Periodontal Diagnosis and Clinical Assessment
Periodontal Diagnosis and Clinical Assessment
This domain tests systematic charting, the 2017 AAP/EFP staging and grading system, and radiographic interpretation.
Core measurements
- PD, CAL, recession, BOP, plaque indices (O'Leary, Silness–Löe), mobility (Miller 0–3), furcation (Glickman I–IV, Hamp), mucogingival deformities.
- CAL = PD + recession (or PD − hyperplasia); it is the only measure of true attachment loss.
- Radiographs: bitewings for crestal bone, periapicals for vertical defects and furcations, CBCT when three-dimensional anatomy changes the plan.
Staging and grading
Stage I: CAL 1–2 mm, RBL 15%; Stage II: CAL 3–4 mm, RBL 15–33%; Stage III: CAL ≥5 mm, bone loss to the middle third, ≤4 teeth lost, plus complexity (PD ≥6 mm, vertical defect ≥3 mm, Class II/III furcation); Stage IV: ≥5 teeth lost, masticatory dysfunction. Grade A: RBL/age <0.25; B: 0.25–1.0; C: >1.0, or smoking ≥10/day, HbA1c ≥7.0%.
Worked example
Interdental CAL 6 mm, 40% RBL, two teeth lost, smoker of 15/day. Stage III (CAL ≥5 mm, ≤4 teeth lost). Grade: RBL/age = 0.40/40 = 1.0 is borderline B, but smoking ≥10/day forces Grade C.
Traps
Reporting PD as attachment loss; staging from an average rather than the worst site; using grade to describe severity (it describes progression risk); calling mobility grade 2 normal for age; diagnosing a perio-endo lesion before pulp testing.