AAP's New Guidelines for Periodontal Disease Classification

Posted by Shawn M. Johnson, ChFC®, CLU®, CLTC on May 26, 2021 9:00:00 AM

The American Academy of Periodontology (AAP) has recently created a new set of guidelines for the classification of periodontal disease. These guidelines are valuable but they can also be confusing and complicated. Because of that, dentists will want to take a careful look at what they offer and what they're requiring, in order to follow them correctly. 

Two of the biggest changes are the classification and calculation of bone loss based on age. This calculation helps to grade the level of the disease the patient has, but can also be difficult to arrive at through mental math. Another concern is that the disease severity may not be the same everywhere in the mouth. So which area is correct? 

Here's a summary for dentists. 


Chairside Arithmetic Isn't Always Practical

While the AAP guidelines are necessary and carefully thought out, some dentists may find them to be complex. The degree of confusion that some dentists may feel in trying to adhere to the guidelines could make them problematic. If the guidelines aren't followed, or are handled arbitrarily, patients could end up categorized differently from the way they really should be for treatment basics and future concerns.

Pulling out a calculator in the exam room may seem strange, but it's something dentists may find themselves doing more frequently. The math isn't the only issue, though, because the information that calculation provides is just part of the equation when it comes to periodontal disease. 

Grades Are Based on Age and Bone Loss

The guidelines set out by the AAP state that the classification of a patient's periodontal disease is based on the percent of their bone loss divided by their age. That calculation gives patients a "grade" that can be included in their chart and used as a baseline for future monitoring of their condition. Provided the patient gets a good grade and there aren't other risk factors or obvious problems appearing, the patient will be at low risk for periodontal disease -- at least for a period of time.

But trying to determine whether the grade is accurate, or whether it should be adjusted because of mitigating issues, is part of the difficulty dentists are facing. Because a dentist is responsible for a portion of a patient's medical care, health, and well-being, following guidelines is part of the job. 

That job is often made difficult by complex guidelines or those that could be very subjective, because that can leave dentists making educated guesses more than they'd like to. For example, a patient with significant disease areas around one or two teeth may need a lower grade, even if the patient's other teeth are generally in good shape. 

How does a dentist really determine that or choose an appropriate option for that patient? The argument could be made that the grade is based on the overall oral health picture, or on the worst area of oral health. Those will provide very different pictures of the patient's periodontal disease levels, in some cases.

Many Clinicians May Ignore Guidelines

The new set of AAP guidelines is only valuable for patients if those guidelines are used by dentists consistently and with care. In the past, a lot of dentists have ignored some or all of the guidelines due to the complexity of them. While it would be nice to say that's a thing of the past, guidelines may still be ignored. But using information about the patient's periodontal disease issues is one good way to determine whether that disease is progressing or staying the same for the immediate future.

Determining the Rate of Progression

Patients who have significant disease progression between checkups, or who have disease progression that's advanced in some areas of their mouth, may need measures to intervene in their periodontal disease.

Without proper treatment, tooth loss and other oral health problems could occur. Additionally, systemic infection could be caused by oral health concerns. That could mean infection in the mouth from periodontal disease spreading to other areas of the body. Organs and tissues could be affected by this process, potentially putting the patient at risk for serious health problems over and above periodontal disease. 

Tooth loss is also a very real problem for those who have gum disease, and discovering the rate of progression gives dentists the opportunity to work with their patients in an attempt to reduce the chances of losing teeth to infection, gum loss, or bone loss.

Pathogens and Medical Conditions Play a Role

The level of pathogens in the mouth, along with other health conditions throughout the patient's body, can play a role in periodontal disease and tooth loss. When a dentist works to evaluate the grade of a patient with periodontal disease and diabetes, for example, determining that patient's level of blood sugar control over time matters.

Good sugar control may slow the progression of periodontal disease, while poor sugar control could mean a faster progression and more damage. That's not guaranteed, but it's something a dentist will want to look out for and be aware of. The guidelines from the AAP account for that and other factors, making their proper use a good way to protect patients more fully.

Making sure you convey complex health information to your patients is just one important part of a dentist’s role. It takes a lot of information and a lot of resources to run a dental practice. If you’re looking to grow your practice and patient list, we can offer you some free resources.

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Treloar & Heisel, Inc. does not offer medical or dental advice. Please review the applicable guidelines and consult with a licensed professional. This content is intended for general informational purposes only and should not be construed as advice.


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