Strategy in Action Part 2
Miss Strategy in Action Part 1? Catch up here!
By: Candy Velez, CRDH, BSDH, IgniteDDS Hygiene Coach
A Different Way to Use What You Already Know
Staging and Grading are not new concepts. Most hygienists have been introduced to Staging and Grading, and many understand it clinically. Now, let’s elevate our strategy and begin using this knowledge in a more intentional and impactful way.
Staging and grading become the bridge, connecting what we see clinically to what our patients understand. Because staging and grading are not just diagnostic tools. They are among the most effective ways to communicate risk and guide patients to the care they need.
A Simple Way to Think About It
Staging answers: Where is the patient today? The level of destruction that has already occurred.
Grading answers: What is their risk? How quickly has this disease progressed?
A helpful clinical reminder: We typically start at Grade B, then use the patient’s risk factors to determine whether they remain at Grade B or shift to Grade A or Grade C. This is key before we move into the impact of grading on patient conversations.
Grading is where the conversation becomes powerful because it connects oral health to the patient’s overall health and lifestyle, a crucial link in fostering understanding and action.
Why Grading Changes the Conversation
Not all patients respond to biofilm the same way. Some patients present with heavy biofilm yet have minimal periodontal destruction, while other patients experience rapid destruction with what appears to be minimal biofilm. These patients have extremely different immune responses, and the pathogens are more virulent in one patient than in another.
Grading gives us the framework to explain why, and to have a more meaningful conversation with our patients about what their diagnosis actually means for their health.
- Grade A — Slow progression, typically seen in patients with low systemic risk and less immune response to bacteria.
- Grade B — Moderate progression, which may include patients with controlled systemic conditions (HbA1c <7%) or lower-risk lifestyle factors.
- Grade C — Rapid progression associated with higher-risk factors such as uncontrolled diabetes (HbA1c ≥7%) or smoking (≥10 cigarettes per day) and heightened immune response.
At this stage, it’s no longer just about what we see clinically. This involves the patient’s unique response and its implications for their long-term periodontal health.
Connecting It to the Patient
The AAP is clear: patients with a history of or active periodontal disease are at greater risk for progression. They should not be managed the same as patients without disease or without a history of disease.
This is where we shift from describing findings to clearly explaining why their care must be different.
What This Sounds Like in Real Life
Example 1:
“Mrs. Jones, I’m glad we talked more in depth about your diabetes today because it directly impacts how we manage your periodontal health. With your A1c at 9.0, you are in Grade C, the highest-risk category for disease progression. That means your body responds more aggressively to inflammation, and breakdown of your gums and bone can occur more quickly. Because of that, you need to be seen every 3 months for periodontal maintenance so we can actively manage and monitor your condition.”
Example 2:
“Mr. Smith, smoking has a direct impact on how your body heals and responds to inflammation. Smoking more than 10 cigarettes per day places you in Grade C, which is the highest risk category for your gum disease to worsen. Even if things feel stable, breakdown can occur more rapidly without consistent care. Because of that, you need to have a thorough periodontal maintenance to help manage your condition on a 3-month basis.” (4 times per year)
The Shift
Staging and Grading are not about documenting a diagnosis in the clinical note. They are about:
- Helping patients understand their condition
- Connecting oral and systemic health
- Creating clarity around risk
- Guiding the appropriate level of care
When patients understand their risk, they are far more likely to:
- Accept treatment because they recognize the benefit to their health
- Stay on schedule for hygiene, knowing it protects their future well-being
- Remain committed to their health as they see how their actions influence their outcomes
Final Thought
Patients do not follow a schedule. They follow what they understand about their own health, and when that understanding is clear, they are empowered to act in their best interest. And when we take the time to use the strategy of connecting their condition, their health, and their risk, we move from recommending care to leading it.
Bonus Resources
Coming Next in the Series
The Hygiene Schedule: How we got here and how to design days that support both patient care, team, and practice success.
Reading blogs is a great place to start, but if you’re ready to turn these ideas into real results, igniteDDS Coaching is here to support your practice with personalized, one-on-one guidance.
