Assessing periodontitis: clinical examples & key points - tutorial by Mariano Sanz

EFP European Federation of Periodontology
10 Apr 202011:34
EducationalLearning
32 Likes 10 Comments

TLDRThe video discusses the staging and grading of periodontitis, covering stages 1 to 4. Each stage is characterized by varying levels of clinical attachment loss, bone loss, and pocket depths. Stage 1 is incipient, while stage 4 involves severe tooth loss and complex rehabilitation needs. The grading considers factors like patient age, biofilm deposits, and risk factors such as smoking and diabetes. The goal is to classify periodontitis patients for personalized and precise treatment, emphasizing the importance of following this classification system for effective patient management.

Takeaways
  • 🦷 **Stage 1 Periodontitis**: Characterized by minor attachment loss of 1-2mm and no pockets deeper than 4mm, with bone loss affecting less than 50% of the root length.
  • 📏 **Stage 2 Periodontitis**: Clinical attachment loss between 3-4mm, with bone loss limited to the coronal third in at least two non-adjacent teeth (15-33% of root length).
  • 🔍 **Pseudo Pockets**: It's important to rule out pseudo pockets when evaluating probing pocket depths to avoid confusion.
  • 📉 **Stage 3 Periodontitis**: Marked by clinical attachment loss of 5mm or more, with tooth loss less than four due to periodontitis, and deep probing depths.
  • 🦴 **Bone Loss in Stage 3**: Vertical bone loss is more than 3mm, with involvement of vocational classes 2 and 3, and a moderate reach defect.
  • 📚 **Stage 4 Periodontitis**: Similar to stage 3 in terms of attachment loss, but with more than four teeth lost due to periodontitis and bone loss extending beyond the middle third.
  • 🚫 **Tooth Loss and Rehabilitation**: In stage 4, complex rehabilitation may be needed due to masticatory dysfunction from tooth loss, leading to bite collapse and severe reach defects.
  • 🔢 **Grading Periodontitis**: Grading (G1, G2, G3) is based on progression rate, risk factors, and patient-specific factors, which can change over time.
  • 👵 **G1 Grade Example**: A 50-year-old non-smoker with stage 3 periodontitis, no further attachment loss in five years, and heavy biofilm deposits, indicating a G1 grade.
  • 👴 **G2 Grade Example**: A 74-year-old patient with controlled diabetes and biofilm calculus deposits commensurate with destruction, maintaining a G2 grade despite being diabetic.
  • 🚬 **G3 Grade Example**: A 28-year-old heavy smoker with rapid progression and more than 2mm bone loss over five years, classified as G3 due to the rapid progression and smoking habit.
  • 📈 **Personalized Treatment**: The staging and grading system aims to classify periodontitis patients and individualize treatment plans, moving towards personalized and precision dentistry.
Q & A

  • What is the main purpose of staging and grading periodontitis?

    -The main purpose of staging and grading periodontitis is to classify the severity and complexity of the condition and to individualize treatment based on the patient's specific risk factors and progression.

  • What is the difference between stage 1 and stage 2 periodontitis in terms of clinical attachment loss?

    -Stage 1 periodontitis is characterized by 1 to 2 millimeters of clinical attachment loss and no pockets deeper than 4 millimeters. Stage 2 shows greater clinical attachment loss, between 3 and 4 millimeters, and may have deeper probing depths but still without very deep pockets.

  • How is bone loss assessed in stage 1 periodontitis cases?

    -In stage 1 periodontitis, the bone loss is assessed through full-mouth x-rays, where the presence of bone loss on at least two non-adjacent teeth affects less than 50% of the root length.

  • What is the significance of evaluating the cementoenamel junction (CEJ) in periodontitis cases?

    -The CEJ is significant because its visibility makes it easier to evaluate the extent of clinical attachment loss, which is crucial for accurate staging and grading of periodontitis.

  • Why is it important to consider the patient's phenotype and risk factors when grading periodontitis?

    -Considering the patient's phenotype and risk factors is important because it allows for a more personalized approach to treatment. Factors such as smoking status, diabetes control, and biofilm deposits can significantly influence the progression of periodontitis and the patient's response to treatment.

  • What are the characteristics of stage 3 periodontitis in terms of clinical attachment loss and tooth loss?

