Back to School!

Author: Andrea Kowalczyk, RDH, BS– – Dental Hygiene Performance Coach – Enhanced Hygiene

At Enhanced Hygiene, we teach hygiene teams that a comprehensive assessment that includes risk assessment and periodontal assessment is the basis for comprehensive care.  We coach that early to moderate periodontal disease must be treated to minimize risk of progression, that maintenance is the most important stage of periodontal therapy, and that all patients need to understand what periodontal disease is.

We remind hygienists that it is their role to thoroughly examine the patient and take responsibility for the periodontal therapy treatment plan. We help hygienists do this by refreshing them on the fundamentals of the etiology and progression of periodontal disease. We review with hygienist’s the various ways to recognize and classify disease, and how to provide the appropriate treatment regimen to include maintenance.

It may sound as if we are going “back to school” with hygienists, and in some ways, we are! For many hygienists, having their basic knowledge refreshed is critical in their ability to successfully map out a periodontal treatment plan and take ownership of it.

In dental hygiene school, we  classified our patients based on the amount of debris they presented with. We called it a prophy 1, 2 or 3, (or A, B, or C) based on the amount of time and skill required to remove the debris. Classifying patients this way is fundamental when a certain level of skill and clinic experience is required in order to ensure a thorough cleaning is performed.

In the real world practice setting however, treatment for periodontal disease is based on the ADT code required to bill out the procedure. This means that hygienists need to understand when localized or full quadrant scaling and root planing is indicated based on factors more complex than just the amount of debris. To know when each procedure is indicated, it is essential to know which disease states require scaling and root planing in order to be arrested.

For us to be confident we must first be educated. There is no shame in refreshing your knowledge. For ease, I have included a quick guide for reference, taken from the American Academy of Periodontology classifications of periodontal disease stages.


ž  Pocket depths 1-3mm

ž  No bleeding

ž  Healthy, pink, firm gingiva

ž  No bone loss

ž  No inflammation


ž  Pocket depths 1-4 mm

ž  Bleeding on probing

ž  No radiographic bone loss

ž  Tissue red, edematous

ž  Only the gingival tissues have been affected by the inflammatory process.

ž  Alveolar bone level is 1 to 1.5mm from the CEJ.

Early Periodontal Disease

ž  Pocket depths 4-5mm

ž  Possible bleeding on probing

ž  Tissue may be fibrotic, with edematous areas

ž  Possible localized areas of recession

ž  Slight bone loss must be present

ž  Slight loss of the interdental septum

ž  Alveolar bone level is 3 to 4mm from the CEJ area


ž  Pocket depths 5-6 mm

ž  Possible bleeding on probing

ž  Bone loss

ž  Possible Slight furcation involvement

ž  Possible Grade I and/or Grade II furcation invasion areas

ž  Possible Tooth Mobility of Class I

ž  Possible Alveolar bone level is 5 to 7mm from the CEJ area


ž  May Include the Following:

ž  Pocket depths >7 mm

ž  Bleeding on probing

ž  Furcation involvement

ž  Increased tooth mobility

ž  Mobility of Class II or Class III

ž  Horizontal and vertical bone loss

ž  Alveolar bone level is 6mm or more from the CEJ area

ž  Radiographic furcations