 Hello everybody, Andrea Majeski here with Dental L. Let's do a quick overview of our new perio classification. And by quick, I mean quick. So I'm not going to spend an hour talking about this because you'll probably fall asleep if I do do that. But I'm sure even at this point you have questions about it. If you were audited to submit your portfolio here in Ontario, that is something that we have to do as a dental hygienist and a lot of you probably had this as something that you had wanted to learn more about further if you have it already. So let me help you by breathing it down a little bit, okay? So to keep things short and sweet for now, basically this new system helps us to not only tell a patient, yes, you have severe periodontitis. And then we see them every three months and then we say yes, you still have severe periodontitis, but it's maintained, you know. So that was a very early and I guess old way of thinking. Now this new system is so nice because this will actually help us to really keep track of how their periodontal condition is either getting better, getting worse, staying the same whereas before we couldn't really monitor that other than doing our probing. And let's be honest, a lot of you guys probably aren't probing every single year. I know this may sound silly, a lot of you guys probably don't believe me, but I make sure that I probe at least every year, almost every six months if needed, because I find if I miss that year mark, then a year becomes two years. And what if I don't see that same patient next time, it might be somebody else in the office, they might not look at the perio chart and then they don't do the probe and then they have to wait another year. So it's just a good idea to get in the habit. So what I want to talk about here, so let's talk about first how do you come up with the different types of staging and then down here you have to look at A, B, or C. So let's talk about staging first. So again this might seem obvious to you, but you need to be doing those assessments. It's not good enough now to see a patient every six months do a quick recall exam and that's it. Every new patient needs a new patient exam. I actually have my own dental hygiene practice for a little over a year now and I do a new patient exam on every single patient. Even if a patient says to me, well I just want my teeth cleaned or I just want this or I don't have a lot of money, can I just have, you know, can I just have this or that. Everybody needs a new patient exam because if you can't do all of those assessments you won't be able to come up with what their overall prognosis is, you know, so you need to have that. So as an example, think about things like well how much plaque does your patient have, how much tartar are the gums bleeding every day while they're using a toothbrush, you know, did the patient actually tell you like, yeah my gums bleed all the time, that's why I don't use the dental floss, you know, do they actually say things to you. So the assessment is not only doing your probing or, you know, say okay, they have six millimeter pockets, the gums are bleeding, okay done. It's so much more than that. So the full assessment, think you have to look at what is the patient telling you? What do you see inside the mouth? When was the last time they had their teeth cleaned? Was it six months ago at another office? Was it 10 years ago? Have they never had their teeth cleaned in the past? Or do they brush every day? Do they brush twice a day? Do they use a water pick every day but not a toothbrush? You know, things like that. Do the full assessment. Even taking it a step further means do they use any tobacco products? Do they smoke cigarettes? They seem to be a thing these days. Are they doing that? Marijuana use? Are they doing that? Do they have any medical conditions? Are they taking any medications? All of that is involved in the assessment. And that sounds like a lot, doesn't it? So you can imagine how at a simple, let's say, one hour cleaning and exam appointment, you really don't get into any of that or most of it unless you do the new patient exam to ask them all of these questions. Even at a rake care appointment, I find a lot of people just simply ask, are there any changes in your health history? No, none. Okay. Moving on. You need to ask them more, like have you been to the hospital? Oh, actually, yes, I have. I did have a heart attack about six months ago. That's a major change, which would change things here. Okay, so let's just go and talk about it a little bit. So first, you need to look at the different types of staging. So this will actually look at the extent of the patient's overall disease and their tissue. Okay, so this looks at the extent. Grading on the on the other hand says, okay, now that we know the extent, how is that extent moving forward? Is it getting better? Is it getting worse? Is it getting worse but slowly or is it getting worse quickly? You know, so we need to look at both of them. But first, we need to look at the first step. So you need to look at, okay, so as an example, do they have no tooth loss? You know, things are looking okay. But they do have probing numbers of four millimeter pockets. Here in Ontario, for some reason, a lot of people think that if some if if, what am I trying to say, if somebody has a four millimeter pocket, they don't have perio. Yes, they do. Even if it's just one pocket of a four millimeter, they have localized perio just as an example. Oh, so I just thought that I would kind of say that. Um, but yes, so even if that's the case, so as I, you know, as I said, like a lot of people ask me, so my patient has two mil, two areas of four millimeter pockets. So what stage would they be in? Because they don't really have perio, do they? Yes, they do. Right