The Shades of Gray in Periodontal Disease Classifications

Within the last few years, periodontists and implant specialists have worked to improve the periodontal disease classification system. When patients are faced with periodontal disease, it’s often not a black-and-white scenario, as clinicians often have to rely on their dental experience and judgment to assess a grey situation, especially when the signs aren’t intuitive or obvious. This article is intended to expand what periodontists and others who treat periodontal disease navigate some of the clinical problems that can be encountered when classifying this disease.

The Severity and Complexity of Periodontal Disease

Patients with periodontal disease can face numerous symptoms. While the most obvious symptoms include inflamed and bleeding gums, the severity and extent of the lesions caused by the tissue-eating bacteria can often be difficult to diagnose directly. To treat periodontal disease means understanding not only the pathology of the disease but how it is personally interacting with the patient’s oral cavity. The introduction of the new classification system back in 2017 has redefined some of the parameters dentists use when looking at periodontal disease and now works to define it by stage and grade of disease.

According to these revised rules, assessing periodontal disease means looking at specific focal points during the diagnosis process, including:

• Stage Level: The stage level is defined by the most severe findings found on the patient rather than the patient’s individual tooth level. This means that disease severity, complexity, and associated tooth loss are considered alternative pathways when defining its stage. It involves using the symptoms associated with the disease itself and other findings to assign treatment and refer to how much gum recession has taken place along the lingual areas.
• Grade Level: Grade level refers to the risk factors associated with the patient’s condition, the patient’s further risk when it comes to their overall health, and anticipated treatment outcomes based on the stage of the disease. The grade takes in factors such as direct evidence of progression, health risk factors contributing to the disease, and other biomarkers that indicate the amount of risk present for the patient if left untreated.

Both of these factors are based on a stage and grade system often used on oncology treatments, and by using this system, many dentists have been able to work in areas of grey obscurity, where the disease and its symptoms show contrasting factors that make it difficult to treat immediately. For oral surgeons, this means that mid-stage cases can be worked through as a primary solution, and unless severe, be referred to a periodontist for further treatment.

Oral Surgeons and Gum Disease Treatments

As oral surgeons, our focus on the oral pathways gives us a great advantage over general dentists when providing treatment for complex cases. By looking into these oral structures and pathologies, oral surgeons can work to reconstruct the face and mouth and help refer the patient to a specialist in cases such as severe periodontal disease. Because of how complex periodontal disease can be, oral surgeons should always be aware of the complications that could occur with reconstruction treatment.