The new periodontal classification *MUST WATCH FOR ALL DENTISTS*
TLDRThe video script introduces a new periodontal classification system released in 2018, following the World Workshop in Periodontology in 2017. The previous four categories of periodontal disease have been updated, with aggressive and chronic periodontitis now unified under the term 'periodontitis.' This new system includes staging from 1 to 4, which indicates the severity of the disease, and grading from A to C, which represents the rate of bone loss. Staging is based on radiographic bone loss, with stage 1 being less than 15% bone loss and stage 4 indicating the most severe form with potential complexity factors. Grading is determined by dividing the percentage of bone loss by the patient's age, with grade A being the slowest rate and grade C the fastest. The system also considers the extent of the disease and secondary criteria such as disease stability and risk factors like smoking or diabetes. An example using the system for a 45-year-old patient, Charlie, is provided to illustrate its application in clinical practice.
Takeaways
- 📚 The new periodontal classification system was introduced in 2019 following the World Workshop in Periodontology in 2017.
- 🔄 The old categories of aggressive and chronic periodontitis have been replaced with a single category called 'periodontitis'.
- 📊 Staging in the new system represents the severity of the disease with stages 1 to 4 corresponding to mild, moderate, severe, and the most severe forms respectively.
- ⚖️ Staging can now be based on radiographic bone loss rather than clinical attachment loss, with percentages indicating the extent of bone loss relative to the root.
- 🏷️ Grading represents the rate of bone loss that has already occurred, with Grade A indicating a slower rate, Grade B a moderate rate, and Grade C a rapid rate.
- 🧮 The grading calculation is simplified by dividing the percentage of bone loss by the patient's age.
- ⏳ A patient with Grade A bone loss may expect to lose about 30% of bone by age 18, Grade B up to 80% by age 80, and Grade C is likely to lose teeth in their 50s or 60s.
- 🔍 Diagnosis can include information about the extent of the disease, with 30% of teeth affected being the cutoff point between localized and generalized conditions.
- 🚑 The British Society of Periodontology (BSP) recommends including secondary criteria in the diagnosis, such as disease stability and presence of risk factors like smoking or uncontrolled diabetes.
- 🌰 An example provided involves a 45-year-old patient, Charlie, with stage 3 periodontitis, grade C, unstable disease, and risk factors including smoking.
- ⚠️ Clinical judgment and common sense should be used in conjunction with the classification system, rather than strictly adhering to specifications.
Q & A
What are the four main categories of periodontal disease in the old 1999 classification system?
-The four main categories were necrotizing diseases, periodontal diseases as a manifestation of systemic disease, aggressive periodontitis, and chronic periodontitis.
What new category replaces aggressive and chronic periodontitis in the new classification system?
-Aggressive and chronic periodontitis have been replaced with a single category called periodontitis.
What are the two key components of the new periodontitis category?
-The two key components are staging and grading.
How is staging determined in the new classification system?
-Staging represents the severity of the disease and is determined based on radiographic bone loss rather than attachment loss.
What does Stage 1 represent in terms of bone loss?
-Stage 1 represents less than 15% bone loss.
What are the three grades in the grading component and what do they represent?
-Grade A represents a slower rate of bone loss, Grade B represents a moderate rate, and Grade C represents a rapid rate of bone loss.
How is the grading calculated?
-Grading is calculated by dividing the percentage of bone loss by the patient's age.
What percentage of bone loss corresponds to Grade A?
-If the percentage bone loss is less than half the patient's age, it is Grade A.
How does the new system classify the disease in terms of affected teeth?
-The disease is classified as localized if less than 30% of the teeth are affected and generalized if more than 30% of the teeth are affected.
What additional factors are recommended to be included in the diagnosis?
-The diagnosis should include the stability of the disease and the presence of risk factors such as smoking or uncontrolled diabetes.
In the example provided, what stage and grade was Charlie's periodontal disease classified as?
-Charlie's periodontal disease was classified as Stage 3 and Grade C.
What risk factors and disease characteristics were noted in Charlie's diagnosis?
-Charlie's diagnosis noted a high bleeding score, pockets ranging from 5 to 7 millimeters, unstable disease, smoking as a risk factor, and generalized disease affecting most of his teeth.
Outlines
🦷 Introduction to the New Periodontal Classification System
The video introduces a new periodontal classification system released in 2018 following the World Workshop in Periodontology in 2017. It explains that the previous four categories have been updated, with aggressive and chronic periodontitis now combined into a single category called 'periodontitis.' This new category includes two key components: staging and grading. Staging indicates the severity of the disease, with stages 1 to 3 corresponding to mild, moderate, and severe categories, respectively, and stage 4 representing the most severe form with additional complexity factors. Grading represents the rate of bone loss, with grade A for slower, grade B for moderate, and grade C for rapid rates. The British Society of Periodontology (BSP) recommends using radiographic bone loss instead of attachment loss for staging. The grading is calculated by dividing the percentage of bone loss by the patient's age. The video also discusses the importance of considering the disease's stability and other risk factors, such as smoking or uncontrolled diabetes, in the diagnosis.
Mindmap
Keywords
💡Periodontal classification system
💡Staging
💡Grading
💡Bone loss
💡Clinical attachment loss
💡Periodontitis
💡Necrotizing periodontal diseases
💡Localized and generalized
💡Risk factors
💡Molar-incisor pattern
💡Complex rehabilitation
💡World Workshop in Periodontology
Highlights
Introduction to the new periodontal classification system released after the 2017 World Workshop in Periodontology.
The old 1999 classification system had four main categories, with necrotizing diseases and periodontal diseases as manifestations of systemic disease remaining unchanged.
Aggressive and chronic periodontitis have been replaced with a single category called periodontitis.
The new periodontitis category includes two key components: staging and grading.
Staging represents the severity of the disease, with stages 1, 2, and 3 synonymous with mild, moderate, and severe categories.
Stage 4 represents the most severe form of the disease, involving factors like vertical bony defects and excessive tooth mobility.
Staging can now be done based on radiographic bone loss instead of clinical attachment loss.
Stage 1 represents less than 15% bone loss, stage 2 has bone loss limited to the coronal third of the root, stage 3 reaches the mid third, and stage 4 reaches the apical third.
Grading represents the rate of bone loss, with grade A being slower, grade B moderate, and grade C rapid.
The percentage of bone loss divided by the patient's age helps determine the grade: less than half the age is grade A, greater than the age is grade C, and anything in between is grade B.
Example of the system: a 45-year-old patient with bone loss extending to the mid third of the root is stage 3 and grade C.
The patient's high bleeding score, pocket depths, smoking habit, and generalized disease are also considered in the diagnosis.
Diagnosis includes staging, grading, disease stability, and risk factors such as smoking or uncontrolled diabetes.
Staging and grading are based on the worst tooth in the patient's mouth.
Best practice is to use clinical attachment loss alongside percentage bone loss for diagnosis.
Emphasis on using clinical judgment and common sense when applying the new classification system.
Transcripts
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