 Hello everybody, welcome back to my channel and welcome if you are new here, I wanted to do an updated video on the AAP perio guidelines because now it's been out for, oh gosh, a number of years when it first came out we were all confused I know I was extremely confused but by now everybody should be using this on a regular basis every day at your dental office or if you have your own practice so I'm going to go through it with you as simple as possible so you can start using it and kind of how to go through it and what it means. Okay, so I just kind of had this image here because I do like this one. It's just basically showing you guys how different things can look like as dental professionals we look inside the mouth is it healthy. So I'm going to give you guys a little bit of advice is their periodontal disease is it very severe periodontal disease. So we need to determine stages, and is it going to be grade a grade B, or grade C, so these are just kind of some pictures for those of you guys who have something to really learn it, I am one of those people. So just as an example, they have, they're fairly healthy here so yes there might be one little spot that is is bleeding when you're probing. But there's no bone loss there's no pockets, none of that they are considered healthy okay I wouldn't worry about that little bleeding spot if it's less than 10% don't worry about it. So this image into our clients of course healthy gums do not bleed but this is minimal brush these areas better and we're not worried about it. Gingivitis though, what if inside the mouth the gums are puffy red swollen, there's more than 10% sites are starting to bleed when you're doing the probing and there are now pockets for millimeter pockets or less for or less. So really in this image here it is saying there's a four millimeter pocket. Actually no sorry it's kind of saying great, less than or equal to so this, this is dependent on how you're looking at things if there's one four millimeter pocket honestly I don't worry about it I'm making a note in the chart, they have localized perio but it's one pocket I'm not worried about it. I'm more focused on the gingivitis part of it. So how do the gums look there's more than 10% of the gums are starting to bleed but there's no bone loss so that is gingivitis but what if we get into more pocketing here. So there's four millimeters or more four to five millimeters that can be considered initial perio otherwise known as early perio and then to moderate perio if it's a five millimeter pocket. So there might be starting to get bone loss, especially at that five millimeter pocket. This is moderate perio early to moderate okay early perio are those four millimeter pockets, moderate perio is when you hit the five millimeter and there might be some bone loss happening, but then you have severe perio so this is stages three to four where there's deep pocket so six millimeters or more. There's absolutely bone loss there's a lot happening. The gums are bleeding everywhere not just a little bit the gums are bleeding everywhere so this is severe perio moving on to the next slide here. You're wondering okay Andrea all of this sounds great I see the pictures I'm a pro now, but then when you go to write a statement you have to write the staging and the grading and this is where people get stumped so I'm going to help to help you with that. So, first you need to do a probe, you cannot determine the bone loss the pockets or the clinical attachment levels without probing. And you also need x rays so you need to be looking at those x rays from there, you can establish a stage and that is kind of what we were talking about our things healthy. Does the patient have gingivitis, is it stage one or two, or is it stage three or four so this is when we put that in there, but then we need to determine, is it going to be grade a grade B, or grade C, and this is where I'm going to explain that a little bit more for you. Those depend on does the client smoke or is there any tooth loss, so I'm going to explain those a bit more in a moment. First let's look at staging so this is a chart you want to print. If you're still getting used to the different stages, pocket levels bone loss percentages all of that I still have these in my practice okay. I have them with me all the time I'm getting pretty good at it though I don't have to look at it as much, but if you're looking at exact percentages pocketing, you need to be looking at this exact chart, but then the next one is going to be this one which I'm going to talk about in a moment. So again you guys stage one, look at the pocketing look at the bone loss, keep it as simple as that you guys pocketing and bone loss, and then you have to determine is it localized pocketing, or is it generalized pocketing. Simple as that stage one, the pockets are going to be less than stage two stage three and stage four so I have it on this chart a little more specific here. So stage one pockets are typically four millimeters stage two the pockets are five millimeters stage three, six millimeters and stage four higher than six so seven millimeters or more. Say that again, write this down stage one and see I still have to look stage one pockets are four millimeters stage two pockets are five millimeters stage three pockets are six millimeters stage four seven millimeters or more, and then you have to determine the bone loss from the x-rays tooth loss we go into that a bit more later on so I will explain that after we talk about either grade a B or C. Okay. So this is 30% so far. So and then, as I said you have to determine is it localized bone loss and pockets, or is it generalized bone loss and pockets you need to write that down localized is 30% is less than 30% generalized is 30% or more of those teeth. So, is it going to be grade a grade B or grade C. Again, we're looking at the bone loss, and how quickly the bone loss is happening, and are they a smoker, or are they not. Do they have uncontrolled diabetes or is it controlled in this chart again I love this one here. I will actually leave the link for this one for you guys on the bottom. Let me see here guys sorry where was I oh yes talking about bonus. So in stage one, there will be no bonus stage two, no bonus stage three for teeth or less. So that would be up to 14 and then stage four five teeth or more. That would be stage four. Okay, so then you would kind of determine that depending on the tooth loss. That kind of thing right typically with the stages. Anything they could be a grade a grade B or grade C, because it depends on how quickly that bone loss is happening. Okay, so just back to the stages again remember how I said stage one there's going to be typically zero bone loss because the pocket is four millimeters. You don't get bone loss with a four millimeter pocket stage three you start or sorry stage two, you start to have five millimeters. Okay. Stage three, six millimeters and stage seven stage four sorry is seven millimeters, but in case you were confused in the interdental cow. So this is talking about clinical attachment loss not pocketing. Again you guys that's why I love this chart instead because it's more specific I can leave the link for you guys. For this I got this from an amazing resource. The DSO hygiene excellence website so definitely check them out, but that's just basically it in a nutshell keeping it simple for you guys okay if you have any questions let me know comment below. I think it easier with practice. Okay, so thank you guys so much for watching please click like to this video if you like it that does help me in my channel, and I will talk to you guys very very soon thank you so much for watching.