The document discusses gum disease (periodontitis) and provides information about its stages and characteristics. It defines key terms like plaque, inflammation, and periodontal pockets. It then describes the four stages of periodontitis from mild to very severe, noting clinical characteristics like bleeding, pocket depth, and bone loss for each stage. Finally, it discusses grading the rate of periodontitis progression and providing a diagnosis statement addressing extent, stage, grade, and identified risk factors.

1. PATIENT
CONSULTATION GUIDE
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2. Business Use
G U M D I S E A S E
Inflammation
Redness, Bleeding
Periodontal
Pocket
Loss of attachment of
supporting structures.
Bone loss
Periodontal - relating
to or affecting the
structures surrounding
and supporting
the teeth.
Plaque - a sticky
deposit on teeth in
which bacteria
multiply.
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T H E G U M D I S E A S E C Y C L E
Healthy Gums Inflamed Gums
(Gingivitis)
Currently
Stable
Less than10% bleeding.
Pockets less than4mm.
No bleeding at4mmsites,
ifpresent.
Currently in Remission
More than 10% bleeding.
Pockets greaterthan 4mm.
No bleeding at4mmsites,
ifpresent.
Currently Unstable
More than 10% bleeding.
Pockets greaterthan orequalto
5mm OR bleeding ata
4mm site.
Reversible
Periodontal Pocket loss of
attachment, surrounding and
supporting the teeth.
How deep are your
periodontal pockets?
No brushing
1mm 2mm 3mm
Timeto act GumDisease Highestriskoftooth loss
Within healthy limits
Pocket
depth
4mm 5mm 6mm 7mm 8mm 9mm+
Bleeding...
No Pocketing
No Bleeding...
No Pocketing
Gum Disease
(Periodontitis)
Gum Disease is treated in front of the
bathroom mirror with careful home care.
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A pocket of 4mm or more which bleeds is a sign of active gum disease.

4. Business Use
G I N G I VA L H E A LT H
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5. Business Use
G I N G I VA L H E A LT H
Diagnosis should also include a comment on plaque
retentive factor where a BPE code 2 is present.
Clinical Gingival Health
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CLINICAL CHARACTERISTICS
BOP: < 10%
Localised Gingivitis
BOP: 10-30%
Generalised Gingivitis
BOP: > 30%

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G I N G I V I T I S
Pigmented Gingiva
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P E R I O D O N T I T I S S TA G E I ( E A R L Y / M I L D )
•Less than 15%
bone loss at
the worst site
- or -
•within
2mm of the
CEJ
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8. Business Use
CLINICAL CHARACTERISTICS
BOP: yes (> 10%)
PD: < 4 mm
RBL: < 15%
Examples of possible risk factors include:
•Smoking (including no. of cigarettes per day)
•Sub-optimally controlled diabetes
P E R I O D O N T I T I S S TA G E I ( E A R L Y / M I L D )
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9. Business Use
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P E R I O D O N T I T I S S TA G E II ( M O D E R A T E)

10. Business Use
P E R I O D O N T I T I S S TA G E II ( M O D E R A T E)
CLINICAL CHARACTERISTICS
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BOP: yes
PD: < 5mm
RBL: 15% - 33%
Examples of possible risk factors include:
•Smoking (including no. of cigarettes per day)
•Sub-optimally controlled diabetes

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P E R I O D O N T I T I S S TA G E III ( S E V E R E )

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P E R I O D O N T I T I S S TA G E III ( S E V E R E )
CLINICAL CHARACTERISTICS
BOP: yes
PD: < 6 mm
RBL: > 50%
Examples of possible risk factors include:
•Smoking (including no. of cigarettes per day)
•Sub-optimally controlled diabetes
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Generalised
Generalised
Localised
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P E R I O D O N T I T I S S TA G E IV ( V E R Y S E V E R E )

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P E R I O D O N T I T I S S TA G E IV ( V E R Y S E V E R E )
CLINICAL CHARACTERISTICS
BOP: yes
PD: < 6 mm
RBL: > 50%
Examples of possible risk factors include:
•Smoking (including no. of cigarettes per day)
•Sub-optimally controlled diabetes
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15. Business Use
P E R I O D O N T I T I S S E V E R I T Y ( S T A G I N G )
Stage 1
Early bone loss
Stage 2
Moderate bone loss
Stage 3
Severe bone loss
Stage 4
Very severe bone loss
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1mm 2mm 3mm
Highest risk of tooth loss
Within healthy limits Time toact Gum Disease
Pocket
depth
4mm 5mm 6mm 7mm 8mm 9mm+