here, you guys. So this is stage one. And then you have to say, well, is it localized? Or is it generalized? Because even if your patient has, let's say, four millimeter pockets in all of their molars and premolars, but they don't have any fives, you might be thinking like, hmm, they have a lot of fours, that's not good. Like that's worse than somebody who has one four millimeter pocket. So I kind of want to put that in there. If I just say that they're stage one, then that's not really helping, is it? Well, yes, it is. Because then you have to move on further and say, is it localized or is it generalized? And I had said that they have four millimeter pockets to the molars and premolars. So then I would take it a step further and say the molars and premolars, but they are still stage one. So even if somebody has one four millimeter pocket, they are stage one. If they have 24 millimeter pockets, they are still stage one because they don't have any higher pocketing. So that's just kind of an easier way to think about it. If that makes sense. And clinical attachment loss, clinical attachment level, however you want to interpret this, you need to look into that. Okay, so is it one to two millimeters? Is it three to four millimeters? Is it more than five or sorry, is it less than five? Is it more than five? You need to look into all of that as well. So so people might be asking me, well, what if they have more than one one stage? Well, that's a good question. So you, let's say they have clinical attachment loss of greater than five millimeters. They probably don't have four millimeter pockets in those areas. If they do, you are doing your probing wrong. If I can say that they might have four millimeter pockets in other teeth. But if they have even two, two areas of above five, then that puts them in another stage. So it's kind of like when we were using the old system. If somebody has, you know, one four millimeter pocket, but they have generalized five millimeter pockets. Well, they do not have have early period, they have moderate, we will we will always go above to the next stage. So I'll just say that one more time. So let's say somebody has a clinical attachment level of four millimeters. But they have some four millimeter pockets, some five millimeter pockets, you would still put them in that higher stage that they are in. So does that make sense? And this should be looked at once every single year. It doesn't need to be looked at more than that, but at least once every year. So once you have the different stages, then you need to move down here. So this is what I like, because this will actually help help you to determine like, Okay, how are things going to get worse? Is there a likelihood of things getting worse or better? Or, you know, what are kind of your thoughts there? So if somebody is a non smoker, then that's obviously a good thing. But let's say they smoke a cigarette a day or a cigarette a week, they're still considered a smoker. So you need to, you know, take that into account. So you have to look into, into all of this. So A, B or C, slow, moderate or, you know, quick. And keep in mind that if things are not getting better, and let's just say you are like me, where you have your own practice. If if their period isn't getting better, you need to send them off to a gum specialist, because you can't do everything. If their period is not getting better, you need to send them off and say, Okay, I need help. You might still be able to clean their teeth every six months. But every three months, they see the gum specialist. So keep that in mind. And another thing that they had made a note here is most people will probably be in the moderate rate, meaning if you see somebody, let's say you're seeing a patient for the first time, and they have generalized four millimeter pockets, we don't want you thinking like, Oh, it's just a four millimeters, not a big deal. We want you to think, Okay, this is a big deal. Because if things don't improve, then things can get worse very, very quickly. So shift your way of thinking, even if you see just one four millimeter pocket, you need to let the patient know and you have to let them know like, Okay, this is not a good thing. We need to see you every three months because this four millimeter pocket could become a lot worse. And if it becomes worse, then we have other problems here. So let's let's just stop that from happening. And then hopefully you'll have nothing to worry about. So sorry, guys, this was actually longer than I thought. Clearly, I'm passionate about this topic because I do love our new system. As you can probably see, I do have a lot of things open here. So I can leave the links for you guys on the bottom. If you guys check out this one, it's specific for us as a dental hygienist, it just sort of sums it down a little bit more for you as well. So I like this. I like this one too, where if you're looking for additional resources that they have everything here, including if you would like to print them for your own practice, you can just kind of click this here. I love that. Let's see what else that I want to show you guys. Again, just sort of summarizing it for why this new system is such a good system. But yeah, so I will leave Oh, that's a link that I have already. So I will leave the links for you guys on the bottom. I hope this helped. I will do another video shortly just sort of explaining everything in more detail. So I do hope you guys liked this. I hope you're still awake. Make sure to click like so that way I do know that people are actually watching because this is more of a lecture style, just sort of a summarizing of our new system here. So if this is the type of video you like, let me know, click like and I will talk to you guys soon and see you in the next one.