    -Stage 3 periodontitis is characterized by an interdental clinical attachment loss of 5 millimeters or more. The patient may have lost teeth, but if fewer than four teeth have been lost due to periodontitis, it remains classified as stage 3.

  • How does the grading system (G, A, B, C) relate to the progression of periodontitis and the patient's risk factors?

    -The grading system is used to categorize the rate of progression and the presence of risk factors. Grade G indicates no loss, A indicates slow progression, B indicates moderate progression, and C indicates rapid progression. This grading can change over time based on the patient's behavior and health status.

  • What is the role of full-mouth x-rays in the evaluation of periodontitis?

    -Full-mouth x-rays play a crucial role in visualizing bone loss and the extent of periodontal damage. They help in assessing the percentage of root length affected by bone loss and in identifying any tooth loss due to periodontitis.

  • Why is it necessary to differentiate between pseudo pockets and real pockets when evaluating periodontitis?

    -Differentiating between pseudo pockets and real pockets is necessary for accurate diagnosis and treatment planning. Pseudo pockets can mislead the assessment of the actual depth of periodontal pockets and may lead to an incorrect evaluation of the disease's severity.

  • How does the patient's age and the amount of biofilm deposits relate to the grading of periodontitis?

    -The patient's age and the amount of biofilm deposits are considered in the grading process to determine if the destruction is commensurate with the expected progression for that individual. This helps in assessing whether the rate of periodontal breakdown is rapid or slow.

  • What is the goal of personalized and precision dentistry in managing periodontitis?

    -The goal of personalized and precision dentistry is to tailor the treatment to the individual patient's needs, taking into account the severity of the disease, the patient's risk factors, and their response to treatment, to achieve the best possible outcome.

  • How can a patient's compliance with treatment affect their grading?

    -A patient's compliance with treatment can significantly affect their grading. Good compliance can potentially turn a rapid progression into a non-progression or slow progression, thereby improving the patient's periodontal health status.

Outlines
00:00
😀 Stage 1 and 2 Periodontitis: Clinical Evaluation and Radiographic Assessment

The first paragraph introduces the staging and grading framework for periodontitis, using clinical examples to illustrate the process. It describes a Stage 1 periodontitis case, characterized by minor attachment loss of one to two millimeters and no pockets deeper than four millimeters. The radiographic assessment reveals bone loss affecting less than 50% of the root length in at least two non-adjacent teeth. The paragraph then contrasts this with a Stage 2 case, which is easier to detect due to greater clinical attachment loss between three and four millimeters and bone loss limited to the coronal third in at least two non-adjacent teeth. The importance of differentiating between true and pseudo pockets is emphasized, and the absence of tooth loss in these stages is highlighted.

05:00
😕 Stage 3 and 4 Periodontitis: Advanced Cases and Risk Factor Considerations

The second paragraph delves into Stage 3 and Stage 4 periodontitis, which are more severe and involve greater clinical attachment loss and bone loss. Stage 3 is marked by an attachment loss of 5 millimeters or more, with tooth loss limited to less than four teeth due to periodontitis. The patient's charting shows deep probing depths and a high percentage of bleeding on probing. Stage 4 is similar in terms of attachment loss but involves more extensive bone loss and tooth loss of more than four teeth due to periodontitis. The paragraph also discusses the impact of risk factors such as smoking and diabetes on the grading of periodontitis, using examples of patients with different grades (A, B, and C) based on their progression rate, biofilm deposits, and systemic conditions.

10:03
📚 Staging and Grading for Personalized Periodontal Treatment

The final paragraph emphasizes the goal of the staging and grading system: to classify periodontitis patients and individualize treatment based on the severity, complexity, and patient-specific factors. It acknowledges the system's complexity but assures that it is simpler than it appears and can be easily implemented by following the outlined steps. The paragraph concludes by stressing the importance of this classification system for achieving personalized and precision dentistry, which is the future approach to patient care. It also highlights how patient behavior, such as smoking cessation or diabetes control, can influence the grading and thus the treatment plan.

