Dental Practice Solutions

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  • Is your hygiene department producing 25-30% of your total production?
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Dental Practice Solutions - Debbie Bittke

What is a Dental Hygienist to Do with The New AAP Classifications?!

By: Debbie Seidel-Bittke, RDH, BS

January 30, 2020

The American Academy of Periodontology has not updated their guidelines for categorizing periodontitis since 1999.

This should be a big deal; right?!

Most clinicians: dentists, dental hygienists and even periodontists tell me they are confused with the new staging and grading for categorizing periodontitis.

What is a dental hygienist to do with the new AAP classifications?

Are you using the new AAP classifications?

Most clinicians I speak to are not using the new classifications.

We are currently working with our client hygienists to embrace this. We show them how to laminate the forms and refer to these when making patient clinical notes.

Let me shed some light on the topic here.

If the AAP has not re-classified periodontitis since 1999, there is a good chance it will be at least ten or twenty years before we have new guidelines.

Let’s embrace the “change!”

The American Academy of Periodontology Classifications are created to help dental hygienists diagnose and treat periodontitis.  Follow these guidelines so consistent diagnosis can occur.

The first step is to assess your hygiene patients and of course, every new dental patient must have a comprehensive periodontal exam.

Steps to Use the American Academy of Periodontology Staging and Grading

Step 1: Assessment

  • Up-to-date full mouth radiographs
  • Up-to-date comprehensive periodontal exam (CPE)
  • Chart missing teeth

Step 2: Establish the Stage

As you know cancer is categorized by stages. Think stages of cancer only this is oral inflammation causing destruction of the supporting bone that results in tooth loss.

When you are assessing the stage of periodontitis, explain to your patient and show them what you “see.” Refer to the mouth/body connection as you explain inflammation in your patients mouth.

Now is your opportunity to speak with your patient about the connection between inflammation in your patients mouth and inflammation in the body.

Inflammation in the body year after year contributes to other inflammatory disease such as (and not limited to) heart attack, stroke, rheumatoid arthritis, Crones, Alzheimer’s, diabetes, etc.

  • Confirm clinical attachment loss (CAL)
  • Rule-out non-periodontitis causes of CAL (cervical restorations, caries of root fractures)
  • Determine CAL or radiographic bone loss (RBL)
  • Confirm RBL patterns (Ex: Vertical or horizontal RBL)

For moderate to severe periodontitis (think Stage III or Stage IV):

  • Determine CAL or RBL
  • Confirm RBL patterns
  • Assess tooth loss due to periodontitis
  • Evaluate complexity factors (Ex: severe CAL frequency, surgical challenges)

Based on your findings from step 2, determination of mild-moderate periodontitis can be made, and this is considered Stage I or Stage II. Severe or very severe periodontitis is considered Stage III or Stage IV.

Step 3: Establish the Grade

What I like best about this new system to categorize periodontitis is we now bring into the picture: inflammatory diseases, systemic considerations and outcomes of non-surgical periodontal therapy.

What’s a Dental Hygienist to Do with the New Classifications?

So glad you asked!

  1. Your first step is to print out this article including the staging and grading charts.
  2. Take the staging and grading charts, add them to a plastic sleeve or laminate them. Keep these in your operatory.
  3. When you evaluate your patients, refer to your staging chart.
    1. In your clinical notes write, “Stage I, II, III or IV”.
    2. Write as indicated
  4. When a patient has 15%-30% RBL definitely consider writing clinical notes a category for the stage and refer to your Grading chart printed and on the flip side of your staging chart.
  5. If a patient has <15% CAL but smokes 10 or more cigarettes, you will write in your clinical notes: Stage I, < 15% localized horizontal BL (Ex: @ #19 & 30), Grade C (Pt smokes 10+ cigarettes daily).
    1. That is all. If you have a positive outlook on this, it won’t be difficult to write these chart notes
    2. If you have templates add staging, horizontal, vertical < or >, etc.
    3. Now using your template mark or indicate the correct description
    4. Use the staging and grading charts to add these notes in your practice management templates
  6. For patients who have diabetes and/or a tobacco user with RBL you will grade them B or C and this is your time to talk about their “potential” for tooth loss if things do not improve.


Many clinicians I meet are fearful about scaring patients ‘if” and “when” they do tell patients “the facts.”

Imagine this, if you have a colonoscopy or mammogram and the doctor finds a suspicious lesion, will the doctor not tell their patient about this for fear of the patient never returning?

Does a physician feel concerned that their patient’s insurance may not pay for removal of an abnormality?

I have never heard of a physician not telling a patient they have an abnormality because of the above mentioned.

Why do us dental professionals fear telling patients what is truly happening in their mouth?

We have a legal and ethical responsibility to tell our patients what we “see” happening in their mouth and body.

In 2020, dental hygienists are doing more than cleaning teeth.

Dental professionals are in the business of helping people live a longer and healthier life.

Will you join me and help conquer the disease process?

This…….is our JOB!


Debbie Seidel-Bittke, RDH, BS

 is founder and CEO of Dental Practice Solutions. Debbie is also a former dental hygiene program director. Her expertise is optimizing the hygiene department by taking a total team approach; including the doctor as the leader.

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