AAP Classification of Periodontal Disease

Stage/Extent/Grading and Peri-Implant Diseases

Stage Description
Clinically Healthy: characterized by no clinical signs of inflammation and/or
attachment loss.
Gingivitis: characterized by the presence of inflammation, confined to the
gingiva and associated with teeth showing no attachment loss.
Periodontitis (add Grade A, B or C)
I Initial Periodontitis: 1-2mm of CAL, less than 15% bone loss, mostly
horizontal, probing depths 4mm or less.
II Moderate Periodontitis: 3-4mm of CAL, 15%-33% bone loss, mostly
horizontal, probing depths 5mm or less.
III Severe Periodontitis: 5mm or greater of CAL, >33% bone loss, horizontal and
vertical, probing depths 6mm or more, Cl II and III furcations.
IV Encompasses all of stage III with the potential for loss of dentition. Less than
20 remaining teeth.

Extent
Localized form Bone loss is around less than 30% of teeth in mouth.
Generalized form Bone loss is around more than 30% of teeth in mouth.
Molar/Incisor Bone loss is found around 1st molars and incisors.
• To move up a classification, 30% or more sites must be involved based on the
clinical findings.

Grading of Periodontitis (Risk Factors)

Grading aims to indicate the rate of periodontitis progression, responsiveness to standard treatment
and potential impact on systemic health
Grade A No bone loss over 5 years, no smoking, no diabetes, heavy biofilm
Slow Progression but no destruction
Grade B Less than 2 mm bone loss over 5 years, < 10 cigarettes/ day, A1c <
Moderate 7%, biofilm is equal with amount of destruction
Progression
Grade C Greater than 2 mm bone loss over 5 years, >10 cigarettes/day, A1c
Rapid Progression > 7%, destruction exceeds amount of biofilm

Implant Diseases and Conditions (by implant and document in chart)

Peri-Implant Health Absence of inflammation, and bleeding on probing and normal
bone support.
Peri-Implant Bleeding on probing and visual signs of inflammation. This
Mucositis condition can be reduced by eliminating biofilm. No mobility.
Peri-Implantitis Inflammation in the peri-implant mucosa and progressive bone
loss. May or may not be accompanied by mobility.

1
 Calculus Codes
Code Description
1 Localized light supra and or subgingival deposits, (code 1 calculus cannot be
used for root planing requirements).
2 Generalized subgingival, moderate clickable or small ledges with or without
supragingival deposits. There must be at least 18 surfaces of detectable
calculus in the entire mouth with no less than 12 surfaces of posterior
subgingival calculus.
D1 = 18 surfaces in the full mouth: (12 posterior + 6 anterior)
D2 = 18 surfaces in ½ of the mouth: (12 posterior + 6 anterior)
D3 = 18 surfaces in one quadrant of the mouth: (12 posterior + 6 anterior)
3 Generalized subgingival moderate to heavy rings and or interproximal ledges
with or without supragingival deposits.
4 Generalized subgingival heavy rings, interproximal ledges or sheets extending
down the roots and is very tenacious.

Clinical Patient Classification Guidelines

Periodontitis Classification Patient Difficulty Level
Pedo Maintenance Code 1 Code 2 Code 3 Code 4
Therapy
Pedo A B

Clinically Healthy Prophy B

Gingivitis Prophy B D1, D2, D3
Stage I Initial PM-D1 B D1, D2,
D3
Stage II Moderate PM-D1 D1 D1, D2, D3
D3
Stage III Severe PM-D1 D1, D2 D1, D2, D3, E E
Stage IV Severe PM-D1, D2 D1, D2 D1, D2, D3, E E,F Category
F
Individual
Contract
PM = Periodontal Maintenance

Patients with Code 2 calculus levels are further classified by the distribution of calculus in the mouth.
See the LWTech Calculus Code table above for all definitions concerning Code 2 calculus. In situations
where multiple numbers are listed in the Clinical Patient Classification Guidelines table above (ex., D1,
D2, D3), the following table is to be used to determine the distribution of scores by quadrants or sextants
for grading purposes. Note: for category F patients and some E patients, the segments to be graded
will be determined on an individual basis any may be graded as quadrants or sextants. Individual
Contracts are reserved for the most severe and difficult of patient classification and their grading
criteria (# of calculus pieces that can be missed by the student to receive a passing score) are determined
by the instructor.

2
 Number of Quadrants or Sextants Per Score Given Based on Patient
Difficulty
Quadrant or Sextants 4 quadrants 2 quadrants 1 quadrant 1 sextant

Patient Difficulty Level A D2 D3 E

B E F
D1 F

Current Dental Coding (CDT) Suggestions

Initial Therapy Continuing
Care Therapy
Healthy D1110 (full mouth) D1110
Gingivitis D1110 (full mouth), D4346 (full or ½ mouth) D1110
Stage I D4341 or D4342 (quads) D1110 or D4910
Initial Periodontitis
Stage II D4341 or D4342 (quads) D4910
Moderate Periodontitis
Stage III D4341 (quads)* D4910
Severe Periodontitis
Stage IV D4341 (quads)* D4910
Severe Periodontitis
*May be scaled in sextants depending on type of calculus, but is still billed as quadrants