 Hello everybody, Andrea Maesky here with Dental L. Well, let's talk about the new periodontal staging and grading classification. So this has been out and a lot, there's room for confusion for sure because it's something new. But we haven't updated our perio classification looking at gingivitis and perio for decades, at least 10 years. I don't know if it's been longer than that, but it's been at least 10 years. So it's time for a change. It makes sense. If you're anything like me, you don't like change. So as soon as I heard that there's a new classification out, I kind of thought, oh, you know, you have to learn something new. But it's not as difficult as it looks. When I first saw this, I thought it looked very confusing. It was difficult. It just looked completely different. But the nice thing is when you're looking at whether the patient has gingivitis or perio, the nice thing is that you can now, for perio especially, you can decide what stage perio they are in. So not just simply saying early, moderate or severe, but taking it a step further and saying, do they have they had perio, but now they're, you know, teeth, gums, everything is perfect or do they have perio but they're continuing to improve or did they have perio and they don't have perio now but they're kind of going back and forth between one visit they have perio, the next visit, okay, things are improving, but then the next time, oh, they have some five millimeter pockets, you know? So the nice thing is you can classify them even further and in different categories. So when you open up the chart, you'll be able to tell like, okay, the patient has active perio now, but this is their first time having perio and they're 35 years old or this patient does not have perio but we have had to watch them, you know? Think of stages of cancer, you know? Somebody gets cancer, they're at a certain stage but you want them to get healthy but even once they get healthy and they're in remission, once that happens, they still have to get checked by the doctor sometimes every three months, sometimes every six months and sometimes every year depending on the stage and type of cancer they were in. So perio is something similar where they may have had perio before, they might not have that now but they can't just stop coming to see us. We can't just say, okay, you are perfectly healthy, we'll see you now every year done and done, no. We will probably still have to be seeing them every three months to make sure that that perio doesn't come back and just like cancer, you know, if you want to compare the two, once somebody is in remission, they're going to do everything they possibly can to not to stay that way, so to not get cancer anymore. Perio is the same thing, once they don't have perio anymore, they're in remission from perio in a sense. They will want to do everything that they possibly can to stay that way and then seeing us every year isn't doing everything that they can to not get perio again. So does that make sense? So I did leave myself some notes here to kind of talk to you guys about this. Actually, let me zoom in because I know sometimes it's a little bit difficult to see. Sorry guys, just takes a second. Let me zoom in for you guys. So my apologies, I should have zoomed in quicker, but that's okay because we haven't actually started talking about it yet. So let me zoom in here. There we go. So I'm going to talk about the first part and I did leave myself some notes. So if you guys see me kind of checking over a couple of things, that's just kind of what I did. So let's look at the different levels first. So we're not quite looking at the staging yet, but let's talk about the different levels. So if somebody's perfectly healthy would be one. So their gum health is perfectly healthy. Level two is where they have well maintained perio health. So yes, they might have four millimeter pockets, but they're well maintained and you don't expect them to get further from that. And then the next one would be their perio disease is now at a stable condition. So let me explain those three levels a little bit better. So obviously if somebody's in perio health, this means they're healthy. So there's no sign of redness, of inflammation. There's just no sign of perio. There is no attachment loss, none of that. So that's healthy. That's pretty easy, right? So let me just kind of move on from here guys, sorry. So then we're looking at let's say somebody's perio is well maintained, okay? So this is where they might have four millimeter pockets, but they're doing everything they can to get that healthier and things aren't getting worse, but things are improving. And then the last one would be if they've had perio before, but they don't have it now. And if you look inside their mouth, yes, things aren't perfect. They might have eight millimeter pockets, you know, or they have a six millimeter pocket, but their clinical attachment loss is quite higher. So no things aren't perfect, but there's no plaque, no tartar, there's no signs of inflammation overall. So those are just kind of different things to think about. But now let's talk about the actual stages. So when somebody has perio, you will need to now determine at what stage they are at. So stage one. So clinical attachment loss of one to two millimeters at the most, but what's important to note is that their perio pocketing would be at four millimeters or less, okay? So one, two and three. So pockets of one, two and three is considered healthy. So they do not have perio at that point. But as soon as they get a four millimeter pocket, that is perio. So to keep it simple, you guys, that would be stage one, okay? So stage one is where they have perio, a pocket of a four. So that's the initial stages of perio. At this point too, it says here that bone loss is less than 15% if at all, okay? So just something to keep in mind. So bone loss less than 15%. But I like to say that to my patients too. I want them to know, okay, perio is not a good thing. You are at the initial stages of perio. If things are left to get worse, that's not a good thing, okay? But even if they're at stage one, you need to determine is this going to be localized or is this going to be generalized where it's more than 30%. So that is something that you will have to calculate too to determine that. This can be easy in some cases, if let's say they have one pocket of a four millimeter, well, you know that that's localized stage one. That would be localized. If they have all of the molars, all of the premolars of a four millimeter pocket, then you can say, well, that's not just localized, that's more of a generalized thing to look at. So then stage two would be three to four millimeters clinical attachment loss. So still five millimeters pockets or less. So as soon as you get to that stage where they have a five millimeter pocket, even if it's only the one, that is stage two. Because you don't want to tell somebody, okay, well, you have mainly four millimeter pockets, but you do have two areas of the five millimeter pocket. So you don't want to tell them that that's only stage one. That would be now stage two, because you always have to look at the higher amount of pocketing if that makes sense. Because we don't want to confuse people and say, okay, so you have stage one and stage two. You always pick the more severe stage if that makes sense. So when you're talking to the patient, when you're in your charting, you always want to say the more severe of