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Understanding Periodontitis Staging and Grading

Apr 27, 2025

Staging and Grading in Periodontitis

Key Concepts

  • Staging and grading are only done for clients with periodontitis who exhibit bone loss.
  • Interdental CAL (Clinical Attachment Loss): Measure the highest CAL to determine severity.
  • Probing Depths: Consider the worst reading in the mouth.
  • Bone Loss: Analyze radiographic bone loss to assess the extent.
  • Lifestyle Factors: Smoking and other habits influence grading.

Example 1: 28-Year-Old Client

Clinical Findings:

  • Interdental CAL: 3-4mm
  • Probing Depths: Max 5mm
  • Mostly horizontal bone loss
  • Smoking: 1 pack/day

Staging Determination:

  • Highest CAL: 4mm (Stage 2-3)
  • Radiographic Bone Loss: Extends beyond middle third
  • Tooth Loss: None
  • Probing Depth: 5mm or less

Grading Determination:

  • Bone Loss Over 5 Years: 2mm or more
  • Smoking: 1 pack/day
  • Calculation: 80% bone loss / 28 years = 2.9 (Grade C)

Conclusion: Stage 3, Grade C

Example 2: 50-Year-Old Client

Clinical Findings:

  • Interdental CAL: 4mm
  • No tooth loss
  • Probing Depth: Max 5mm
  • Bone Loss: Coronal third
  • Horizontal bone loss
  • Non-smoker, Non-diabetic

Staging Determination:

  • Stage: 2 (Based on bone loss and probing depth)

Grading Determination:

  • Bone Loss Over 5 Years: <2mm
  • Calculation: 30% bone loss / 50 years = 0.6 (Grade B)

Conclusion: Stage 2, Grade B

Example 3: 47-Year-Old Client

Clinical Findings:

  • Interdental CAL: 5mm
  • Tooth Loss: 4 teeth
  • Probing Depth: 6mm or more
  • Radiographic Bone Loss: Middle third
  • Vertical bone loss
  • Not a smoker, Diabetic

Staging Determination:

  • Stage: 3 (Due to extent of bone loss and number of teeth lost)

Grading Determination:

  • Bone Loss Over 5 Years: <2mm
  • Calculation: 50% bone loss / 47 years = 1.0 (Grade B)

Conclusion: Stage 3, Grade B

Example 4: 53-Year-Old Client

Clinical Findings:

  • Interdental CAL: 5mm
  • Tooth Loss: >5 teeth
  • Probing Depth: 6mm or more
  • Radiographic Bone Loss: Middle third
  • Vertical bone loss
  • Non-diabetic, Smokes half a pack/day

Staging Determination:

  • Stage: 4 (Significant tooth loss and bone loss extent)

Grading Determination:

  • Bone Loss Over 5 Years: <2mm
  • Smoker: Half a pack/day

Conclusion: Stage 4, Grade B

General Tips for Grading:

  • If lacking detailed information, assume Grade B.
  • Always select the worst-case scenario for staging and grading.
  • Use percent bone loss over age for more accurate grading.

Conclusion

Understanding the methodology for staging and grading periodontitis is critical in providing accurate diagnoses and treatment plans. This involves assessing clinical attachment loss, probing depths, bone loss, and lifestyle factors such as smoking. Always choose the worst case for both staging and grading to ensure the client receives appropriate care and intervention.

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