Changes with the American Academy of Periodontology - Staging and Grading

The Periodontal Staging and Grading Classification system developed by the American Academy of Periodontology in 2017 introduced more detail to clinical documentation and the patient care process overall.

The staging and grading system enhanced the ability to diagnose and predict periodontal treatment outcomes; it has also introduced new functionality in how patient care is managed and communicated.

Most of the clinical data collected is the same, however, a few additional key components such as the stage and grade of the case have been added.  The new level of detail required creates a more thorough documentation process.

The 1999 Periodontal Classifications, were structured as broad categories only:

1. Gingival Diseases:
   Dental plaque-induced gingival diseases
   Non-plaque induced gingival lesions
2. Chronic Periodontitis
3. Aggressive Periodontitis
4. Periodontitis as a Manifestation of Systemic Diseases
5. Necrotizing Periodontal Diseases
6. Abscesses of the Periodontium
7. Periodontitis Associated with Endodontic Lesions
8. Developmental or Acquired Deformities and Conditions

The many sub-categories within each of these headings seemed to complicate an already difficult disease classification and it was not always beneficial in helping to determine a diagnosis and an appropriate treatment plan. 

Many clinicians, using only CAL as the main classification criterion left us unsettled.  We now know so much more about this disease than we did in 1999.  Now, we have ‘Stages’ and ‘Gradings’ to further our commitment to better diagnosis and treatment of this disease.  Maintaining professionalism when faced with ever-changing information is a daunting task. 

As we continue to learn about the causes of periodontal disease and the many associations with systemic health and wellness, the experts will undoubtedly be required to provide further revisions to these classifications in the future.

Keeping up with the new demands.

With the new staging and grading classification system, there are many more components to assess, making data collection much more complex.  It is, important to be able to collect this data consistently to create snapshots over time when looking back on the comparisons.  If the data is incomplete or inconsistent in the way it was collected, it is difficult to make an accurate comparison.  Unlike the old classification system, giving a rough order of magnitude is no longer enough. 

Communication styles can vary between professional-clinical understanding and patient case presentation.

The steps of staging and grading make the diagnosis easier and clearer to communicate with the patient and the referring doctor.  The new classifications present Periodontitis in much the same way that other diseases are categorized, as stages.  Most people are familiar with the concept that Stage IV cancer is more serious than Stage I. The same is true for Periodontitis.

The ideal data output and types of reports are often vastly different between dental professionals and patients.  What is very necessary for you as a doctor to track, may not be suitable for the patient, hygienist, or referring dentist's practice.  This means you may create several translations to accommodate not only yourself the provider, but all the other stakeholders involved in the care of the patient including the patient themselves. 

When comparing historical data that has been collected over time, do you have enough information to be able to accurately get a feel for the changes in the case overall?  Or do you wish you had been able to capture more data to clarify the roadmap in front of you?

The data necessary to make a thorough assessment is now more detailed and requires more effort to record in its entirety.

This brings up the question, “How is data being collected to facilitate an accurate diagnosis?” Do you have the capability to be able to not only completely and consistently record the clinical data, but also provide the appropriate output to accommodate the reader at their level of understanding? Or do you simply keep it all in your mind including just enough information to meet the medical-legal requirements, then later, making the necessary formalities to accommodate everyone else?

Allocate appropriate resources to ensure the integrity of the data collection during the documentation process. 

When doctors are faced with most of the workload including all or most of the patient care documentation, the risk of inconsistency increases.

Allocate the appropriate resources needed to maintain your records, for example, staff and physical resources. By doing this, you will be able to better manage your administrative records effectively, leaving staff feeling supported and more positive about their position. 

Don’t be afraid to modify your record-keeping system if you find a more efficient way to achieve results. Regular reviews of your record-keeping systems will keep them up-to-date and operating in a way that is beneficial to the practice.

Embrace new that may help improve the efficiency of your administrative record-keeping system. Practice staff will appreciate any efforts made to improve the task of keeping records, giving them additional job satisfaction.

Know the capabilities of your software and provide appropriate training to staff. Most software used in practices today has capabilities that will make it easier for you to keep accurate administrative records. Training your staff in record keeping will benefit your practice by increasing the reliability and consistency of your practice and patient records.

PANDA Perio is the perfect solution to address these needs including.

• Various styles of customized output reports that are automated based on the data collected, to translate the information in a format that is useful for the audience. Click to View
• High-resolution graphical reports improving case presentation and the motivational factors affecting case acceptance. Click to View
• A clear and comprehensive way to systematically record data for a more thorough complete and clear comparison year after year for the Periodontist and dental hygienist. Click to View
• Modernization of current classification on staging and grading as well as unlimited flexibility to incorporate/ include traditional styles and methods.

_{References*  https://aap.onlinelibrary.wiley.com/doi/full/10.1002/JPER.18-0006  https://deltadentalks.com/dentist/updates/staging-and-grading-of-periodontitis-what-you-need-to-  know#:~:text=The%20New%20Periodontal%20classification%20system%20has%20a%20staging,of%20destroyed%20and%20damaged%20tissue%20attributable%20to%20periodontitis. https://www.perio.org/sites/default/files/files/Staging%20and%20Grading%20Periodontitis.pdf  https://aap.onlinelibrary.wiley.com/doi/abs/10.1002/JPER.19-0390  https://www.oralhealthgroup.com/features/periodontitis-staging-and-grading/#:~:text=The%20steps%20and%20staging%20and%20grading%20will%20make,way%20that%20other%20diseases%20are%20categorized%2C%20as%20stages.  https://www1.health.gov.au/internet/main/publishing.nsf/Content/admin-record-keeping-book}