16. Business Use
P E R I O D O N T I T I S S TA G I N G
Adapted from Tonettietal. J Periodontal. 2018;89(Supp 1):S159-S172)
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INTERPROXIMAL BONE LOSS
(useworstsite of bone loss due to periodontitis)
<15%
(or <2mm attachment
loss fromCEJ)
Coronalthird
of root
Mid third
of root
Apical third
of root
Stage 1
(Early/Mild)
Stage 2
(Moderate)
Stage 3
(Severe)
Stage 4
(Very Severe)

17. G R A D E D E T E R M I N AT I O N
% BONE LOSS ÷ PATIENT AGE
(useworstsite of bone loss due to periodontitis)
<0.5 0.5-1.0 >1.
0
Grade A
(Slow rate of
progression)
Grade B
(Moderate rate
of progression)
Grade C
(Rapid rate of
progression)
Continuing the care that
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18. G R A D E D E T E R M I N AT I O N
Grade
modifiers
I >
15%
II 15-33%
III > 50%
IV
Age 35
20 55
45 65 75
STAGE BONE LOSS
85
Assessment of current Periodontitis status
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Risk Factor Assessment
Diagnosis Statement Extent - Periodontitis - Stage - Grade - Stability - Risk Factors
eg. Generalised Periodontitis Stage 3 Grade B - Currently Unstable - Risk(s): Smoker 15/day
Currently Stable
BOP: < 10%
PPD: < 4mm
No BOP at 4mm sites
Currently in Remission
BOP: > 10%
PPD: < 4mm
No BOP at 4mm sites
Currently Unstable BOP:
> 5mm or
PPD: > 4mm & BOP
For example:
•Smoking, including
cigarettes/day
•Sub-optimally controlled
diabetes

