The new periodontal classification system emerged from the 2017 World workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. The classification includes systemic modifying factors thus recognizing the role of factors such as diabetes and smoking on the onset and progression of periodontal disease. This article is written to give you a brief overview of the classification. For detailed information, please refer to all the related full text articles on www.perio.org/2017wwdc.
The previous classification system of periodontitis was mainly based only on the severity of the periodontal disease. For example: Mild, Moderate and Severe Periodontitis. The previous classification failed to capture factors of the disease such as complexity that influences approach to therapy (ex: furcations, mobility etc.). The New Periodontal classification system has a staging and grading system - instead of the previously used Case Types or descriptive severity.
Staging is utilized to classify the severity and extent of an individual based on currently measurable extent of destroyed and damaged tissue attributable to periodontitis. Staging also assesses complexity that may determine the complexity of the controlling current disease and managing long term function and esthetics of the patient’s dentition. Please refer to table 2 below for a detailed breakdown of the factors taken in to consideration while staging a patient.
Grading the periodontitis patient is to estimate future risk of progression in periodontitis. Grading also helps estimate the potential impact of periodontitis on systemic disease and the reverse to guide systemic monitoring and co-therapy with medical colleagues. Please refer to table 3 below for a detailed breakdown of the factors taken in to consideration while grading a patient.
The diagnosis for Periodontitis is now reported as a stage and grade. For example: What was previously reported as generalized moderate periodontitis is now reported as Generalized Stage II periodontitis; Grade A, B, or C.
Table 1: Framework for the new classification1
Table 2: Staging of Periodontitis1
While clinical attachment loss (CAL) is a primary determining factor of the staging, radiographic bone loss (RBL) can be used in the absence of clinical attachment loss. The presence of a complexity factor moves the staging to a higher stage. Patients who have been treated for periodontitis should be staged frequently to monitor them.
Table 3: Grading of Periodontitis1
Clinical implications:
The diagnosis for Periodontitis is now reported as a stage and grade. For example: What was previously reported as generalized moderate periodontitis is now reported as Generalized Stage II periodontitis; Grade A, B, or C. If the patient is diabetic with HbA1c of 8.o%, then the diagnosis is Stage II Grade C Periodontitis. In the absence of smoking or diabetes, the progression of the case is assessed to determine grading. Please refer to table 3.
References:
1 - Tonetti MS, Greenwell H, Kornman KS. Staging and grading of periodontitis: Framework and proposal of a new classification and case definition. J Periodontology. 2018;89(Suppl 1):S159– S172. https://doi.org/10.1002/JPER.18-0006
Thanks to Satheesh Keerthana DDS MS, Chair, Department of Periodontics, UMKC for her contributions to this article.
We have some additions to our Professional Relations team here at Delta Dental of Kansas! You may speak with these individuals on the phone, or see them at our events.
Meet Natalee Dye, Professional Relations CoordinatorMeet Natalee Dye, Professional Relations Coordinator
Delta Dental of Kansas (DDKS) is pleased to welcome Natalee Dye as the Professional Relations Coordinator. Natalee has spent most of her life in the dental field. Over the past 8 years, she has worked in both insurance coordinating and office management roles. Natalee also holds a Bachelor’s degree in the Modern French Language which she obtained from Wichita State University. With her extensive dental experience, Natalee is already proving to be a wonderful asset to the PR team in helping your dental office’s staff. We look forward to your office becoming familiar with a new voice to help you with your insurance business needs.
Meet Sydney Tuttle, Professional Relations Administrative Assistant
Sydney joined Delta Dental of Kansas as the Professional Relations Administrative Assistant in April of 2019. Sydney is from the Wichita area and comes to DDKS with many years of experience in office management, project supervision and administrative responsibilities. In addition to her administrative duties, Sydney is an additional contact to assist dental office staff with setting providers up in one or more of our networks as well as direct deposit. Sydney’s attention to detail and customer service makes her an excellent addition to the DDKS Professional Relations Team.