STEP 4a Grading when there are no existing records
When previous periodontal records are not available, the bone loss/age (BL/A) ratio should be calculated from the full-mouth radiographs. If BL/A is between 0.25 and 1.0, the diagnosis is Grade B periodontitis. If less than 0.25, the diagnosis is Grade A periodontitis: if higher than 1.0, the diagnosis is Grade C periodontitis. Grades A and B can be modified if the patient smokes or is diabetic. A patient who smokes 10 or more cigarettes per day will be changed to Grade C, while one who smokes fewer than 10 cigarettes will be upgraded to B. Similarly, a diabetic patient with HbA1c below 7.0 will be upgraded to B and one with HbA1c of 7.0 or more upgraded to C.
Periodontitis case
Grade A periodontitis
< 0.25
Previous records available
Apply grade modifiers
Grade B periodontitis
Bone loss/age
No
0.25-1.0
Yes
˃1.0
Grade C periodontitis
Estimate progression (5 years)
Smoking
Diabetes
No diabetes
Proceed to 4b
Yes HbA1c 7.0 or more
Yes HbA1c < 7.0
< 10/day
No smoking
10 or more/day
No change in grade
Upgrade to B
Upgrade to C
Periodontitis: clinical decision tree for staging and grading
7
Guidance for clinicians
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