 So I don't forget now. Can everybody see and hear me. Okay. If you don't mind just letting me know. Awesome. Thank you. Excuse me. So nice to see you guys Let's see. Yes, we're it's not quite 1030 so we won't get started yet. I promise. I just wanted to hop in just to make sure that everything was working. Okay, I'll be sharing my screen very soon. Hi, Mackenzie. How's it going. I know a lot of you guys are taking the board exam tomorrow. Good luck before I forget to mention something. Yes, it's early for a lot of you. Thank you guys for hopping on early. It's always tricky with the different time zones because it's either too late too early. If it's in the middle of the day for some people that just doesn't work for some people so it's always kind of tricky so sorry about that. But for those of you who are watching the recording afterwards just remember if you can't attend the live sessions that is understandable just make sure to watch the recording afterwards because these will really help you guys kind of tune into everything and know a little bit more every time for the board exam, you know, there's nothing like listening to a video. It's just better than just trying to read the material on your own, trying to go through things on your own and just kind of helps to put everything together especially today. We're talking about the new AAP classification system. Mackenzie we were actually talking the other day I still have not gotten an email back. But what I've done is I did ask some of my colleagues not to be annoying but everybody gave me different answers so everybody I'll quickly mention what I was talking about with another student here. And hey maybe some of you guys have something to say about this but for the new AAP classification system. I'm not confused about it but there's a couple different things that I'm hearing that I don't know which way to go about it. And that is and I mean I'll talk about that today we're going through case studies, but just a quick mention is you know if somebody has one tooth that puts them in stage three but everything else is a generalized stage two. Do you go up to that stage three yes or no what do you do so that's just kind of where there is still some slight confusion on that I was talking to my colleagues. And again we will be going through this this is just a very informal chat right now, but I was talking to my colleagues and they just pretty much say that well you would just simply word it differently. And you guys hold that thought and Mackenzie I did ask about you were talking about you can't go once you establish a grade for a patient you can't go down that grade but you can go up so you wouldn't say to a patient. They're a grade you know they're the highest one and then six months later things are healthy again so now they're a grade eight you know you wouldn't do that. I'm sorry guys let me just in case you guys are. Let me kind of put up a slide at least as we're having this informal conversation. There we go. And don't worry we will be going through all of this came looking for the great egg, there we go. So, I'm Mackenzie, and I think I was actually talking to a few of you guys about this too. Oh, you guys can see my screen yet anyway doesn't matter there we go. So, you can't move down in a grade, meaning if you, if you have established grade C for a patient two years later they wouldn't be a grade a that is correct so I might have said something different in our last session I'm sorry I don't remember, but that has been clarified again you guys this is just an informal chat right now we will be going through things. I'm going to make my chat box bigger because some of the text isn't showing up. Yes, Stephanie, I have been hearing so many different answers and it's frustrating because, you know, it is, it's not so bad for the real world because it's not like we're going to fail. I would say something wrong in our charting but for the board exam you guys need to know what the right answer is, but I'm not going to lie to you and say this is the right way to do things when I personally don't know either. So, but I know that's that's that's not helpful but I'm just being honest I did send emails I have made phone calls to the major associations and the board exam committee but nobody has gotten back to me yet so I do not know. I'm going to help you guys today, even like just to kind of go through everything so at least you will have a good idea okay. If that helps but yes we will go through all of that. Yes, and Stephanie that is correct so you would always go to the worst case scenario because Stephanie makes a good point because you can't grow the bone back so it's not like somebody would have nine millimeter pockets and then have three millimeter you know, so you would always go for the worst case scenario, even if it's just that one tooth, but to my understanding there's a way you would write that in the chart, so localized and generalized and that's what we will talk about today. Mackenzie, thank you so Mackenzie was saying that when she took the practice exams. They would have the case studies and she would go with the highest area of the clinical attachment loss, and she would get the answer right. So yes. Thank you Mackenzie that is actually very very helpful. That's what I suggest everybody do then so go with the area of the highest clinical attachment loss. And that's the best way to do things but again, I do have some case studies for you guys I'm actually going to go back from our last PowerPoint. I do have some of the case studies towards the end, but just to do a quick review because I do see a lot of new students and if I don't do the review it will be even more confusing. So, and feel free you guys for those of you guys who are new, feel free to ask questions anytime so I can't see or hear anybody else. I do that on purpose because if I allowed everybody to be seen and heard, then the Internet would be slow, it would probably be choppy so I find that this is just easier, but feel free to ask me questions anytime. There is a chat box that you should be able to see and open up. When you guys send a message in the chat box, I'm the only one who can see it. So, I, if you have a question, I will likely you know read out the question so that the other students can hear it but I just do that so it's not too distracting. But if you send me a message and you would prefer I don't read it out loud or something then just sort of make a note when you send me the message but I don't really see that happening because we're all working together right. Today, it's 1030 right good okay so today we're talking about the new aap perio classification system. There are some courses online you can take that are free check them out for sure, even for myself, this is something new for me to learn or I should say it has been new. So I have been taking courses and listening to them over and over again, and I find I learned something new every single time. So for the board exam I'm going to give you guys kind of a nutshell on this new system okay. So I do have this PowerPoint uploaded inside your course under perio. If you're in the board exam prep Academy the full course that would just be at the end of your course like the end of the modules where I upload all of the new PowerPoints all of the new sessions okay. These are great charts print them out that's what I do even for my own practice I have to constantly be looking at these charts. I look at the staging and I look at the grading because you need to determine that. So for the board exam so we're talking about