To provide our patient with a periodontal diagnosis using the 2018 AAP Staging & Grading system, we need clinical attachment loss (CAL).
Currently in the perio module, CAL seems to stand for clinical attachment level. It is the sum of the pocket depth and the gingival margin (GM), which is how we chart recession. For example, if:
#13 B pocket = 2 mm, and
#13 B GM = 0 mm (or no entry),
#13 B CAL = 2 mm (automatically calculated).
Also, if:
#13 B pocket = 2 mm, and
#13 B GM = 2 mm,
#13 B CAL = 4 mm (automatically calculated).
Charting recession is a cumbersome task requiring a lot of mouse clicking to do a full mouth (multiple points per tooth) of it. A 2 mm pocket on #13 B is typical of healthy gums, so a 2 mm pocket with no entry for GM should not indicate any attachment loss. This issue can be overcome by denoting a "positive" gingival margin (GM is coronal to the CEJ), but this requires even more clicking per site, and is not feasible when a patient requires charting of multiple recession sites per tooth.
There needs to be an easier way to chart GM in sequence as we do pockets, and perhaps a keyboard shortcut (for example pressing CTRL or ALT with the number) to create positive numbers so that we can quickly and easily arrive at an AAP Stage diagnosis.
Either that or a healthy pocket depth should be automatically subtracted from the pocket depth measurement, then added to recession, to arrive at true CAL.
Keith Watson
I agree, this is a huge issue! one solution could be hold the plus button while entering the number. I had a situation where my hygienist told me that we have had issues in the past with insurance not paying for SRP on 4 mm bleeding pockets. Periodontal disease is not diagnosed based on probing depth, it is based on a combination of probing depth and gingival marginal location which provides the sum that equals clinical attachment loss. And if you are working in a practice that relies on insurance reimbursement, this data is key. However, because GM is annoying to chart/ requires assisted hygiene to chart efficiently, many offices will only chart GM if there is recession past the CEJ so they can easily click the number pad and record. In this scenario, we are waiting until there is already 2-3 mm of clinical attachment loss prior to even recording it. This is not good practice. There needs to be an easier way to chart this information.