Hygiene Atlas

Atlas · Plate X · Periodontology · 03

2017 classification: staging and grading

The 2017 AAP/EFP system replaced the old chronic and aggressive labels with a single periodontitis described by stage, extent and grade. Stage I-IV reflects severity and complexity from CAL, bone loss and tooth loss. Grade A-C reflects the rate of progression, using bone loss divided by age, smoking and HbA1c. Gingivitis means 10% or more bleeding sites without attachment loss.

High-yield facts · 19

  1. Periodontal health: under 10% bleeding sites and probing depths 3 mm or less on an intact periodontium.S12S13
  2. Dental plaque-induced gingivitis: 10% or more bleeding sites with probing depths 3 mm or less and no attachment loss.S12
  3. Localized gingivitis is 10-30% bleeding sites; generalized is over 30%.S12
  4. Periodontitis case: interdental CAL at 2 or more nonadjacent teeth, or buccal/oral CAL of 3 mm or more with pocketing over 3 mm at 2 or more teeth.S12S11
  5. Stage I: interdental CAL 1-2 mm, bone loss under 15%, max PD 4 mm or less.S11
  6. Stage II: CAL 3-4 mm, bone loss 15-33%, max PD 5 mm or less.S11
  7. Stage III: CAL 5 mm or more, bone loss into the middle third or beyond, tooth loss from periodontitis of 4 or fewer teeth; PD 6 mm or more, vertical defects 3 mm or more, class II/III furcations.S11
  8. Stage IV: Stage III plus loss of 5 or more teeth from periodontitis, masticatory dysfunction, bite collapse, drifting/flaring, fewer than 20 teeth (10 opposing pairs).S11
  9. Grade A: no bone loss in 5 years; bone loss/age under 0.25. Grade B: under 2 mm in 5 years; 0.25-1.0. Grade C: 2 mm or more; over 1.0.S11
  10. Grade modifiers: smoking under 10 cigarettes/day = B, 10 or more = C; HbA1c under 7% in a diabetic = B, 7% or more = C.S11
  11. Bone loss/age example: 40% bone loss at age 40 = 1.0 (grade B); 50% at age 30 = 1.67 (grade C).S11
  12. Extent: localized under 30% of teeth; generalized 30% or more; molar/incisor pattern is described separately.S11
  13. Necrotizing gingivitis: punched-out papillae, pain, bleeding, fetid odor; risk factors are stress, smoking, poor nutrition and immunosuppression.S39S12
  14. Necrotizing periodontitis adds attachment and bone loss; necrotizing stomatitis extends beyond the gingiva.S39
  15. Periodontal abscess: localized pus in the pocket wall, often in a patient with existing periodontitis or after incomplete scaling.S12
  16. Gingival recession is now classified by Cairo: RT1 (no interproximal attachment loss), RT2 (interproximal loss up to the buccal loss), RT3 (interproximal loss greater than buccal).S12
  17. Peri-implant mucositis: bleeding and/or suppuration on gentle probing without bone loss beyond initial remodeling; reversible.S12
  18. Peri-implantitis: bleeding/suppuration plus progressive bone loss; without baseline data, bone level 3 mm or more and/or PD 6 mm or more with bleeding.S12
  19. Systemic diseases with severe periodontitis include Papillon-Lefevre syndrome, leukocyte adhesion deficiency, Down syndrome and Chediak-Higashi syndrome.S12

Facts are written in our own words; each tag links to its source. Values marked "sources vary" differ between references, so check the one your program uses.