the board exam here. The main thing you guys have to know truthfully is, you will look at clinical attachment loss, not just pocket depth, whereas the old system hey I have been through a few offices where I will go back to look at the chart and clinical attachment loss was never recorded, meaning they have never charted the gingival recession. If you don't do that you can't get a proper determination on the patients oral health you just can't do it so I like this new system, because it is all about the clinical attachment loss. If there's anybody here who doesn't understand clinical attachment loss, let me know but I will be talking about that a little bit as well so I'm just going to go through the first slides quickly because we did do a video on this actually twice, but I still feel like it's good to review if I move too fast or too slow you guys let me know so everybody can see my screen okay everybody can hear me if you can't please let me know I'm assuming if you couldn't hear me you would be typing something by now so that's good. Okay, so basically you guys as I said before know this new system, it is divided into staging, and then you have to pick either a grade A, B, or C, but there's also modifiers that you guys have to know. Is the patient a smoker? Is the patient a diabetic? Because if a patient is smoking a packet day all day every day, that will determine how you feel their perio is going to progress so that's where the grade A, B, and C come in. Okay, so you guys have this PowerPoint I'm not going to read out everything to you but feel free to read it of course on your own. I'm pretty much saying what's on this slide anyway but just in a different way. Okay, so staging and grading. Okay, next one. And this new system looks at implants and the gingival health around implants. So for those of you who do not know or you perhaps forgot. The gingival around implants can get gingivitis very very quickly and I should say you can get like perio around implants quickly because there's not that natural ligaments attaching everything because yes, it's the most like your natural tooth but it's not your natural tooth. Any disease that happens around the implant can happen very very quickly so we need to make note of that and we need to nip that in the bud as quickly as possible so that's another thing that I feel that the new system really looks at which is excellent. Okay, so I have the steps in a chart form but then I have also taken this from today's rdh.com they are excellent with just sort of providing those additional resources. Okay, so step one you are sorry so you basically want to determine okay does the patient have perio or not. If they do is it mild moderate is it severe so then you would know how to put them into stages. I will show you again on the chart but stage one and stage two is pretty much on one side of the spectrum and stage three and stage four is another side so you kind of go. Okay, does the patient have four millimeter pockets does does the patient have five millimeter pockets or does the patient have six seven eight millimeter pockets that would be severe so I will show you guys that later. So that's what I've said in step two here. But as I said again you guys it's more than just the pockets you need to calculate pockets but then chart every tooth, their gingival recession that is so important. You cannot. So, you know, kind of a good question on the board exam might be. If you don't chart gingival recession, can you do this perio classification will know you have to do that. If a tooth doesn't have any gingival recession awesome, then you would just look at the pocket depth because the gingival recession isn't there. Mackenzie yes. So you guys if you are a CDHA member, they do take students at a reduced fee so hope if you're obviously in Canada here, but if you are a CDHA member they have a great webinar. Oh, and it's free okay sorry even better. I, I think I had to pay when I was a student oh no I didn't I think it was free but anyways, I actually saw the webinar twice yesterday Mackenzie to just sort of refresh my memory it was very very good very very good. So everybody should check that out. There's a link for that later. Of course you have to be a member to watch it but it is a good, a good webinar. There's parts one and parts to you have to take quizzes to go to the second part, but it's really really good. And then you guys after you establish a stage so think about it easy like this try not to make it complicated. So how do you establish a stage right away so does the patient have mild moderate or severe perio. How do you know that by calculating the clinical attachment loss can also be called clinical attachment level so Cal. Okay, so you would first establish that. And then you would say, Okay, so let's look at the other factors. Does the patient smoke a pack a day. I'm afraid about this perio getting really bad really fast. Are they 14 years old and have five millimeter pockets, you know, so that would establish a grade. We're 95 years old and have four millimeter pockets we won't be as concerned when a 95 year old has pockets than we would be a 14 year old because that 90 year old has probably had those for who knows, you know, 70 years, but that 14 year old okay did they get those pockets so that would determine the grade. So I go through that in some case studies for you guys and a little bit. So I just kind of put the chart here in a different like way to look at it. Stage one and stage two you guys remember. Sorry if I sound like a broken record here but you're looking at the cow, not the pockets at the site of the greatest loss. Okay. So you're looking at Cal. Oh, I should mention when you guys are probing when you guys are doing all of this. It is like six sites you know what you guys should know but just in case they happen to ask that on the board exam. So you look at the greatest loss. Okay, this is Cal here so one to two millimeters of Cal three to four millimeters Cal so this is Cal, not pocket depth. Okay, is it greater than five so on and so forth. Okay, but also look at which again you guys we do talk about but I'm just sort of doing a quick review. Look at the bone loss definitely look at the bone loss and the age so when I took the CDHA webinar yesterday like I reviewed it I took it again or I took a couple weeks ago but I wanted to kind of review everything. They really talk about age you know look at the age of the patient and the bone loss kind of when I said if a 90 year old has bone loss we're not going to be as concerned than if a 14 year old does because for that 90 year old hey it makes sense they have lived their life they're they are doing a great job. It doesn't matter when they got the bone loss but that's kind of a better prognosis than a 14 year old. Okay, because that's not normal for a 14 year old let's say to have moderate bone loss but we do talk about it. And then they want you to look at of course have they lost any teeth. We're not talking about teeth because they had teeth taken out for orthodontics or teeth taken out because they have wisdom teeth. No, so that could be a question on the board exam. Do the fact that they don't have their wisdom teeth does that matter with tooth loss. No, it's tooth loss due to perio. So due to a tooth being lost because it was so loose they had to take it out. Does that make sense. Please stop me if something doesn't make sense you guys because I am kind of going through this quickly because it's more of a review. But then of course look at the probing depths also which would help you to