent example would be, for example, a 15 year old who presents with 50% bone loss. For that patient being so young, it is very concerning that they are experiencing that percentage of bone loss. These also are patients that present with a very unique case phenotype. The amount of destruction in their mouth exceeds the expectation given the amount or lack thereof of biofilm deposits. This is where we start to look at very specific clinical patterns that could suggest rapid periods of progression or early onset of disease.
So we go back to some of the things that we understood about aggressive periodontitis, where we may see a molar or incisor pattern, meaning the earliest of the secondary teeth or the adult dentition coming in are the ones that are presenting with this rapid rate progression of the disease process. But this is, of course, where we would likely see patients experiencing a lack of response that we would typically expect to see with standard bacterial control therapies. These could also be patients who are tobacco users who smoke ten or more cigarettes a day, or are diabetic patients who present with a hemoglobin A1C at or above 7.0%.
Finally, in the inflammatory burden category, these are patients who present with a high sensitivity C reactive protein reading above 3mg per liter. The idea here being that these patients who present with rapid rate progression of the disease process are patients who may not respond favorably to standard therapeutic modalities and may subsequently require more aggressive monitoring in order to stabilize or arrest their disease process.
With that, we've concluded the conversation around Grading! Stay tuned next week as we continue the conversation about some of the other different types of classifications of periodontitis that we can see in patients.
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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