Welcome back to the academy. In this session, we will get into the real core of what this academy is about: transformational practice. This is a different and more holistic way of being an integral part of our patients’ lives and health. This information will assist in taking a typical, underachieving dental hygiene department and helping it excel at being a key source of a patient’s health maintenance.

This session will focus on classifying patients using an easy-to-understand method based on their level of illness presented.

Classifying Patients by Illness

• Class I: The patient is in good health with no periodontal disease, no bone loss, and no missing teeth. They are also a Mallampati 1, with no airway concerns.
• Class 2: This patient is starting to show signs of periodontal disease, including early to detectable gingival recession and bone loss. They may have certain illnesses that predispose them to further and faster breakdown, such as controlled diabetes or autoimmune disorders like leukemia. They have no missing teeth yet, but some may be in jeopardy, and they may be under a physician’s care. This stage represents gingivitis converting to periodontal disease. The patient is a Mallampati 1/2 with no airway concerns.
• Class 3: This patient has obvious signs of periodontal disease and is missing more than five teeth, with a high probability of losing more. They may be an avid smoker with poor oral hygiene, and genetic factors may also play a role. Their predisposing illnesses, like diabetes, are uncontrolled, with blood sugar levels above normal. They are a Mallampati 2 or greater, with potential airway concerns they may not be aware of.

Diagnostic Stages of Disease Identification

• Stage 1: This patient is healthy, a non-smoker, and has no bleeding points. They generally have 1-3mm pockets at a proper cervical/gingival position and no missing teeth.
• Stage 2: These are the treatable stages. With diligent care and home maintenance, their condition can be reverted back. They present with mostly 1-3mm pockets but have some occasional 4mm pockets with very early bone loss.
• Stage 3: This is a very important and difficult stage. These patients present with 5-6mm pockets and some bone loss but don’t feel as if they have any problems. Offices for the most part only feel as if root planing is needed, but this is far from the truth. These cases can and should be operated on at this stage to prevent and attempt to reverse the disease process to a more maintainable position. The patient may be on the verge of losing some teeth with no treatment or improper treatment.
• Stage 4: This patient presents with every sign and symptom of advanced disease and has a high risk of losing all their teeth. This may even be what they are asking for. This is a patient who has given up both medically and dentally.

This session was very meaningful and impactful. This information will assist in taking a typical, underachieving dental hygiene department to excelling at being an integral part of the patient’s health maintenance sources.

For more on our approach, please refer to our previous posts: The Dr. Nilo Hygiene and Periodontal Academy Mindset: Session 2 and The Dr. Nilo Hygiene and Periodontal Academy Mindset: Session 3.