determine Cal, but they do talk about probing depth they talk about forcation involvement. Another thing to note if a tooth has forcation involvement that puts them in stage three you guys they would not be a stage one or a stage two because it's not normal for people to have forcations. Something's going on the tooth isn't healthy. Now for generalized or localized that's the same if it's 30% that's localized if it's more than 30% it is generalized. Okay. And quickly again looking at the grading. So they like you again to look at the age of the patient. And to determine the bone loss that type of thing. Thankfully in the CDHA webinar which I have always thought but they did mention we won't have time to take out a calculator and do calculations. On the board exam they may ask you to do that Mackenzie I think you said you had to do that or somebody was telling me they had to do that you guys it's ridiculous. But oh no okay good then somebody was telling me trying to think somebody did have to do it but maybe it was a different type of exam I'll double check. Oh good so so Mackenzie is saying that they give you the bone loss in the age. Okay perfect that's nice because that's just what you need to kind of calculate those numbers. That's a key determining factor even if you guys don't remember anything else look at the bone loss and pick which grade they should be in. Okay, honestly, but hopefully you'll remember the other stuff too. Okay. And then the modifiers the risk factors so smoking and diabetes. Okay, that is definitely it. This is just the charts that I put in a link form for you guys to download if you wanted to just another look at those charts, the same charts. Remember how I said to determine a stage you know keep it simple first look at okay is it is it going to be mild or moderate period or is it going to be severe period. Down here again this will just kind of help you guys go through the different stages to know what to do. I like this it is on that website link that I have given you here. If you guys want to print that out it's just helpful to kind of go through the steps you do get used to it after some time. Your first few times kind of thinking of case studies and going through all of this you will be very confused. Okay, you will be very confused, but it takes practice like with anything it takes practice and it will get better. So the mild to moderate period is typically stage one or stage two. So so severe period can lead to the stage three and stage four, and then you have to say okay well how severe is it so mild to moderate stage one or two. This is just kind of a different way to look at things. They are just kind of showing you guys so if you're trying to determine okay is the patient healthy or not. Look at the basic things like is the gingiva red is it pink is the papilla swollen are the margins puffy. Is there, you know, like overgrown gingiva look at that this is healthy so this is a good example of a healthy patient. Okay, yes, technically you guys I might see some gingival recession here actually no sorry I see a lot of gingival recession, but we're looking at the gums primarily yes there is gingival recession, but they likely don't even have a pocket there but this looks like the gingival recession of three or four though so that on so that so that automatically puts them into a cow of three or four, even if technically there's no pocket or something but you can't really have a zero pocket can you. So let's just say that this patient had a pocket of like two here and a gingival recession of a three. So that's three plus two is five so that puts them at a cow of five. This patient looks pretty healthy so for me to kind of say okay you guys there's a cow of five here. Are we going to put them in stage three I mean come on give me a break, but it will depend on if if all of the teeth are like that. Yes, or no. But what they want you to do is to put that patient in a stage three because that's what their cow is, but then bone loss, you would have to calculate the bone loss. Have they lost any teeth will know there's no tooth loss because it looks like that person had all of their teeth right so then they're now stage one or two so then you kind of have to determine okay what's going on here. Good question so with the new AP if the case study says a cow of three or four. So here you guys would you automatically refer them because that puts them in stage two. Yes, you would in the real world, we would not because that would be very easy to clean the team. No big deal, but the board exam wants you to know with moderate perio you do refer them so Mackenzie that's a great question. As silly as that might sound to refer somebody, but you would okay. Yes, I don't agree with it but the new system yes moderate perio automatically means to refer them. Obviously if they're severe perio you would definitely refer them same type of thing. And these are just sort of you need to know the three distinct forms. So there's periodontitis. We used to call it aggressive and chronic but then you would also have necrotizing periodontitis. And then period periodontitis as a manifestation of systemic condition so think if a patient's pregnant if oh goodness why can't I think if they're on a medication that's causing their ginger will overgrowth perhaps that kind of thing. Okay, so this is calculating Cal so remember, you take the probing depth plus recession. Okay, plus recession. If the gingival margin is is is above that CEJ I couldn't think of the word is above that CEJ then that's almost like a minus number. Okay, because you, you need to determine kind of that length. Okay, so if the pocket depth is six, like, look at the middle one here you don't see any gingival recession here. If the pocket depth is six, then that makes Cal six so who knows, they might try to be confusing for you and ask you a question on the board exam such as if a pocket is six millimeters and there's no gingival recession. What is the clinical attachment loss well it would be six it would be the number of that pocket. So does that make sense to everybody here. Just making sure just making sure. Just going through the different like implant cases again you guys. They want you to take x rays on implants, not you know every six months or something but consistently like like every year every two years, just to really determine how the health of that implant is just like a quick little side note there. Okay, so I like this slide because it kind of brings it all together doesn't it. So stage one, two, three and four this is a great slide, even if you guys just want to take a picture of this slide now with your phone. That can just sort of help you as you're going through things to just sort of go okay well let's kind of practice practice makes perfect let's determine what stage this patient could be in. So just sort of a little side note there. I like this slide. And then how they kind of calculate the bone loss you guys so I like that so Mackenzie was saying on the board exam, they will give you the bone loss percentage and the age right. Awesome so then it just shows you right now how to calculate that in the real world what we would do is just sort of look at the x-ray and kind of do like a little. Okay, well if if the bone levels here well that's pretty darn good if the bone levels here okay that's 35% bone loss if bone losses if that like levels here then that would be 70% you know, don't put lines of course on the x-ray or like you know these don't be there. Oh they give you the actual number Mackenzie. Oh, thank you that's good