Clinical guidelines to assess periodontal stability of maintenance patients

1. Periodontal Maintenance Guidelines:
Any periodontal patient in maintenance should be considered UNSTABLE and be
referred to the Periodontist if any of the following periodontal clinical sign is present.
Inflammation as measured
by bleeding on probing a. Full mouth BOP > 15%, suggests
(BOP) instability
b. Sites that consistently show BOP
overtime may be unstable
c. Sites that consistently show no BOP are
likely stable
Probing depth
measurements (PD) a. Sites with PD increase of > 2mm from
baseline or previous visit, unstable# of
significant periodontal pocket depths
b. 10 or more sites > 4mm PD, unstable
c. 6mm or greater PD at any site consider
unstable
Progressive gingival recession from baseline or
previous charting
Radiographic considerations
a. Loss of crestal bone height based on vertical
bite wings, unstable
b -Consistent presence of crestal lamina dura
suggests stability
Patient-level considerations
a. Poor hygiene in the presence of
attachment loss PI > 30%, unstable
b. Smoking > ½ Pack / day, unstable
c. Diabetic with HBA1c > 9, unstable
High stress events, divorce, loss of loved one,
unemployment, unstable