Writing a Periodontal Diagnosis American Academy of Periodontology & cpitn



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Date: 6-22-04

Writing a Periodontal Diagnosis

American Academy of Periodontology & CPITN

Classification of Periodontal Diseases and Conditions




Classification of Periodontal Disease


Conditions

CPITN

Periodontal Health

None


0 - Periodontal Health
Gingivitis/Gingival diseases

No pockets, bleeding on probing

A. Dental plaque-induced gingival diseases

B. Non-plaque-induced gingival lesions


Sextant Scores of - 1 & 2

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

-4 = > 6mm probing depth
Severity of Disease:

  • Slight – CPITN of 3

  • Moderate – CPITN of 3

  • SevereCPITN of 4


Aggressive Periodontitis

A. Localized

B. Generalized (> 30% of sites are involved)





Age Distinction: Usually described as early onset < 35 years of age or rapidly progressing

Severity of Disease (same as above):

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

-4 = > 6mm probing depth
Severity of Disease:

  • Slight – CPITN of 3

  • Moderate – CPITN of 3

  • Severe – CPITN of 4






Classification of Periodontal Disease


Conditions

CPITN


Periodontitis as a Manifestation of Systemic Diseases



A. Associated with hematological disorders

(neutropenia, leukemia)

B. Associated with genetic disorders

(Down’s, histiocytosis)

C. Not otherwise specified





Necrotizing Periodontal Diseases

Necrotizing Ulcerative Gingivitis (NUG) – gingival disease...does not extend into periodontal attachment.

Necrotizing Ulcerative Periodontitis (NUP) - extending into periodontal attachment



Abscesses of the Periodontium

A. Gingival abscess

B. Periodontal abscess

c. Pericoronal abscess





Periodontitis Associated With Endodontic Lesions

Combined periodontic-endodontic lesions




Developmental or Acquired Deformities and Conditions

A. Localized tooth-related factors that modify or predispose to plaque-induced gingival diseases/periodontitis

B. Mucogingival deformities and conditions around teeth

C. Mucogingival deformities and conditions on edentulous ridges

D. Occlusal trauma







Community Periodontal Index of Treatment Needs (CPITN)


CPITN SCORES

CLINICAL DESCRIPTION

Treatment needs

0

Periodontal Health

Promote self-assessment skills - Oral hygiene instructions (OHI)

1

Bleeding on probing

OHI

2

Calculus or Restoration overhang present

OHI + prophy (ultrasonic scaling/overhang removal)

3

3.5 – 5.5 mm probing depth

OHI + ultrasonic scaling

4

Pocket depths >6 mm

Evaluate Severity & Rick Factors (such as DM, Smoking, Immunocompromised, Age)

AGE DETERMINES RISK CATEGORY

14 – 35 YEARS

HIGH RISK

High Intensity OHI

Non-Surgical Pocket Debridement

Chemotheraphy

Active Recall

36 – 59 YEARS

MODERATE RISK

OHI

Pocket Debridement

Optional Recall

>60 YEARS

LOW RISK

OHI

Pocket Debridement

Optional Recall




  • 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!


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