Periodontal Staging and Grading

Periodontitis presents differently for everybody. A recent change to the classification of periodontal disease helps your periodontist express the severity and complexity of the disease (Staging) as well as the patient’s risk for progression (Grading).

The four stages (stage 1-4) of periodontitis are determined by several variables. Staging intends to classify the severity and extent of a patient’s disease based on a measurable amount of destroyed/damaged tissue from periodontitis. Next, we look at the patient-specific factors that contribute to the complexity of long-term management such as probing depths, the number of lost teeth, the shape of bone loss, access for hygiene, occlusal trauma, tooth alignment, and many others. Extent and distribution can be further subdivided into localized (<30% of teeth involved) or generalized (>30% of teeth involved).

Next, your periodontist will assess the rate of progression (Grade A, B, and C) for their specific patient. This is determined usually by comparing the patient’s disease level to their age. The periodontist will also compare the amount of bacterial biofilm to the destruction level. Extensive disease seen in younger patients or with minimal bacterial deposits represents a high rate of progression (Grade C). A slow rate of progression (Grade A) would be seen in older patients or patients with heavy biofilm deposits that show minimal periodontal bone destruction. Also, a periodontist will compare radiographs taken over time to further assess rates of progression. Lastly, certain risk factors are associated with progressive bone loss including smoking and diabetes. By including these grade modifiers, your periodontist can discuss taking an active role in the management of these conditions as well.

All in all, this Staging and Grading system helps your periodontist provide a patient-centered evaluation and treatment plan as well as an effective way to communicate more clearly with our patients.