Periodontitis: Grade Modifiers Revisited

ABSTRACTObjectiveThis review aimed to propose new grade modifiers for the risk assessment of periodontitis.Materials and MethodsLiterature on the known risk factors, current, and potential grade modifiers was reviewed.ResultsThe transition to a staging and grading system for periodontitis was driven by the need for consistent and comprehensive classification that facilitates diagnosis and personalized treatment planning. The new system assesses severity and complexity based on clinical attachment loss, radiographic bone loss, and patient history, and integrates risk factors into the grading scheme as grade modifiers. The two commonly used grade modifiers are smoking and diabetes mellitus. The changes to grade B or C are based on the number of cigarettes smoked per day and the level of glycemic levels, which are known thresholds used in association studies of risk factors for periodontitis. New grade modifiers such as systemic inflammatory response, rheumatoid arthritis, osteoporosis, obesity, and neurodegenerative disease were identified.ConclusionWhile adding grade modifiers may increase complexity, they could improve the prognostic accuracy of the current classification, enabling more precise assessment, personalized treatment, and better management of periodontitis, especially in patients with systemic risk factors.