to know. Cool. Well, I guess that might be confusing for some people though I wish they would just not ask you guys those questions but I get it. So like on on an x-ray like we would just kind of look at it but it sounds like on the board exam they give you the actual number to help you calculate it which is really nice. So just simply doing those calculations will give you well is it grade A, B or C. So that's kind of nice and always look at the risk factors which we talked about in the case studies. Are they a smoker? Are they a non-smoker? Do they do they smoke a lot a lot? You know do they just kind of smoke a little bit a lot. So these things you guys do have to know. Again just another way to look at it. And guys I apologize I'll be right back my washer is beeping and it's not going to stop beeping unless I turn it off so I'm so sorry hold that thought I'll be right back. There guys sorry and you probably saw my my shorts that's what happens when you work from home. You wear shorts. Um okay good question. So Mackenzie has a question here. So if if they have a bone loss slash age actually here I'm going to copy that question and just kind of ask people. Let's see actually no maybe I don't have to. Let me see here. Actually Mackenzie that's a great question just hold that thought and I'm going to ask everybody. Oh come on. Why does this slide why is it blank? Okay guys I'm going to ask you a quick question. Let me do this here. So what do you guys think if if you have here let me get that chart as well. So I have a slide up here everybody if you don't mind answering for me. So if if somebody has a bone loss slash age of 0.75 but they smoke more than a pack of date. And that's a great question what grade would you put them in and Mackenzie you are right by the way I just want to see what everybody is thinking. So if you have calculated this and it's 0.75 which would put them here correct but they smoke more than a pack a day. What grade would you give them and I will give you guys a second to think about it. Don't you worry. Lindsay yes so it's kind of tricky. Stephanie you are correct. S you are correct. What are you guys saying because this is kind of tricky because remember how I said you can't go below in a grade, you can always go higher but you can't go below in a grade. I'm just waiting on a few more people I'm just because this is a good question. We do talk about them in the case studies to. So yes, it would put them in a grade C because they are smoking a lot. You would not you know like it just sort of means that they're constantly doing something to their mouth that's going to make things worse. So things are going to progress quickly. So that's a great question. We will talk more about those and the grading so a B and C, you would determine okay you guys. Is it going to be a slow progression, moderate or, you know, pretty fast. If a patient's 90 years old and yes they might have a higher cow. But are you worried about things progressing quickly because they're a non smoker they have no diabetes well that's just sort of how it determines it, but you do of course also have to look at the bone loss and things like that. This is just sort of showing you guys some not so nice mouths. Obviously, these things look pretty bad and that will give them a higher grade. We did do these case studies last time like this is an older one but let's just sort of go through them again. So you have a 50 year old patient. He's experiencing a bad breath and his wife wanted him to come in. He is he is receiving treatment for high blood pressure, depression, smoking cessation. These are the medications he's on smoking one pack of cigarettes a day for 35 years you guys that's a long time it's not like he just started smoking which would be weird but for 35 years. Um, you know his his meds he drinks alcohol his last visit was over 10 years ago. He only goes when he's in pain. So you guys hopefully you took a picture of like these things here okay of the sorry of the staging and the grading to this will help you determine these things. Okay, so. So he brushes once a day which is not enough he doesn't really floss. He has a lot of bio I'm sorry he has a lot of calculus, light biofilm know, which is good I guess but he has gingival or he hasn't generalized gingival recession bleeding index plaque free score. His mouth basically. Just from everything I've told you guys. So far, what stage and what grade are you guys thinking. Let me bring up another chart for you so that's like 23 I'll come back to that. Just from everything I've told you guys so far. What staging and grading are you thinking like just sort of off the top of your head here. So what are you thinking. Let's do the stage first what's what stage just are you guys thinking so let me go back. So think of the stage as we're going through this here. So this is the patient he's 50 I mean this he's he's obviously not 50 I don't know why he's there but anyways, he's 50. He doesn't go to the dentist often so those are some key points. He doesn't brush a lot he does have generalized tartar which is moderate to heavy his biofilm is light. So even with just that information we haven't looked at, we haven't looked at his x-rays yet. We don't have it we don't know his probing depths, his clinical attachment loss but let's just say we're just thinking, you know, thinking about it. What stage are you guys thinking, even without, you know, so you should have a stage in mind like just to sort of have a stage in mind. Okay, and then moving on here. So we're looking at the clinical attachment loss, which is the bottom number here okay it's really hard to see even for me it's blurry. So the clinical attachment loss here okay the bottom number so look at these numbers you guys so clinical attachment losses of eights and sevens I think it's really hard to see eights and sevens okay so go back again to our favorite chart clinical attachment losses of eights and sevens we pick the highest number remember where was that on the probing depths we have three thousand fives threes and twos you know all of that. So, and thank you guys for you know thinking about it that is awesome. I will explain this. Okay, so feel free you guys to type in the in the chat box if you're thinking of something. Okay, so then having a closer look but guess what you guys they he also has some forcation involvement class three or sorry class three two forcation involvement. Oh yeah sorry so I was thinking like three four or five okay sorry I think I'm thinking of other things. So class two forcation involvement. Look, he has missing teeth you guys the wisdom teeth normal to be missing but why is he missing his sixes and sevens in some cases. Probably not just for the heck of it. So then we have to go back again. I kind of want to use this other chart right now. So staging. Okay, so we look at tooth loss. We look at cowl. We look at the pocket depths to of course but all of that. So hopefully everybody's thinking for now stage three or four right you might be kind of going oh is it stage three is it stage four is it stage three is it. So hopefully you're thinking about all of that he smokes it was a packet day correct or wasn't more than pack smoking a packet day so that's a great modifier. Okay. Just move down here. These are the x rays. Obviously you guys severe bone loss I'm sure I don't have to tell you that like you can just see it. Like I wouldn't even have to do calculations it's kind of right there. Okay. So bone loss vertical bite wings bone loss bone loss bone loss. So for those of you guys who have said