19. Business Use
P E R I - I M P L A N T M U C O S I T I S
CLINICAL CHARACTERISTICS:
BOP: Yes
PD: Increase
RBL: No
Visual Inflammation: Yes
Biofilm: Yes
Mobility: No
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20. PERI-IM PLANTITIS
P E R I - I M P L A N T I T I S
RISK INDICATORS:
•History of severe
periodontitis
•Poor biofilm control
•No regular maintenance
care
CLINICAL CHARACTERISTICS:
BOP &/or suppuration: Yes
PD: Increase/correlated to bone loss
RBL: Yes
Visual Inflammation: Yes
Biofilm: Yes
Mobility: Yes
More rapid progression than found in periodontitis
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NEC ROTIZING PERIO DO NTA L DISEASES
P E R I O D O N T I T I S N E CR O T ISIN G U L CE R AT IV E G IN G IV IT IS
CLINICAL CHARACTERISTICS:
BOP: Profuse and generalised
PD: < 3mm
RBL: none
Biofilm: moderate - heavy
Inflammation/necrotic tissue
Pseudomembrane, Gingival recession,
Necrosis, Loss of interproximal papillae.
Pain/fever: variable
RISK FACTORS:
•Inadequate oral hygiene
•Smoking
•Psychological stress
•Nutritional deficiency
•Immunosuppression
• Sleep deprivation
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22. Business Use
2 0 1 7 C L A S S I F I C AT I O N
O F P E R IO DO N T AL & P E R I - IMP L AN T DISE ASE S
Gingivitis &
Gingival Conditions
Periodontal Health
andGingivalHealth
Necrotizing
Periodontal Diseases
Systemic Diseasesor
Conditions affecting
periodontal supporting
structures
Periodontal Abscesses
andEndodontic-
PeridontalLesions
MucogingivalDeformities
andConditions
Traumatic Occlusal Forces
Peri-Implant Health
Peri-Implant Mucositis
Peri-Implantitis
Peri-Implant soft andhard
tissue deficiencies
ToothandProstheses
relatedfactors
Gingivitis:
BiofilmInduced
Periodontitis asa
manifestation of
systematic diseases
GingivalDiseases:
Non-BiofilmInduced Periodontitis
Periodontal Health, Periodontitis Other conditions
affecting the
periodontium
Peri-implant
diseases and
conditions
Adapted from Caton et al.J Periodontal2018.
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23. Business Use
T H E O R A L M I C R O B I O M E
Imbalanced
bacteria
Releases
toxins
Triggers
immune
response
Activatescells
that degrade
bone
Amplifies
disease
Symbiosis
Host-microbiome
Resistance
to
colonization
Anti-
inflammatory
factors
Support
host
defense
Maintains
ahealthy
digestive
tract
Antioxidant
activity
Regulates
cardiovascular
system
Diabetes
Poor
oral
hygiene
Smoking
Genetics
Poor
diet
Antibiotics/
antimicrobial
agents
Salivary
factors
Immune
factors
Dysbiosis
Calculus
Plaque
More than
meets the
eye...
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24. Business Use
A N AT O M Y O F A T O O T H
Common
tooth
problems
Crack
Enamel
Dentine
Pulp
(nerves & bloodvessels)
Filling
Caries
Gum
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25. Business Use
P R I M A R Y & P E R M A N E N T D E N T I T I O N
Primary Eruption Dates Permanent Eruption Dates
Central incisor: 6-10 mos
Central incisor: 8-12 mos
Lateral incisors: 9-11 mos
Lateral incisor: 10-16 mos
1st Molar: 14-18 mos
Canine: 17-23 mos
Canine: mos
1st Molar: 13-19 mos
2nd Molar: 25-33 mos
2nd Molar: 11-
13yrs
2nd Premolar: 11-12yrs
Central incisor: 7-8yrs
Lateral incisor: 8-9yrs
Canine: 11-12yrs
1st Premolar: 10-11yrs
2nd Premolar: 11-12yrs
1st Molar: 6-7yrs
2nd Molar: 11-13yrs
3rd Molar: 17-21yrs
Maxillary
Mandibular
8
7
5
6
3 2
4
1 1 2
3
4
5
6
7
8
8
7
6
5
4
3
1 1 2
5
6
7
8
C
D
E
B A A B
C
D
E
E
D
C
B A A B
C
E
D
Canine: 9-10yrs
1st Premolar: 10-12yrs
1st Molar: 6-7yrs
3rd Molar: 17-21yrs
4
3
2
5
2nd Molar: 22-31 mos
Lateral incisor: 8-9yrs
Central incisor: 7-8yrs
FDI World Dental Federation
International Numbering
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4
3
2
7
1
2
3
4
5
5
4
3
2
1 1
2
3
4
5
18
17
16
15
14
13
12
11 21
22
23
24
25
26
27
28
38
37
36
35
34
33
32
31
41
42
43
44
45
46
47
48

26. Business Use
D E N TA L D E C AY
Pit & fissure Interproximal Smooth surface Cervical / Root
AnusaviceKJ. Presentand future approaches for thecontrol ofcaries. J
Dent Educ. 2005 May;69(5):538-54. PMID: 15897335.
EO
No lesion
E1
Lesion within
the outer half of
enamel
E2
Lesion within
the inner half of
enamel
D1
Lesion within
the outer third
of Dentine
D2
Lesion within
the middle third
of Dentine
D1
Lesion within
the inner third
of Dentine
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27. Business Use
T I P S T O P R E V E N T D E N TA L D E C AY
Saliva Fluoride
Bacteria
•Sugary foods that cling to your teeth
•Frequent snacking or sipping
•Bottle to Bed /Feeding after final brushing
•Reduced or poor manual dexterity
•Dry Mouth
•Not getting enough fluoride
•Dexterity(young and old)
Risk
Factors
Sugar Bacteria Acid Decay
Tooth & Plaque
Acid
forms
Balance risk factors with prevention
forms
+ +
Pit &
Fissure
Sealants:
Sugar
Decalcification (or weakening) of
enamel is the early sign oftooth decay.
Reduce sugars and increase fluoride.
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R E S T O R AT I V E O P T I O N S
Implant
Filling Bridge
White Crown
Abutment
Implant
Silver
Crown Veneers
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R E S T O R AT I V E O P T I O N S
Adhesives
Biggest advantages for
denture wearers:
•Patient Confidence
•Strong long-lasting hold
•Movement reductions
• Food seal
Full Denture
Partial Denture
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30. Business Use
E R O S I V E T O O T H W E A R
Healthy Severe
Natural contourswithslight
groovesandimperfections
BEWE 0
(Basic Erosive Tooth WearExam)
No erosive tooth wear
Acid softened enamel is more susceptibleto wear from physical abrasion and attrition.
Erosion is irreversible.
BEWE 1
Initialloss ofsurface texture
BEWE 2
Hard tissue loss involving <50%
surface area
BEWE 3
Hard tissue loss involving
> 50% surface area
Smoothandmore translucent
alongthe gumline
Dull andconcave areas
begintoform
Yellowasunderlying
Dentine beginstoshow
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Bartlett, D., Ganss, C.& Lussi, A. Basic ErosiveWearExamination (BEWE): a newscoring system for scientific andclinical needs.
Clin Oral Invest12, 65–68(2008). https://doi.org/10.1007/s00784-007-0181-5

