STEP 4b Grading when there are existing records
When the patient’s periodontal records are available, the rate of periodontitis progression over the previous five years should be calculated. If progression is less than 2mm, the diagnosis is Grade B periodontitis. If there has been no progression in five years, the diagnosis is Grade A periodontitis. When the progression has been 2mm or more, the diagnosis is Grade C periodontitis. Grades A and B can be upgraded to a higher grade 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
No progression
Level of progression (5 years)
Apply grade modifiers
Previous records available
Grade B periodontitis
Yes
< 2 mm
No
2 mm or more
Grade C periodontitis
Estimate bone loss by age
Smoking
Diabetes
No diabetes
Proceed to 4a
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
8
Guidance for clinicians
Made with FlippingBook Annual report