stage four grade C that is correct. Okay. And Stephanie yes you are correct so he wasn't stage three for the most part, but then as soon as he gets tooth loss as soon as there's mobility is happening, then that puts them into a stage four. Okay, and great see I think everybody who answered did say great or sorry. Yes, great see, because that's, you know, it's not a good sign with all of the bone loss he has all of that. So then they put everything together for you again. So there's previous tooth loss from perio we didn't necessarily know that when sixes and sevens are missing it's kind of a good indication if there's one six missing. It could have been a fluke where like literally they hit themselves they had trauma it's not usually a molar though. If you see a molar missing it's probably due to perio. Okay, like usually. They talk about the cow they talk about the probing depth again. The bite wings obviously and then they just talk about how they would go about cleaning this patients teeth. Okay, so good for you guys. Great job. Okay, so and then they did some highlights. Oh, Mackenzie I like that so Mackenzie is saying so a good way to remember if something is generalized or localized. If it's greater than 30% it's the same as eight teeth being affected in 28 teeth in the mouth. That's really smart. I'm going to write that down. I like that. So if it's greater than 30%. Yes, eight teeth are affected I will repeat that I'm actually writing it down in a 28 mouth. Okay, so Mackenzie is saying that to remember if something is generalized or localized she was told that for it to be greater than 30% making it generalized. It's the same as more than eight teeth are affected in a 28 teeth mouth. Okay, does that make sense. That is so smart. So she's she is also saying in a case study. I'm going to use that for my own practice, so thank you. And I'm sure everybody has had some major like, ah, that makes sense. So thank you Mackenzie. That was great. So, so I'm see you guys so there was some stage three, there was some stage four areas here, put some into stage four just because there's more things happening in stage four. Okay, so this is another oh sorry why did they put the stage and everything there I want to cover that up but it's too late. Okay, so just to kind of think about it so so this is another patient type two diabetic. They are a smoker. She has a greater than nine level of the HBA one C her cowl is four to five millimeters bone loss 20%. I'm sorry, I'm talking about the probing depths here. So, stage two grade C. So I just kind of want to show you guys that for one second. Stage two grade C. So let me tell you why. So Cal is four to five millimeters. Let's see. Okay, so when Cal is four to five millimeters. So we're kind of looking at stage two and stage three here right so it's kind of like. Hmm, but the probing depths I believe my apologies I need to go back to that again the probing depths I believe they said were less than or equal to five so that's 31. So then that just puts her into stage two again you guys so there's more happening in stage two Cal did say from four to five millimeters but they still put her in stage two. So it could and and this is pretty much greater than five anyway. I think if it if it was a lot of the teeth affected were five millimeter Cal, then she would go into stage three but it could have just been the one tooth or something so that's why they're putting her into stage two and looking at the probing depth as well okay so they kind of did did both, but they put her in grade C so you might be thinking well stage two isn't that bad, but grade C is bad, and I'll tell you why it's because remember they mentioned where's that chart. So we mentioned the diabetes. Okay, so that is a great modifier. It's more than seven so that's grade C. So does everybody see that the smoking and the diabetes. Stephanie exactly sorry yes, exactly. So that's why. This is just sort of something to put everything together again for you guys looking at different risk factors look at the age. Oh boy things like that. Excuse me. This is just sort of how you would probe around teeth with implants. They might, I think it'd be pretty cool to have like an image like this on the board exam and then you have to say which is the right one to probe implants. I don't know. That would probably be too easy right but it's kind of different because you kind of have to go like straight up and down for the tooth you do have to angle it a little bit. I probably knew that but I just think that's pretty cool. This is just sort of showing a different color of perioprobe I love these they're amazing. I need to order more I just don't know where to find them. So again you guys looking at this chart looking at everything study it memorize it printed out look at it you know it's great. I do have some additional case studies for you. But let me tell you it was really hard to come up with case studies because I don't have like from actual patients. So I just kind of had to think of some and go from there. So let's see how we do. Okay, so, and I kept it simple for you guys. So Mary Ann she's age 78. These are her vital she's five foot five 165 pounds. These are her x rays. Okay you guys these are the x rays they're not actually her x rays I just pick them. I try to find some, you know, pertaining to the particular case study. So look at the bone levels you might not think it looks that bad in some areas, but then look at like the lower interiors look at like over here where there's a little bit more. You see calculus spurs so that can indicate okay it's not just little bone loss here and might be a little bit more so more about Mary Ann. Mary Ann's teeth. Okay, so her lower interiors like moderate to heavy deposits look at the like swollen gingiva on the bottom here. You might be looking at her from this way and saying oh it doesn't look too bad you know the gums actually look fairly healthy yes you do see some staining there, but look at the moderate to heavy charter even kind of showing up here. You see gingival recession, so that would put her in a higher cow. Hope I didn't give you guys the grading yet. No I don't think I did. So her cow is from three to nine millimeters. Okay, pockets two to seven millimeters. So three millimeters generalized the molars are four to seven millimeters so I kind of summed it down for you guys a little bit. But remember, look at the key points here. Is there for occasion involvement. Sorry, maybe I shouldn't be so obvious. Sorry guys, I'm probably being too obvious but I'm trying to help you. So you should automatically have a stage in your mind right now. Okay, so let's go back to Mary Ann again. This is Mary Ann she's 79 this is all of the information that I have given you I kept it simple, very very vague look at her x-rays. Look at her teeth. A couple other information here so I didn't have like a period chart to put things in all of this you guys so you are looking okay so stage three and I'll tell you guys why okay so this is not. Sorry, this is not a case study that I just made up on my own I took a course and I just changed the name I like I changed slightly the age things like that. Okay, so you were probably thinking stage three or stage four, but I didn't mention anything about smoking I didn't mention anything about diabetes. I'm considering her age. Okay, so in the course what they said to me was or sorry what they had said to everybody was she's 79 years old in some in some areas she has early bone loss in some areas she has moderate bone loss, but she's 79 years old she's