Perio Staging & Grading

Gingivitis
(Gingival statement if there is gingival inflammation)

Choice A— Gingival Health

NO gingival condition is present, write “Gingival health”
YES, “Gingival Health (on an intact/reduced periodontium)” is checked off
NO Periodontitis

Choice B— Gingivitis

YES, a gingival condition is present
YES, “Gingivitis (biofilm induced)” AND “Gingivitis (on an intact periodontium / reduced periodontium) are both checked off
NO Periodontitis

Choice C— Periodontitis

NO gingival condition (write a gingival health statement)
NO Periodontal Health and Gingival Diseases/Conditions
YES, Periodontitis is checked off

Periodontitis

Considerations when classifying Periodontitis:
InterdentalCAL is detectable at ≥ 2 non-adjacent teeth 
OR
Buccal or oral CAL ≥ 3mm with pocketing >3 mm is detectable at ≥ 2 teeth

Observed CAL cannot be ascribed to non-periodontal causes such as:
-Gingival recession of traumatic origin
-Dental caries extending in the cervical area of the tooth
-Presence of CAL on the distal aspect of a second molar and associated with malposition or extraction of a third molar
-An endodontic lesion draining through the marginal periodontium
-Occurrence of a vertical root fracture

PERIODONTAL ASSESSMENT GUIDECONTRIBUTING (RISK) FACTORS GUIDE
The fillowing is a list of acceptable “Contributing Factors” related to the initiation and progression of periodontal diseases. It is important to note there must be a probable link to the client’s condition for the factor(s) identified. A client may present with factors listed below without them being a probable link to their specific oral condition.
This list is not exhaustive. Contributing factors must be considered on a client specific basis.
SYSTEMIC FACTORS:
tobacco smoking
diabetes
immune conditions (any condition with an oral implication), poor nutrition
systemic infections
disorders
allergic reactions
Hormonal influences: pregnancy, puberty, menopause
medications – diurectics, allergy medications, antidepressants, blood pressure, hormone therapy,
anticonvulscents, immunosuppressants, calcium channel blockers, (any medication with an oral side
effect)
alcohol use
LOCAL FACTORS:
calculus
dental caries
tobacco smoking
mature plaque biofilm related to increasing severity of periodontitis
malpositioned teeth, grooves, concavities
restorations poorly contoured, rough margins, overhangs
open contacts
crown contours
appliances – orthodontic, prosthodontic
oral jewelry
recession causing plaque retention
frenum pulls causing recession and plaque retention
gingival enlargement, psuedopockets,
occlusal trauma causing fremitus or mobility