Bleeding on probing, and/or calculus or restoration overhang present
Chronic Periodontitis
A. Localized
B. Generalized (> 30% of sites are involved)
Example: Two sextants of CPITN of 4 could be “localized chronic periodontitis” and maybe three or more sextants would be “generalized chronic periodontitis”
Age Distinction: Was described as adult onset periodontitis, in people older that 35 years.
Severity of Disease:
Slight: 1-2 mm clinical attachment loss (CAL); (3-4mm pockets, < 30% bone loss)
Moderate: 3-4 mm CAL; (4-6mm pockets, < 50% bone loss)
Severe: >5 mm CAL: ( > 6mm pockets, > 50% bone loss)
Written Diagnosis:
Use the descriptors localized or generalized depending on the distribution of sextant scores, and severity of disease. Ex. Gen slight chronic perio
Gen slight, locally severe chronic perio
Sextant Score of – 3 to 4 CPITN- 3 = 3.5 – 5.5 mm probing depth
Slight: 1-2 mm CAL; (3-4mm pockets, < 30% bone loss)
Moderate: 3-4 mm CAL; 4-6mm pockets, < 50% bone loss
Severe: >5 mm CAL: > 6mm pockets, > 50% bone loss
In the world of oral epidemiology, any pocket depth >6mm is considered a "deep pocket" with advanced or severe periodontal disease.
Written Diagnosis Example:
Localized Severe, Aggressive Periodontitis
Sextant Score of – 3 to 4 CPITN - 3 = 3.5 – 5.5 mm probing
Antibiotics should be used in conjunction with the initial full mouth cleaning in the High Risk patient. Antibiotic use without full mouth root debridement is of very little benefit.
Discussion: 90-95% of diagnoses will be gingivitis or chronic periodontitis. Add the “localized or generalized” descriptor, as well as the severity (slight, moderate, or severe).
Generally, use the age break point of 30-35 years as a help to determine whether it is Aggressive or Chronic Perio.
Remember, the CPITN does not recognize recession and clinical attachment loss. A patient could have generalized severe periodontitis with 70% bone loss and mobile teeth, but 3mm or less pocket depths due to recession. CPITN scores could look like: X / 2 / 2 because probing depths are shallow.
2 / 2 / X
Medical legally one should have a written diagnosis!