doing pretty darn good for 79 years old. She's not missing any teeth for 79 years old that's pretty darn good and that's what they said in the course. They said she's not missing any teeth at 79 years of age, but there's forcation involvement so that automatically puts her into a stage three. But then you have to think is it a stage three or is it a stage four. So let's go back again. And a lot of you guys said stage three and a lot of you guys had said stage four so let's talk about it. So she's in stage three, not in stage four, basically because in the course they had said, does Mary and will complex rehabilitation be needed. Are there any teeth loose? No. Are there any dysfunctions in the mouth? No. Is she missing teeth? No. So that's what they said. Okay, that's why they said it's not stage four it's stage yeah it's not stage four it's stage three. Okay. So does that make sense so far to everybody? Shoot where'd that go? And it would be grade B. So let's go down to the grading again. It would not be grade A just simply because she has more bone loss than that. So that puts her in grade B or sorry did I say A or B. It's not grade A because hey she's 79 you guys but there is bone loss there and Cal. Grade B that's because of the bone loss that she had. Okay. Mackenzie that's a good question. What is a ridge defect? Can anybody tell me? Because that is a grade modifier. It's kind of like a stage actually so it kind of puts things into perspective. I'm just looking for that chart. Okay, so what is a ridge defect? Can anybody tell me? So Mackenzie you might not be the only one who doesn't know. Oops, I just put up a Facebook thing. What is a ridge defect? I'm going to try to find a picture for you guys. Does nobody know? What is a ridge defect? Tiffany yes you got it. Thank you. I kind of found some pictures here you guys. It's not super awesome but at least I can show you guys. So a ridge defect is basically think of your older patients and if they're missing teeth. If they're missing teeth they have not cared to get a bridge or a partial denture anything like that. So a ridge defect is just simply can everybody see this by the way I put up a picture. I might have to refresh my screen if you can't see it. A ridge defect is kind of when the avial or bony ridge is just not looking right. I'm probably not explaining it properly but when there's missing teeth okay that's why we tell patients I know you have one missing tooth or you're 80 years old you had just lost like three teeth this side three teeth that side you don't think it's going to make a difference. Your face will change. That ridge is going to change. So yes. So what it is you guys. Thank you. But that was a great question because you obviously weren't the only one Mackenzie who didn't know so thank you for asking that. Okay, so let's let's go through another one. Okay because case studies are awesome but it was really hard for me to make these case studies. I should say like picking the x-rays because I took a course I took the case studies from the course but I just kind of changed a couple things but I couldn't take the pictures from the course because it was like on the screen right. Anyways okay so for Joe 68 smoker a packet day so what does that mean when he smokes that puts them into a certain grade already probing three to nine millimeters whoa those are heavy pockets, clinical attachment anywhere from two millimeters to 12 millimeters holy moly for patients for teeth and guess what there's mobility. Honestly, even just looking at these x-rays I know what stage and grade he's going to be in to be perfectly honest with you. Mackenzie good question because I don't smoke either somebody told me that 10 cigarettes is a pack, or is it 15. Does anybody know what's in a pack of cigarettes 10 to 15. I think so though that's what I've always. Oh it might depend on the brand. And Ali is saying 20 cigarettes holy cow somebody is seriously smoking 20 cigarettes a day even 10 cigarettes a day. How do you have time for that. Ew, that's gross. Anyway, sorry if anybody smokes here I apologize. Ali is saying that 20 is standard. Does anybody smoke here because I apologize for what I just said I was being very rude. Does anybody smoke here. I'm curious. Okay, so let's talk about Joe because he's a smoker. Sorry if I offended anybody I apologize. I'm so mean okay. So what's everybody thinking from a stage and a grade from everything I've said to you. Look at the cow so that should put you him into a stage smoker that's a certain grade Mackenzie good. What do you guys think like what are you guys thinking hopefully you're thinking stage three or stage four right. But there's mobility and there's tooth loss stage for automatically you guys stage for some of you guys might have thought grade B, but it's grade C because of his major smoking. Okay, and I put this here just to remind myself to say, since he's a major smoker that puts them into a grade C. Yeah, I know these bite wings insane so that's definitely more than 50% so you know it's going to be stage for hopefully you guys will have easy ones like this on the board exam seriously. But is anybody confused with that because there's one more to go through. Okay, so I don't think anybody smokes here that's good. If you are watching the the recording I apologize if I sounded rude I didn't need to do that. Okay, Lisa type two diabetes probing depths two to 10 millimeters clinical attachment levels, clinical attachment loss whatever two to 16 millimeters whoa. I don't think I've ever seen such bad clinical attachment. But anyways, mobility of three in some areas puffy papilla negative recession so that can make it a lower cal. What do you guys think, I'm not trying to confuse you but I know. Stephanie I was thinking the same thing but I wasn't going to say it pretty much automatically put somebody into a stage. For because of the mobilities. Oh, Mackenzie good question, you know what they didn't mention that in the course, they didn't mention anything else about the diabetes only that she was type two so I should have asked that. So I don't know if it's controlled or not so I'm sorry. I don't know that I think most of you guys said stage four and grade C. Did everybody say that good. So what's on this next slide I can't remember oh yeah sorry okay so great be a grade C so you know what, in the course, they did actually say that it does depend on a couple things so let's go back to the grading here where's my chart. They had actually said it does depend on a couple things. They were talking about her, her diabetes, and, but all they said was type two. We didn't know their HBA one C number on the board exam you have to know that you have to ask the patient what that number is and that would determine either a grade B, or a grade C. So remember her here type to her probing depths or clinical attachment levels, mobilities, but look you guys look at the bone loss seriously that's ridiculous. I would put them in a grade C because of that bone loss it's not like the bone loss is going to get better right because remember for group for our grading. There's a lot going on percentage of bone loss. Look at that I mean come on like she's going to lose those teeth I'm assuming. So if you're and I put this in in here because if you're ever not sure oh is it grade B or grade C. Look at the x-rays and you know think about it this way it's kind of cheating but not really cheating. Oh sorry wrong person look at the x-rays that's not going to get better. So that puts them in grade C. Okay. So again, it was hard to do the case studies