How to Diagnose Periodontal Disease

‘Under-treatment may lead to disease progression, over-treatment will lead to loss of attachment’

Dr. David Dunivan, A.T. Still Missouri School of Dentistry and Oral Health

The severity of periodontitis is measured by the amount of clinical attachment loss¹ (CAL). A CAL of 1-2 mm is categorized as slight, 3-4 mm is categorized as moderate, and 5+ mm severe. We do not use pocket depths to determine the severity of periodontitis.

‘In general, a tooth with deep pockets and little attachment and bone loss has a better prognosis than one with shallow pockets and severe attachment and bone loss’

Carranza’s Clinical Periodontology, 12th edition

Are there other ways to categorize periodontitis?

Periodontitis can be divided into stages and grades. Stages are similar to the classification described earlier – Stage 1 is similar to slight, stage 2 is similar to moderate, and stage 3/4 similar to severe.

Grades reflect features of the disease, including the risk of progression, the anticipated treatment response, and the effects periodontitis may have on systemic health. Grades are divided into A, B, and C.

How do we differentiate stages 3 and 4?

The amount of tooth loss due to periodontal involvement is key when diagnosing the difference between stage 3 and stage 4 chronic periodontitis. If 4 teeth or less have been lost due to periodontal involvement, the disease would be indicative of stage 3 periodontitis. If 5 teeth or more have been lost due to periodontal involvement, the disease would be indicative of stage 4 periodontitis.

How do we differentiate the grades of periodontitis?

Grade A periodontitis is indicative of a slow rate of progression. This means that the patient is not a smoker, does not have diabetes, and theres is no evidence of bone loss over five years.

Grade B periodontitis is indicative of a moderate rate of progression. Patients with grade B periodontitis will have evidence of < 2 mm of loss over 5 years. These patients also do not have controlled diabetes, and smoke a moderate amount of cigarettes per day.

Grade C is the worst grade of periodontitis, and shows a rapid rate of progression. This means that they have evidence of 2 mm or more loss over 5 years. These patients smoke more than half a pack a day, and can have uncontrolled diabetes.

Glossary:

  • ¹Clinical Attachment Level – Reveals the approximate extent of root surface that is devoid of periodontal ligament

(n.d.) Periodontal Disease Classification. Dr. David Dunivan. A.T. Still Missouri School of Dentistry and Oral Health.

Carranza, F. A., & Newman, M. G. (2012). Carranzas clinical periodontology. St. Louis, MO: Elsevier Saunders.

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