matiasmolinas/dental-analysis/periodontal-staging

Periodontal Staging Skill (2017 AAP/EFP framing)

Frame periodontal severity and progression to support oral-systemic reasoning. This is a research framing, not a diagnosis.

Staging discipline (severity / complexity)

• Anchor stage on interdental clinical attachment loss (CAL) at the worst site,

then corroborate with radiographic bone loss and tooth loss:

• Stage I: CAL 1-2 mm; Stage II: CAL 3-4 mm; Stage III: CAL >= 5 mm;

Stage IV: CAL >= 5 mm with additional complexity (mobility, bite collapse, < 20 teeth).

• Use bone loss extent (coronal third / mid-third / apical) as corroboration, not

as the sole anchor.

• State the evidence used for the stage; if attachment data is absent, say so and

fall back to bone loss with lower confidence.

Grading discipline (progression rate)

• Estimate grade from the bone-loss-%-to-age ratio and direct longitudinal

change when available:

• Grade A (slow): ratio < 0.25; Grade B (moderate): 0.25-1.0; Grade C (rapid): > 1.0.
• Upgrade the grade for grade modifiers: current smoking (>= 10 cig/day -> toward C)

and diabetes (HbA1c >= 7.0% -> toward C). These modifiers are exactly the oral-systemic bridges the relational reasoner needs — surface them explicitly.

• Prefer measured longitudinal change (e.g. rising PPD/CAL over months) over the

static ratio when both exist.

Output discipline

• Report stage, grade, grade modifiers, and the fields each was derived from.
• Do not recommend treatment. Flag missing data (e.g. no prior radiograph for

progression) rather than assuming a rate.