Periodontics
Core concepts
Periodontics hinges on diagnosis, risk assessment, and staged management. Learn the distinction between gingivitis (reversible inflammation confined to soft tissue, no attachment loss) and periodontitis (attachment loss with pocket formation and radiographic bone loss). Understand the 2018-style classification logic: staging reflects severity and complexity (clinical attachment loss, probing depth, bone loss, tooth loss, complexity factors), while grading reflects rate of progression and risk (smoking, diabetes, radiographic bone loss relative to age).
Know the local and systemic risk factors: plaque, calculus, smoking, poorly controlled diabetes, drugs causing gingival overgrowth, pregnancy, puberty, and immunosuppression. Smoking is the single most important modifiable risk factor and blunts bleeding on probing - a classic trap where a heavy smoker has deep pockets but little bleeding.
Management principles
Initial therapy is cause-related: oral hygiene instruction, scaling and root surface debridement, risk-factor control, and reassessment. Surgical and regenerative options follow only after reassessment. Antibiotics are adjunctive, never a substitute for mechanical debridement. Learn the role of systemic antibiotics in aggressive or necrotising presentations and the risk of resistance.
Traps
- Diagnosing periodontitis from pocket depth alone without attachment loss.
- Assuming absence of bleeding excludes disease in smokers.
- Prescribing antibiotics instead of debridement.
- Forgetting diabetes and smoking control when asked for the most important next step.
Worked example
A 45-year-old smoker has 7 mm pockets with minimal bleeding and 40% bone loss on radiographs. Rule of thumb: staging uses severity (bone loss, attachment loss, tooth loss) and grading uses progression risk (smoking, diabetes). Here the low bleeding is explained by smoking, not health, so the answer is smoking cessation plus cause-related debridement and reassessment, not reassurance.