that's why I have those ones, but it kind of gives you guys a good indication okay practice makes perfect for the grading. Look at how you feel like it could progress, even just think about bone loss you know if that's easier for you think okay is this is, is there like heavy heavy bone loss then whoa. Yes basically so Stephanie is saying for the grading it is the prognosis I did have that in a slide somewhere. So basically how you feel the prognosis is you know is it good is it bad like there's not much we can do. So think about that when it comes to grading so can everybody see this slide it's slide 19. So think about that when it comes to grading the prognosis are things going to get worse are they going to stay the same are they going to get better. But that's why you can't go back in a grading because if they have perio they have bone loss, you can't bring the bone back so that's kind of a good way of thinking about it. So if you're just staging everybody that is looking at cow, you know pocket depth looking at cow, looking at the bone loss of course but then saying how they lost teeth is their vocation is their mobility. If there's vocation automatically stage three so hey to keep it even more simple for you guys. So if you're like oh my God this is so confusing, read the case study if there's vocation, you know it's at least stage three, it might be stage four or two, but at least you know it's stage three. McKenzie let's see so. Say a patient has diabetes but if they don't give their HBA one C, they might be a grade a. Yes, good point McKenzie. McKenzie actually saw you guys makes a great point I should have mentioned this. So thank you McKenzie you should be doing this class today clearly. So for diabetes let's see where can I find that if you don't know their HBA one C number perhaps it says in the case study you don't know the number, and the diabetes is controlled. Oh yes, Lindsay I see that too. So does not have diabetes. So grade a is if they don't have diabetes but the question for you guys is, if diabetes is controlled. In our minds, it means they're a healthy patient. Yes they have diabetes, but if it's controlled they're a healthy patient their numbers would be normal. Um, Stephanie, yes, yes, you were thinking exactly. We treat them as a normal healthy patient if it's controlled diabetes. But I hope on the board exam they will give you a number because that just makes things easy. If on the board exam, all they say is the patient has controlled diabetes. So think grade a. Okay, they might move into great be or grade C because of other things like maybe they do still have severe bone loss. Then they might be a great see anyway, but don't think oh they have controlled diabetes, but they have diabetes so they're automatically here or they're automatically here. No, if it's controlled diabetes, think grade a unless they give you the HBA1C number. But remember that doesn't just mean okay they're controlled they're perfectly healthy, maybe not. They might be a heavy smoker. Crazy, right. So then they might be a great see anyway. So Mackenzie, thank you for bringing that up. Since you guys. Clearly I was talking too loud because my throat is really sore. So sorry if I was yelling at everybody. I'm not a quiet talker, especially when I talk dental I get very excited. So does this help you guys. I am actually probably going to upload this video on YouTube because I want other people to see it too because I feel like this was very helpful. Oh, that's smart. Stephanie was saying that she was listening to a podcast that said never treat a stranger you want to get to know them as much as you can. Which podcast, because I want to start listening to podcasts again. Yes, I'm Ali I am so I am so happy that this helped is everybody okay though. It's there now how do you listen to podcasts you guys like is there an app to download I think right. Oh Spotify I have Spotify no way I can listen to it in the car. Because as you guys know I'm a mobile hygienist so I travel. I'm going to Woodstock tomorrow and that's about an hour away from me. Oh my god. Oh, maybe I should be doing podcasts then. Oh there's podcasts about boarding fans. If I don't have enough to do. Does anybody know how to make a podcast. Is it easy like I just have to download the app or something I'll figure this out one day. Didn't even think about that all that would be so good. Okay you guys. So I hope that helps I will actually upload this onto YouTube, you will have it inside your course as well. Of course, I'm going to put this in our private Facebook. Oh, thank you. Yeah, this is a toothbrush bracelet need a. I can give you guys the link for it if you guys want it. And if you use my promo code you get money off. So if you guys want I can give you the link to that. Actually I can type it in the chat box right now. It's tooth life.ca but make sure to enter in the promo code dental L. I like I have like three bracelets to necklaces I need to get earrings yeah. I have the watch which is so cool I wonder if I have it here. Sorry guys if you guys don't want to see the watch or hear me talk about my tooth accessories you can definitely go. I will be uploading this later on. Any questions though about our session today sorry guys I can't find the watch I probably have it in my washroom somewhere. Sometimes I put it here. But is there any questions everybody's okay with everything. Practice makes perfect just study practice. You guys will have this PowerPoint as well to go through the case studies just basically remember grade modifiers oh yes you guys. For those of you who are taking the board exam tomorrow good luck Mackenzie good luck I know you're nervous that's normal. You know I kind of feel like at this point just keep reading there's nothing new I can tell you guys I really can't. I you know if you guys don't know something now I'm not saying you won't know it tomorrow but don't stress about things you don't know. Just try to know a little bit about everything read your notes do all of that you can do this you can do this believe me I still remember like it was yesterday. Me taking my board exam, but I felt so good afterwards it was like this huge weight was lifted off of my shoulder I had no idea if I passed or not, but it just felt so good afterwards. You guys are so welcome anytime I am very happy that this helped I did upload a lot of videos on you or I'm sorry on our private Facebook page yesterday. So definitely have a peek at that. I did some medical emergencies because Sonya was asking about it I did eating disorders. Look at all of that. Mackenzie look at that video about eating disorders because we didn't really talk about that too much. Oh, and sorry I can't see who's typing because the names are cut off since I'm not sharing my screen anymore which is weird. But somebody just said they had a question about inhalers. Yes, you guys are so welcome. So we recommend to rinse their mouth after using an inhaler because it could cause thrush. Yes, that's true. Is that just regarding corticosteroid inhalers because they suppress the immune system actually it is any inhaler the reason why we do that is because it can dry out the mouth, which can cause thrush. This is a fungal infection even in some cases. So you want to have the patient rinse with water afterwards like just to get that out of the mouth. So it doesn't cause any bad like gingival reactions or something like that. So that's a good question. There are two different types actually which you probably don't have to know for the board exam but there's two different types of