Periodontics · patient case question
How is this periodontal case classified?
Patient case: Advanced Periodontitis
demo: 48-year-old male
chief: “My teeth are moving and I have gaps that were never there.”
history: Type 2 diabetes, HbA1c 8.4%. Smokes 15 cigarettes per day.
meds: Metformin
findings: Probing depths 7–10 mm generalized. Interdental clinical attachment loss extending beyond the middle third of the root at more than five teeth. Class II furcations at #3 and #14, tooth mobility degree 2, pathologic migration with flaring of the maxillary incisors, 18 remaining teeth. Radiographic bone loss has advanced 3 mm in the last 4 years.
Show answer and explanation
Correct answer: D. Stage IV, Grade C
- A. Stage II involves attachment loss confined to the coronal third with maximum probing depths around 5 mm.
- B. Grade A denotes slow progression with no bone loss over 5 years and no risk modifiers — the opposite of this patient.
- C. Stage III lacks the masticatory dysfunction and drifting that push this case to Stage IV, and Grade B would require slower progression, lighter smoking, and better glycemic control.
- D. Correct. Stage IV is established by the need for complex rehabilitation — secondary occlusal trauma with mobility degree ≥2, bite collapse and flaring, and fewer than 20 remaining teeth. Grade C follows from ≥2 mm bone loss over 5 years, smoking ≥10 cigarettes/day, and HbA1c ≥7.0%.
Note: Staging is set by severity and complexity; grading is set by rate of progression plus the risk modifiers of smoking and diabetes. Grade is the part that moves with the patient's habits.