Periodontics
Scope
Tests periodontal examination and diagnosis using the 2017 classification, the evidence base for nonsurgical therapy, and the recognition and management of peri-implant disease.
Examination
- Probing depth, clinical attachment level, bleeding on probing, plaque scores, mobility, furcation involvement and radiographs. It is CAL, not pocket depth alone, that defines severity.
2017 classification
- Stage (severity and complexity): I CAL 1–2 mm; II CAL 3–4 mm; III CAL ≥5 mm with four or fewer teeth lost; IV CAL ≥5 mm with five or more teeth lost plus complexity such as collapse or mobility.
- Grade (rate of progression): A bone loss divided by age under 0.25; B 0.25–1.0; C above 1.0, or heavy smoking of 10 or more per day, or HbA1c ≥7.0%.
Therapy
- Cause-related care: oral hygiene instruction, scaling and root planing, and risk-factor control for smoking and glycaemia; re-evaluate at 6–8 weeks.
- Adjunctive systemic amoxicillin 500 mg plus metronidazole 400 mg every 8 hours for 7 days in grade C disease, never as a substitute for debridement.
Peri-implant disease
- Mucositis is reversible; peri-implantitis shows progressive bone loss with inflammation. Smoking and uncontrolled diabetes raise risk, so decontamination and supportive maintenance are essential.
Worked example
A 45-year-old smokes 15 cigarettes a day, has HbA1c 8.0%, 60% bone loss on the worst tooth, CAL 6 mm and has lost two teeth. Reasoning: CAL ≥5 mm with four or fewer teeth lost is Stage III; bone loss divided by age above 1.0, plus heavy smoking and HbA1c ≥7.0%, gives Grade C. Answer: Stage III, Grade C.
Traps
- Staging from pocket depth or radiographs alone instead of CAL.
- Placing smoking or diabetes into the stage rather than the grade.