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Staging and Grading of Periodontitis: What You Need to Know

March 25, 2020

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.