Grading
Grading a periodontitis patient involves estimating the future risk of periodontitis progression and the likely responsiveness to standard therapeutic principles. This estimate guides the intensity of therapy and secondary prevention after therapy. Grading adds another dimension and allows the rate of progression to be considered, using direct and indirect evidence. Direct evidence is based on the available longitudinal observation: for example, in the form of older diagnostic-quality radiographs. Indirect evidence is based on the assessment of bone loss at the worst-affected tooth in the dentition as a function of age (measured as radiographic bone loss in percentage of root length divided by the age of the subject). The periodontitis grade can then be modified by the presence of risk factors. Clinicians should approach grading by assuming a moderate rate of progression (grade B) and look for direct and indirect measures of whether there is a higher disease progression that would justify the application of grade C. Grade A is applied once the disease is arrested. If the patient has risk factors that have been associated with greater disease progression or lesser responsiveness to bacterial-reduction therapies, the grade score should be raised independently of the primary criterion represented by the rate of progression. For example, a case could be characterised by moderate attachment loss (stage II), where the assumption of a moderate rate of progression (grade B) is modified by the presence of poorly controlled Type-2 diabetes, which is a risk factor that could shift the grade definition to rapid progression (grade C).
Grade A: Slow rate of progression
Grade B: Moderate rate of progression
Grade C: Rapid rate of progression
Periodontitis
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Guidance for clinicians
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