STEP 1 New patient
When seeing a patient for the first time, we should first ask if there is a full-mouth radiograph of adequate quality. If yes, we should assess whether there is detectable marginal bone in any area of the dentition. If bone loss (BL) is detectable, the patient is suspected of having periodontitis. At the same time, irrespective of radiographic records, we must clinically explore the patient and assess interdental clinical attachment loss (CAL). If CAL is detectable, the patient is a possible case of periodontitis. If interdental CAL is not detected, we must evaluate the presence of buccal recessions with probing pocket depths (PPD) greater than 3mm. If such recessions are present, the patient is a possible periodontitis case. If there are no buccal PPD greater than 3mm, we must evaluate full-mouth bleeding on probing (BoP). If this is present in more than 10% of the sites, the patient is diagnosed with gingivitis and if present in less than 10% of sites, the patient is diagnosed with periodontal health.
Diagnostic quality & full-mouth
Detectable marginal bone loss
X-Rays available
Yes
Yes
New patient
No
No
No
Yes
Assess interdental CAL loss
Yes
Suspect periodontitis
No
Yes
Buccal or oral rec & PPD ˃3mm
Yes
Localised gingivitis
No
BoP 10-30%
Periodontal health
Measure BoP
≥ 10%
Gingivitis
< 10%
BoP ˃30%
Generalised gingivitis
Proceed to Step 2
Periodontitis: clinical decision tree for staging and grading Based on: Tonetti, MS & Sanz M. Implementation of the New Classification of Periodontal Diseases: Decision-making Algorithms for Clinical Practice and Education . Journal of Clinical Periodontology , 2019.
Periodontitis: clinical decision tree for staging and grading
2
Guidance for clinicians
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