Carrying the torch: AAP classification from academia to practice
As graduate dental hygienists step into leadership roles within clinical practice, one of our greatest responsibilities is to translate academic frameworks into consistent, evidence-based patient care. Nowhere is this more evident than in the application of the American Academy of Periodontology (AAP) periodontal staging and grading system. While students master these concepts in the classroom, inconsistent use in practice—especially around clinical attachment measurement—can create diagnostic ambiguity that undermines treatment planning and interprofessional communication.
Clinical attachment level
One of the most overlooked foundations of accurate classification is the distinction between clinical attachment level (CAL) and clinical attachment loss (CAL). Though often used interchangeably in charting software and everyday language, these represent different clinical realities. CAL refers to the position of the attachment apparatus relative to a fixed reference point (the cementoenamel junction), whereas true clinical attachment loss results only from apical migration of the junctional epithelium due to periodontal disease. Misinterpretation of these metrics—especially when probing depths are used as a stand-in for attachment loss—can lead to misclassification of disease stage and grade, ultimately affecting treatment and patient outcomes.
Moving forward with purpose
Graduate-prepared hygienists are uniquely positioned to bridge this gap. We are trained to not only understand the AAP system, but to advocate for accurate application in everyday care. This means engaging colleagues in discussions about measurement consistency, challenging software defaults that obscure true attachment loss, and calibrating teams on terminology and technique.
By embracing our role as interpreters and implementers of periodontal classification, we uphold the integrity of diagnosis and elevate patient care. In doing so, we carry the torch from academia into practice—one calibrated measurement and one informed conversation at a time.
About the Author
Marianne Dryer, MEd, RDH
Marianne Dryer, MEd, RDH, is a dynamic speaker, educator, and consultant in curriculum development. She has lectured nationally and internationally on periodontal instrumentation with a focus on ultrasonic technique, risk assessment, infection prevention, and radiology technique. Her experience in dentistry spans more than 30 years. She is currently the Director of Dental Sciences at Cape Cod Community College. She is a graduate of Forsyth School for Dental Hygienists, Old Dominion University, and received her master’s in education from St.Joseph’s College of Maine. Contact her at [email protected] or through her website at mariannedryer.com.