Making the Most of the New Periodontal Classification System

In 2017, the American Academy of Periodontology and the European Federation of Periodontology held a world workshop to formulate an improved classification of periodontal disease. In 2018, the findings were published in the Journal of Periodontology and Journal of Clinical Periodontology.¹ Since its publication, the 2018 classification has become the standard used to classify and describe periodontitis. However, the clinical application of the new classification as a guide to the delivery of care for patients in need of periodontal treatment has remained unclear.

We recently published a paper describing “decision points” for periodontal therapy based on the new classification.² The goal of the decision points is to assist the clinician in using the advanced features of the new classification system to help formulate effective treatment plans for patients in need of periodontal therapy. The decision points also assist clinicians in evaluating the effectiveness of periodontal therapies, thus, helping to determine when advanced therapies are needed as well as to better plan for optimal periodontal maintenance.

Periodontal Classification

The 2018 periodontal classification can be accessed in detail at: https://www.perio.org/wp-content/uploads/2019/08/Staging-and-Grading-Periodontitis.pdf. Table 1 outlines the essentials of the classification. In its simplest form, the classification can be summarized as Stage I being the earliest manifestation of periodontal disease and then graduating up through Stage II and III to Stage IV, which is the most severe manifestation of periodontal disease. The speed of periodontal disease progression is described as Grade A through C, with Grade A representing slow progression and Grade C indicating rapid progression.

The grade of a case is extremely important in determining the long-term prognosis of a patient but it requires more than a single evaluation of the patient. When periodontal patients are initially classified, they are graded as B until the passage of time permits a more accurate estimate of periodontal progression. If it is determined that a patient has rapidly progressing periodontal disease (Grade C), prompt referral to a periodontist is recommended.

The full classification article referenced earlier should be reviewed for more information on determining the speed of disease progression and assigning a grade.¹

References

1. Caton JG, Armitage G, Berglundh T, et al. A new classification scheme for periodontal and peri-implant diseases and conditions—introduction and key changes from the 1999 classification. J Periodontol. 2018;89(Suppl 1):S1–S8.
2. Harrel SK, Cobb CM, Sottosanti JS, Sheldon LN, Rethman MP. Clinical decisions based on the 2018 classification of periodontal diseases. Compend Contin Educ Dent. 2020;43:52–56.

This information originally appeared in Harrel SK, Rethman MP, Cobb CM, Sheldon LN, Sottosanti JS. Clinical decision points as guidelines for periodontal therapy. Dimensions of Dental Hygiene. 2022;20(6)28–33.