Questions and Answers
What does CAL stand for?
Clinical attachment loss
The formula for CAL when there is gingival recession is _____ + distance of margin from CEJ.
Pocket depth
If the gingival margin covers the CEJ, the formula for CAL is Pocket depth - _____ = CAL.
Amount covering CEJ
No calculation is needed for CAL when the gingival margin is normal.
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What is the gold standard for periodontal diagnosis?
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What constitutes an automatic stage 3 or 4? (Select all that apply)
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What is the likely periodontal classification for a client with CAL on the distal of their 7s and a BOP of >10%?
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Based on a 50-year-old client with 50% bone loss, what grade would they most likely receive?
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The extent or distribution of periodontal disease can be: (Select all that apply)
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What is the stage and grade for a case with interdental CAL of 1-2 mm, no tooth loss, and no probing depths over 4 mm?
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What is the stage and grade for a case with interdental CAL of 3-4 mm and evidence of 2 mm attachment loss over a 5-year period?
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What is the stage and grade for a 44-year-old client with 5 mm or more CAL and 4 teeth lost due to periodontitis?
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What is the stage and grade for a case with interdental CAL of 3 to 4 mm and no tooth loss?
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What is the stage and grade for a client with interdental CAL of 5 mm or more and less than 2 mm additional attachment loss over 5 years?
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What is the stage and grade for a 53-year-old client with more than 5 teeth lost due to periodontitis?
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Study Notes
Clinical Attachment Loss (CAL)
- Definition: Measure of destruction to tooth-supporting structures around a tooth.
- Calculation: Probing depth + distance from gingival margin to cementoenamel junction (CEJ) = CAL.
CAL with Gingival Recession
- Calculation: Pocket depth + distance from gingival margin to CEJ.
CAL when Margin Covers CEJ
- Calculation: Pocket depth - amount covering CEJ = CAL.
CAL with Normal Gingival Margin
- Calculation: No calculation needed; Probing depth equals CAL.
Periodontal Diagnosis Tips
- Interproximal CAL is the gold standard for diagnosis.
- Radiographic bone loss (RBL) is a secondary option.
- Tooth loss from periodontitis encompasses both past and potential future loss.
- Staging of periodontal disease can increase over time but does not decrease, except with successful regenerative therapy.
Automatic Staging Criteria
- Automatic designation of stage 3 or 4 occurs with vertical bone loss of 3 mm or more, class 2 or 3 furcation involvement, and tooth loss due to periodontitis.
- Assess direct or indirect evidence before applying grade modifiers.
Case Classifications
- Health classification applies if CAL is identified but there is no significant periodontal disease.
- A 50-year-old client with 50% bone loss is classified as Grade B.
- Extent of periodontal disease can be localized, generalized, or exhibit a molar/incisor pattern.
Example Cases
- Case 1: 45 years old, interproximal CAL of 1-2 mm, no tooth loss, horizontal bone loss, no probing depths over 4 mm. Classified as Stage 1, Grade A.
- Case 2: 28 years old, interproximal CAL of 3-4 mm, no tooth loss, probing depths ≤ 5 mm, horizontal bone loss past middle root. Classified as Stage 2, Grade C with evidence of attachment loss.
- Case 3: 20 years old, interproximal CAL of 3-4 mm, probing depths ≤ 4 mm, RBL into coronal third of molars. Classified as Stage 2, Grade C with possible grade modifiers of smoking and diabetes history.
- Case 6: 50 years old, interproximal CAL of 3-4 mm, no tooth loss, probing depths ≤ 5 mm, RBL extends to coronal third. Classified as Stage 2, Grade B.
- Case 8: 53 years old, interproximal CAL of 5 mm or more, more than 5 teeth lost, probing depths ≥ 6 mm, vertical bone loss. Classified as Stage 4, Grade B.
Summary of Important Attributes
- Different scenarios impact CAL calculations and periodontal staging.
- Age and history (such as smoking and diabetes) play significant roles in grading.
- Understanding staging criteria is essential for effective diagnosis and treatment planning.
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Description
Test your knowledge on Clinical Attachment Loss (CAL) and its implications in periodontal diagnosis. Understand how CAL is calculated under different conditions and familiarize yourself with staging criteria. This quiz is essential for dental students and practitioners focused on periodontal health.
