 Hello everybody. Good afternoon. Andrea Trust here with Dental Tutoring. Let's talk about perio. So whether you are a general hygienist or a dental assisting student, perio is always something that you have to constantly study, constantly look at, and if you haven't noticed yet there's perio case types, there's perio categories, so things can get very very confusing but I'm going to make it a little bit easier for you today and hopefully explain it in such a way where even you looking in your textbook and reading your notes from school, this will make a lot more sense because I know how confusing, I know how complicated things can be. So I will be going through your perio case types. Okay so not the categories, not the different methods but perio case types. So we're talking the case type 1, 2, 3, and 4. Okay so let me talk about them first. So I'll go through all of them and then I'll talk about each of them one by one. So the first one is your gingival case type. The second one is is early perio. The third one is moderate perio and the fourth one is advanced perio. Now some textbooks call it also severe perio but the right way to do it, the best way to do it, if you are studying for the board exam for example, is the last stage is called advanced perio. So depending on the textbooks you look at depending on if you're from Canada or from the States too, that can change but they all kind of mean the same thing. So whether you learned advanced perio as your fourth stage or severe perio, it means the same thing. So let's talk about the first one first. So gingival diseases. So you might be confused thinking how is that part of the perio case types if gingival diseases isn't perio. Well what they just talk about is just simply perio, sorry not perio. They just talk about the gingival only. So your gingiva, gingival area. So they're not talking about the ligaments around the teeth which classifies perio. So the first case, I know it sounds confusing but has nothing to really do with perio. Yes it is a perio case type but case type one has nothing to do with perio. I think they put it in there because you kind of, I'm not saying that you need to have gingivitis to get perio because that's not really the case but usually before you get perio your gingiva is red, it could be sore, it could be unhealthy, it could be bleeding, like things always have to start from somewhere. So I think that that's why they put that in as case type number one. So gingival disease is case type number one and that is just simply talking about your gingiva could be red, it could be bleeding, there could be swelling even, there could be pus. So it's just things are not healthy. So does that make sense so far? Yeah, okay. So case type two is early perio. So early perio and listen up here is four millimeter pockets. So not five, not six, not three, but early perio is four millimeter pocket because as soon as you have perio you have a four millimeter pocket even if you only have one tooth, one area with a four millimeter pocket and all of the other areas are threes, twos, ones even you still have perio and that's case type number one. Let me just check my notes here. So in the textbook they say that early perio there's slight bone loss but technically you do not notice any bone loss until you get a millimeter of five but they do say slight bone loss because yes early perio means four millimeter pockets but it could also be a four point two, a four point four, a four point whatever right but as soon as you hit that five millimeter pocket you are automatically into the next stage moderate perio. So but to know for the board exam early perio you could have slight bone loss. You can't really tell unless you have a look in an x-ray and in the x-rays you can't tell until you have at least a five millimeter pocket but that's what it says in the textbook. So a nutshell is the first stage is your gingival diseases, the second stage is early perio there could be slight bone loss and early perio is a four millimeter pocket. Okay let's see. So the third case type is moderate perio. I just I left myself some notes to make sure I didn't forget anything. So this is where you have the five to six millimeter pockets likely you have a bone loss as well okay so likely you do you do have that and the tooth could start to become loose also because if you have a five or six millimeter pocket if you think about it your instrument is going in there pretty far so it would make sense to have slight bone loss okay so that's the third case type. The fourth and the last one is advanced perio so think your seven millimeter pocket and up and that would be you have a lot of bone loss at this point your teeth would be quite loose or your tooth you know wherever the advanced perio is and you would likely see some for patients so does that make sense to everybody so far so I tried to explain it in a much easier way I do hope that helps let's do a quick recap so the case type one is your gingival diseases okay so that involves your gingival only so think if the gums are red bleeding sore something like that. Case type two is your early perio so that starts at four millimeter pocket there could could be evidence of bone loss stage type three or sorry case type three would be your moderate perio so that's your five to six millimeter pockets there's likely some bone loss happening and the teeth or tooth is probably a little bit loose also the last case type is case type four and that's known as advanced perio and that's seven millimeter pockets or more there's probably quite a lot of bone loss probably quite a lot of mobility in that area and you start to see some for patients so does that make a little bit more sense I do hope so I'm just checking my nose to see if I forgot anything so I could get into a lot more detail but I tried to keep it simple for you if you guys have questions as always please let me know