inhalers. There's a corticosteroid one that you would get but then there's also yes one that dilates everything. So there are two different types. So you would still you would still have the patient rinse with water after every inhale. Yes, in our private Facebook group you guys here, let me bring that up. I hope you guys are in it because I send emails, I put the link on top of your courses to make sure you guys are in it. If you're not, it could just be because when you had requested to join you didn't answer the questions and it automatically doesn't allow you to join. So just answer the questions I do that because I get like 20 people daily wanting to join our private group and they're not students so it just kind of helps me we know which ones are students or not. Can you guys see my screen this is our private students of dental L tutoring group for you guys only so for students only. This is facebook.com slash groups slash dental L. Let me put that in the chat box for you guys if you can't see it. I did upload a lot of videos yesterday I'm going to do more today don't feel like you have to watch them if you feel like you know the topic, but it's for people who have been sending me a message saying can you talk more about this can you talk more about that my exam is like tomorrow. See you guys I did. I'm see 20 member requests and that is just from this morning. So make sure to answer the questions if you are a student so I can let you get. So I did one on like special needs eating disorder some of these these videos are older but it's because the information doesn't change. Okay, and I like to focus on the harder topics for the newer ones but I should update some of those. I did I should do it HIV AIDS session. It's a good one to review because they might have a question on the board exam you want to know it. I had uploaded a board exam boot camp session which just kind of goes through questions medical emergencies the whole works. So definitely check that out you guys I'm going to upload more videos today so not to overwhelm people, but just to really help you guys study for the exam. Okay. Please email me tomorrow after you take the exam and let me know what you thought. Okay. I really want to know in fact all of you guys whoever's taking the exam tomorrow please like even just post if you would prefer post in the Facebook group email me whatever and please let us know how you felt you did. It's you know it is a private student group only let us know how you feel. Let us know what types of questions you had let us know. Yeah. It's pretty crazy. But at least you won't have to study anymore Mackenzie that will feel very good. Oh, Mackenzie sorry I still have to send you the receipt I'm so sorry I'm the worst person in the world. So forget for lately. Doing a lot of tutoring. Oh boy, if I forget. Email me and yell at me please. It's okay somebody has to. Mackenzie on people are wondering if you're taking the exam at home. I'm not sure if you want to answer that or not yeah. Yes she is you guys. I think everybody is correct. I believe so. Yes, so crazy. Things have changed so much. I think you more stressed out but that would probably stress me out more. I don't know, like I would prefer to. I don't know. Oh, so some people have to go to a testing center in Florida so probably if there's bigger spaces and things, then you do have to go to a testing center. Hi there guys yes the the session is done I apologize we aren't going to go through anymore so if you have things to do go right ahead. I will let you guys go because I do actually tutor in about 20 minutes. So I do have to go myself anyway. I'm going to have a quick bite to eat piece of toast or something. I'm so happy to help you guys. Again, I don't want to overwhelm you guys too much but I will be uploading a lot in our Facebook group today. Don't look at it if you feel you know the topic please don't worry, but if there's any last minute questions post in the Facebook group, so that that way other students can see it too. I can answer them and everybody can see it because emails can be hard sometimes, just because I get so many all the time that I check it like once in the afternoon once in the evening but if I miss your email, then I'm sorry I do apologize so posting in the Facebook group is usually better, because others are like other people probably have the same questions. In fact, maybe I'll do another YouTube video today since I put makeup on today and stuff I should probably do some more videos. Yes, I will be uploading this video like right now. It might take a little while to process because this was a little over an hour session but I'm going to actually upload it right into YouTube so I'm going to make it private. Or I'm sorry public and in the Facebook group to because our sessions aren't usually public but this one will help a lot of people you guys so I'm going to make it public. Any questions though let me know in the Facebook group I will be checking it throughout the day a lot of tutoring today. So I apologize if I don't get back to you guys right away but if if a student has a question you guys feel free to comment feel free to comment and help to answer the question for them. Even if you get the wrong answer, I will say no this is the right answer but it can't hurt to just try. In fact, hey you guys I have an idea I have an idea shoot I should have mentioned this earlier because there's only three of you left. I suggest everybody post questions in the Facebook group post questions and like a BC or D and then give everybody the the answer say tonight. I don't know I think that's kind of cool. So that way we're just thinking of a bunch of questions kind of like we're doing this big study group. I'm not. Is that cool or not cool. Can somebody help me get that started just post random questions you guys, because I feel like I can't post any more random questions because I just feel like I said them all but I probably have it post questions. I don't know if you guys want to give the answers right away in the comment section so you don't forget to give the answer, but then when somebody comments on your question they might see the answer and you don't want that right. So maybe if you guys don't mind just posting a question whoops, as they almost dropped this. I'll post some later. Okay, I'll post some later and then I'll post the answers later on tonight. Yeah, I don't know Mackenzie I think that's a good idea. If you have any questions in the Facebook group. I think that would be a lot of fun. Okay, this YouTube video is going to be public and people are going to think I'm crazy. They're going to be like we don't want to sign up for her sessions she's making us post questions. Have a good day. Have a good lunch breakfast whatever time it is for you guys have a good coffee Mackenzie good luck everybody good luck who's taking the exam tomorrow good luck good luck good luck believe me I am going to be nervous as heck. As well I get very very nervous for my students almost to the point where I feel sick. So I'm seeing patients tomorrow to try to distract me. Hey guys, good luck good luck good luck okay. Bye, I will post the video soon soon soon hopefully within the next 45 minutes. Bye guys, bye see you guys later next week I think I have to check the schedule but I'll see you guys later. Bye. Oh, actually you guys wait, we will wait I have something oh no I just lost everybody. I'm going to pop on again to do like a board exam question session later on tonight. Okay, I'll post it in the Facebook group. I will. Okay guys see you soon. Bye.