everything, okay? Whereas before, if somebody had a perio pockets of four millimeters and five millimeters, let's just say, you don't want to say that they have early and moderate perio. Because that's just confusing to them probably. So you want to take the greater extent which would be moderate, okay? So they're now looking at class stage three. So this is where there's more than a five millimeter clinical attachment loss. So tooth loss could be happening, okay, in stage three because that's not a good thing. And this is also saying that the teeth to be lost is four teeth or less. So now they're saying, what teeth have they lost due to perio? Is that four teeth or less? Well, then that will automatically put them in stage three. But that makes sense because if they're losing teeth, they're going to have pretty deep pockets, right? So then you have to think about that too. Now, in this case though, the pocketing is of six millimeters or more pretty much, okay? So let's just say, as soon as you hit that six millimeter pocketing, that's a stage three. I tend to think of things a little bit easier where I just automatically think, okay, if they have four millimeter pockets, that would be stage one. Five millimeter, stage two, six millimeter, it's stage three. But then if you want to further classify it, this chart helps. I will leave you guys the link if you like to print these charts because I find that these help for the office, especially since it's something new. You know, even me, my mind automatically goes to the old system, but we're starting to write the new system and the charts, which is a lot easier for us and it makes it easier to classify the patients too. So it is helpful. I know it's a new system, but it is helpful. And this one is also starting to look at class of frication. So class two or three, a neighbor's probe will help to measure that. Every office should have at least one. You might not need one in all of your kits, but every office actually should have a couple, depending on how many dentists and on how many people you have in the office because that's the only way to know for sure if it's a class one, two or three. So class one is when you might be able to see a little bit of a frication, but you can't really put the neighbor's probe through. Class two is when you can put it through and it's kind of in the frication a little bit. Class three is when you are able to put the neighbor's probe in and then it goes all the way through to the other side. So if you kind of, if you don't have a neighbor's probe, although you should, if you don't, then you will just have to look at it clinically and say to yourself, okay, if I put an instrument through that frication, what would happen? Is it in there just a little bit? Is it in halfway through or is it all the way through to the other side? And then stage four, so this is obviously when they have lost five teeth and the pocketing is obviously quite, like quite intense. So it basically means if they have pocketing of six millimeters or more, so they kind of look at stage three for this too. So stage four is actually part of stage three, but stage four is when you're looking at stage three and then saying, okay, there's more happening here. I don't just want to say that they had stage three period because a lot more is happening. So stage four is stage three, but it just means that there's a lot more happening. So can everybody see that? So just to kind of help you guys, but just remember for every single stage you need to say, is this going to be localized or generalized everywhere? So I guess technically you can pick apart. So let's say a patient has localized areas of four millimeter pockets, you would say that they have localized stage one, but generalized, let's say stage two. So you can pick apart two of them if you choose to do that, but it just kind of gives you an idea of where to get started. Okay, so let's move down to the next one here. So this is when you need to also assign if it's going to be slow, moderate or happening quickly. So this I quite like because this will help you talk to the patient about, you know, saying things like, okay, you have heavy plaque, okay, heavy plaque, but so far you're not having a lot of pocketing. There might be a four millimeter pocket here or there, but over the next five years, I don't expect things to get further, you know, along if you're doing everything that you can at home, if you're seeing us every three months, you know, depending on their perio staging that you had decided in the previous charting here, okay? But for perio, you do have to take it a step further. For gingivitis, you don't have to do this part. So for gingivitis, you do not have to say, well, it's a grade A, B or C. You do not have to say that. This is only for perio. So I just kind of wanted to tell you guys that too. But then let's say you have a patient who says, well, or they have a lot of stains. So it's pretty obvious. And then they say to you, well, I do like to smoke about, you know, six cigarettes a day, you know? Well, they will no longer be at that to low rate over five years, because if they're doing something that's a risk, then you know, well, their probability of getting better isn't good unless they stop what they're doing. That's making things worse, if that makes sense. So the grade A is just basically people who might not yet do everything that they're supposed to do. They might be coming in to see you every year, but there's a lot of plaque, even a lot of tartar. But over the past five years, things have kind of stayed the same. So it's good to know a patient for a length of time. If they're a new patient, then of course we won't really be able to determine that yet because it's good to kind of check things over five years, but you can still say to them, okay, well, from everything you're telling me, I know that you're a new patient. You don't have any other of the risks other than you don't like to use a toothbrush every day, you know? So yes, things can get bad, but maybe not as bad and as quick as some of the other areas there. So everything's kind of self-explanatory here. I'm just kind of checking my notes. Just kind of determine over the past five years, what has happened? So taking a look at the x-rays is helpful because you need to look at, okay, has there been bone loss the past five years? Even from the other office, if you're seeing a new patient, you should be able to get their peri-o charting, their checkup x-rays at the very least, hopefully the other office was taking a pan, PAs, so you can check the bone support around that and then tell them kind of what you're looking at because the patients want to know. If you don't say things to them like, okay, well, if you look in the x-rays here, there has been bone loss happening for the past three years. They could say to you, oh, I didn't know that or they might say to you, okay, well, I was told that but I didn't really understand what that means but now you're showing me in the x-rays where the bone is supposed to be, that actually helps me. So it's good to show them because if you don't do that, then they might not consider peri-o as bad as it actually is. It's not a good thing. Things do not get better until the patient knows what's happening. So I will leave you guys the links for these. I just kind of wanted to talk about some of the key points but if you guys have any questions, please just let me know and I will see you guys in the next one.