Writing a Periodontal Diagnosis American Academy of Periodontology & cpitn

Download 32.8 Kb.

Date conversion	22.11.2016
Size	32.8 Kb.

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 Severe – CPITN 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

Periodontal Health

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

Bleeding on probing

OHI

Calculus or Restoration overhang present

OHI + prophy (ultrasonic scaling/overhang removal)

3.5 – 5.5 mm probing depth

OHI + ultrasonic scaling

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!

Writing a Periodontal Diagnosis American Academy of Periodontology & cpitn