 Hello everybody, good afternoon. Andrea Trioski here with Dental Health Tutoring. Let's talk about clinical attachment level, otherwise known as clinical attachment loss. When I was a student, this was the hardest thing for me to remember, I don't know why, because it would depend on if the patient had loss of tissue or if they had more tissue than they should have. So when you're measuring your clinical attachment loss, pay attention if there's a pocket or not. And then you also have to pay attention to if the gum tissue has shrunk away in recession, or if it's actually come above in a gingival overgrowth. So hold on guys, just one second, sorry. I was sick all last week and I still have a little tickle here. Okay, so let me share my screen here because I want to show you guys a picture because this will be much easier to explain showing you guys a picture. So look at the left side here, or it could be the right side depending on how you're looking at it, but this side right here, so this is normal. So there's no pocketing, so things look normal. But when you're looking at clinical attachment loss, also known as clinical attachment level, you need to look at the pocket and the loss of tissue. So let's go back to the other side. So let's just say hypothetically that this patient has a pocket of a five millimeter. But then let's say their gingival recession is of a three. Okay, so those two numbers you have to pay attention to. So there's a pocket of five, I think I said right, and the gingival recession of a three. So you have to add those two numbers together in order to have your clinical attachment loss number or the clinical attachment level number. So five plus two is seven, five, six, seven, right? So that's your clinical attachment loss. So you might be looking at the patient and measuring their pockets and thinking, well, a five millimeter isn't too, too bad. Yes, it's not good, but it's not too, too bad. But you have to take an account, their clinical attachment level. So if they have a gingival recession of a two, so now their overall number is of a seven. So that's obviously pretty serious. But in the event where the patient, their gum tissue has overgrown, then that's different. You would take their pocket number. So let's say their pocket is of a five. And then if you were to measure from the CEJ area here to measure to how high their gingival overgrowth is past it, say it's a millimeter. Their overall number, you have to subtract it. So their number is now a four. So the pocket was a five. And their gingival overgrowth, I think I said of a one, right? So then to minus the numbers, five minus one is four. Because if the gingiva is over the tooth, you would not add that. You would take that away. So does that make sense? So there's two different ways to calculate clinical attachment loss, also known as clinical attachment level. So I'll say that one more time. So if you have a pocket and gingival recession, you have to add the numbers. If there's gingival overgrowth, you would have to subtract the number. So the pocket and the gingival overgrowth. So if there's a pocket of a five and the gingival overgrowth of a one, then you would take away the numbers. So the number would actually equal four. So five minus one equals four. But if you're looking at it the other way, if there's a pocket and recession, you would add the numbers. So let's say the pocket is a five and the recession is of a two. So then a five plus two equals seven. So does that make sense? So here I'll stop sharing my screen so you guys can see me. But this is something that you do have to make notes on. It takes practice, but put it on a cheat sheet somewhere so that you can look at it every so often so you don't get the two confused because it depends. If the gingival tissue has shrunk away or if there's too much, if the gingival tissue has shrunk away, then you have to add numbers. But if the gingival tissue is too much, then then you have to take away the numbers. So I hope that helped. If I'm still make if I'm still not making myself clear, let me know. Just feel free to comment and then I'll try to kind of explain it in a different way. But this is something that you have to know while you're in school. If you're in clinic, if you're taking the exam soon, this is also something that you have to know. In the real world, you don't really have to apply this to too many. I've been in offices now for about 13 years and I've never had to use clinical attachment loss or clinical attachment level, but you never know. I think it depends on the city where you work and the office where you are in to so it's good to have some kind of an idea. So if you guys need help, let me know and thank you so much for watching.