31. Business Use
E R O S I V E T O O T H W E A R
Assessed
SextantbySextant
BEWE0
Noerosivetoothwear
BEWE1
Initiallossofsurface texture
BEWE2
Hard tissuelossinvolving
<50%surface area
BEWE3
Hard tissuelossinvolving
>50%surface area
General Guidelines for Management
Recordscore for most SEVERE surface per sextant
Cumulative Score
No ETW:
0-2
No ETW •Routine maintenance and observation
•Repeat at 3-year intervals
Low:
3-8
Initial lossof surfacetexture •Oral hygiene, dietary assessment
•Routine maintenance and observation
•Repeat at 2-year intervals
Medium:
9-13
Distinctdefect; hard tissueloss involving
<50% of the surfacearea
•Oral hygiene, dietary assessment
•Medications,salivary gland function,
vomiting, should be reviewed
•Routine maintenance
•Fluoridemeasures
•Avoid restorations
•Repeat at 6-12 month intervals
High:
>14
Hard tissueloss,involving>50% of the
surfacearea
•Oral hygiene, dietary assessment
•Routine maintenance
•Fluoridemeasures
•Repeat at 6-12 month intervals
•Consider restorations
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32. Business Use
P R E V E N T I O N & M A N A G E M E N T of Erosive Tooth Wear
Use a straw for
acidicbeverages
Chew
sugarlessgum
Dairya er acidicfoods
Drinkwater
pH of common
food and drinks
Acid ScaleDanger Zone
pH (acid scale)
Lemon
juice
Fizzy
drinks
2.6
Orange
juice
Beer Banana Avocado Saliva Water
Brushwitha
StannousFluoridetoothpaste
Stannous Fluoride is recognised as being more effective
than Sodium Fluoride in the prevention of dental erosion.
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2 3.3 3.7-4.2 5 6.5 6.7 7
1 2 3 4 5 6 7 8

33. Business Use
S TA N N O U S F L U O R I D E
External
Stimulus
Causes
Movement Stimulates Pain Signal
Transmission
Patients are 3.7x more likely to transition to
gingival health using a stabilized, bioavailable
Stannous Fluoride toothpaste versus sodium
fluoride or MFP.
Stannous Fluoride
Therapeutic Benefit Mechanismof Action
Enhances Remineralization
Inhibits Demineralization
Anticaries
Prevents erosion
Reduces biofilm Reduces
bleeding gums
Reduces sensitivity
Reduces halitosis
Erosion
Caries
Bleeding
Biofilm
Has the potential for slowing the
progression oferosive tooth wear
(European FedofConservativeDentistry)
Stannous Fluoride
Halitosis
Gingivitis
Sodium Fluoride protects to
pH < 5.5 while Stannous
protects against dietary acids
in the enamel danger zone
Fluids in
Dentine
Tubules
Occludes dentinal tubules
Nerve
Receptor
Transient
Tooth
Pain
1. BiesbrockA, et al.The Effects ofBioavailableGluconateChelatedStannous FluorideDentifriceon
Gingival Bleeding: Meta-Analysis ofEighteen Randomized ControlledTrials.J Clin Periodontol. 2019 Sep 28.
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B R U S H I N G I N S T R U C T I O N S
POWER
MANUAL
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35. Business Use
I N T E R D E N TA L C L E A N I N G
FLOSSING
OTHER
METHODS
INTERDENTAL
BRUSH
TONGUE
CLEANER
IRRIGATOR
POWER
INTERDENTAL
FLOSS
HOLDER
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36. Business Use
T I P S F O R O R T H O D O N T I C P AT I E N T S
Improve Your Smile
by Removing Plaque
Effectively
Decalcification (or weakening)
of enamel is caused by
plaque around brackets and
wires.
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37. Business Use
C O N T I N U I N G E D U C AT I O N
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