STEP 2 Patient suspected of periodontitis
When the presence of interdental CAL in the oral examination has identified the patient as a suspected case of periodontitis, we need to ascertain whether this CAL is caused by local factors only – endo-perio lesions, vertical root fractures, caries, restorations, or impacted third molars. If not, we need to ascertain that the interdental CAL is present in more than one non-adjacent tooth. If this is the case, we have a periodontitis patient and we need to make a comprehensive periodontal diagnosis through periodontal charting and full-mouth radiographs. If the periodontal charting does not show PPD of 4mm or more, we need to evaluate full-mouth BoP. When BoP is higher than 10%, the diagnosis is gingival inflammation in a periodontitis patient; when it is lower than 10%, the diagnosis is a patient with a reduced but healthy periodontium. If the periodontal charting shows PPD of 4mm or more, the diagnosis is a periodontitis case that needs to be assessed according to stage and grade.
Endo-perio lesion
Vertical root fracture
Suspect periodontitis
Local factors only
Yes
Caries or restoration
No
Impacted wisdom tooth
Suspect periodontitis
Assess gingivitis and monitor
CAL loss ˃1 N-A tooth
No
Step 1: Measure BoP
Step 1: Measure BoP
Periodontal charting & radiographs
PPD 4mm or more
Periodontitis case
BoP
No
Yes
No BoP
BoP +
Periodontal & bone appraisal
Reduced but healthy periodontium patient
Gingival inflammation in periodontitis patient
Staging & grading
Periodontitis: clinical decision tree for staging and grading
3
Guidance for clinicians
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