Mindmap
Keywords
💡Periodontitis
Periodontitis is a chronic inflammatory disease affecting the structures around the teeth, leading to the destruction of the gums and bone that support the teeth. In the video, it is the central theme, with staging and grading used to classify the severity and progression of the disease.
💡Staging
Staging in the context of periodontitis refers to the classification of the disease based on the severity of the condition. The video outlines different stages, from stage 1, which is an incipient form of the disease, to stage 4, which indicates a more advanced and severe form of periodontitis.
💡Grading
Grading is the process of evaluating the rate of progression and the presence of risk factors in a patient's periodontitis. It helps in determining the aggressiveness of the treatment required. The video emphasizes the importance of grading in tailoring the treatment to the individual patient's needs and risk profile.
💡Clinical Attachment Loss (CAL)
Clinical Attachment Loss is a measure of the loss of periodontal attachment, which includes both the gum and the bone supporting the tooth. It is a critical diagnostic criterion in staging periodontitis. The video discusses how CAL is assessed and its significance in determining the stage of periodontitis.
💡Probing Pocket Depth
Probing pocket depth is the measure of the depth of the space between the tooth and the gum. It is an essential diagnostic tool in periodontics. The video explains how the presence of deep pockets, typically 5 millimeters or more, can indicate a more severe stage of periodontitis.
💡Full-mouth X-rays
Full-mouth X-rays are a series of dental X-rays that provide a comprehensive view of all the teeth and supporting structures in both the upper and lower jaws. They are used to assess bone loss in periodontitis. The video uses full-mouth X-rays as a diagnostic tool to evaluate the extent of bone loss in different stages of periodontitis.
💡Bone Loss
Bone loss refers to the resorption or destruction of the alveolar bone that holds the teeth in place. It is a significant indicator of periodontitis progression. The video discusses how the extent of bone loss is evaluated and its relevance in staging and grading periodontitis.
💡Cementoenamel Junction (CEJ)
The cementoenamel junction is the point where the enamel of the tooth crown meets the cementum of the tooth root. It is a landmark used in periodontal assessments. The video highlights the importance of the CEJ in evaluating the presence and severity of periodontitis, particularly in the early stages.
💡Risk Factors
Risk factors are variables that increase the likelihood of a disease or condition. In the context of the video, risk factors such as smoking, diabetes, and poor oral hygiene are discussed in relation to their impact on the progression of periodontitis and the grading of the disease.
💡Tooth Loss
Tooth loss is the loss of natural teeth due to various reasons, including periodontitis. The video uses tooth loss as a criterion for staging periodontitis, with the number of teeth lost influencing the classification of the disease's severity.
💡Personalized Dentistry
Personalized dentistry refers to tailoring dental treatments to meet the individual needs, preferences, and conditions of each patient. The video emphasizes the goal of moving towards personalized and precision dentistry by using staging and grading to individualize treatment plans for patients with periodontitis.
Highlights

Reviewing the framework for staging and grading periodontitis using specific criteria.

Clinical example of stage 1 periodontitis with minor attachment loss and no deep pockets.

Evaluation of radiographic evidence for bone loss in stage 1 periodontitis cases.

Stage 2 periodontitis characterized by greater clinical attachment loss and no very deep pockets.

Importance of discerning pseudo pockets from true periodontal pockets.

Radiographic identification of bone loss limited to the coronal third in stage 2 cases.

Stage 3 periodontitis easily detected with significant clinical attachment loss.

Criteria for stage 3 include loss of fewer than four teeth due to periodontitis.

Clinical charting and radiographic evidence of deep probing depths and bone loss in stage 3.

Stage 4 periodontitis involves loss of more than four teeth and more extensive bone loss.

Assessment of complex rehabilitation needs due to masticatory dysfunction in stage 4 cases.

Grading periodontitis based on progression, risk factors, and patient-specific factors.

Example of a grade A periodontitis patient with no further attachment loss in five years.

Grading can be revised based on changes in patient behavior or health status.

Importance of a personalized and precision approach to periodontitis management.

The staging and grading system aims to classify and individualize treatment for periodontitis patients.

Emphasis on the simplicity and implementability of the classification system for clinicians.

Final goal is to move towards personalized and precision dentistry for future patient care.

Transcripts

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Periodontitis StagingDental GradingClinical AttachmentBone LossTooth LossSmoking ImpactDiabetes ConsiderationRisk FactorsDental HealthPersonalized DentistryPrecision Medicine