So I don't forget now. Can everybody see and hear me. Okay. If you don't mind just letting me know. Awesome. Thank you. Excuse me. So nice to see you guys Let's see. Yes, we're it's not quite 1030 so we won't get started yet. I promise. I just wanted to hop in just to make sure that everything was working. Okay, I'll be sharing my screen very soon. Hi, Mackenzie. How's it going. I know a lot of you guys are taking the board exam tomorrow. Good luck before I forget to mention something. Yes, it's early for a lot of you. Thank you guys for hopping on early. It's always tricky with the different time zones because it's either too late too early. If it's in the middle of the day for some people that just doesn't work for some people so it's always kind of tricky so sorry about that. But for those of you who are watching the recording afterwards just remember if you can't attend the live sessions that is understandable just make sure to watch the recording afterwards because these will really help you guys kind of tune into everything and know a little bit more every time for the board exam, you know, there's nothing like listening to a video. It's just better than just trying to read the material on your own, trying to go through things on your own and just kind of helps to put everything together especially today. We're talking about the new AAP classification system. Mackenzie we were actually talking the other day I still have not gotten an email back. But what I've done is I did ask some of my colleagues not to be annoying but everybody gave me different answers so everybody I'll quickly mention what I was talking about with another student here. And hey maybe some of you guys have something to say about this but for the new AAP classification system. I'm not confused about it but there's a couple different things that I'm hearing that I don't know which way to go about it. And that is and I mean I'll talk about that today we're going through case studies, but just a quick mention is you know if somebody has one tooth that puts them in stage three but everything else is a generalized stage two. Do you go up to that stage three yes or no what do you do so that's just kind of where there is still some slight confusion on that I was talking to my colleagues. And again we will be going through this this is just a very informal chat right now, but I was talking to my colleagues and they just pretty much say that well you would just simply word it differently. And you guys hold that thought and Mackenzie I did ask about you were talking about you can't go once you establish a grade for a patient you can't go down that grade but you can go up so you wouldn't say to a patient. They're a grade you know they're the highest one and then six months later things are healthy again so now they're a grade eight you know you wouldn't do that. I'm sorry guys let me just in case you guys are. Let me kind of put up a slide at least as we're having this informal conversation. There we go. And don't worry we will be going through all of this came looking for the great egg, there we go. So, I'm Mackenzie, and I think I was actually talking to a few of you guys about this too. Oh, you guys can see my screen yet anyway doesn't matter there we go. So, you can't move down in a grade, meaning if you, if you have established grade C for a patient two years later they wouldn't be a grade a that is correct so I might have said something different in our last session I'm sorry I don't remember, but that has been clarified again you guys this is just an informal chat right now we will be going through things. I'm going to make my chat box bigger because some of the text isn't showing up. Yes, Stephanie, I have been hearing so many different answers and it's frustrating because, you know, it is, it's not so bad for the real world because it's not like we're going to fail. I would say something wrong in our charting but for the board exam you guys need to know what the right answer is, but I'm not going to lie to you and say this is the right way to do things when I personally don't know either. So, but I know that's that's that's not helpful but I'm just being honest I did send emails I have made phone calls to the major associations and the board exam committee but nobody has gotten back to me yet so I do not know. I'm going to help you guys today, even like just to kind of go through everything so at least you will have a good idea okay. If that helps but yes we will go through all of that. Yes, and Stephanie that is correct so you would always go to the worst case scenario because Stephanie makes a good point because you can't grow the bone back so it's not like somebody would have nine millimeter pockets and then have three millimeter you know, so you would always go for the worst case scenario, even if it's just that one tooth, but to my understanding there's a way you would write that in the chart, so localized and generalized and that's what we will talk about today. Mackenzie, thank you so Mackenzie was saying that when she took the practice exams. They would have the case studies and she would go with the highest area of the clinical attachment loss, and she would get the answer right. So yes. Thank you Mackenzie that is actually very very helpful. That's what I suggest everybody do then so go with the area of the highest clinical attachment loss. And that's the best way to do things but again, I do have some case studies for you guys I'm actually going to go back from our last PowerPoint. I do have some of the case studies towards the end, but just to do a quick review because I do see a lot of new students and if I don't do the review it will be even more confusing. So, and feel free you guys for those of you guys who are new, feel free to ask questions anytime so I can't see or hear anybody else. I do that on purpose because if I allowed everybody to be seen and heard, then the Internet would be slow, it would probably be choppy so I find that this is just easier, but feel free to ask me questions anytime. There is a chat box that you should be able to see and open up. When you guys send a message in the chat box, I'm the only one who can see it. So, I, if you have a question, I will likely you know read out the question so that the other students can hear it but I just do that so it's not too distracting. But if you send me a message and you would prefer I don't read it out loud or something then just sort of make a note when you send me the message but I don't really see that happening because we're all working together right. Today, it's 1030 right good okay so today we're talking about the new aap perio classification system. There are some courses online you can take that are free check them out for sure, even for myself, this is something new for me to learn or I should say it has been new. So I have been taking courses and listening to them over and over again, and I find I learned something new every single time. So for the board exam I'm going to give you guys kind of a nutshell on this new system okay. So I do have this PowerPoint uploaded inside your course under perio. If you're in the board exam prep Academy the full course that would just be at the end of your course like the end of the modules where I upload all of the new PowerPoints all of the new sessions okay. These are great charts print them out that's what I do even for my own practice I have to constantly be looking at these charts. I look at the staging and I look at the grading because you need to determine that. So for the board exam so we're talking about the board exam here. The main thing you guys have to know truthfully is, you will look at clinical attachment loss, not just pocket depth, whereas the old system hey I have been through a few offices where I will go back to look at the chart and clinical attachment loss was never recorded, meaning they have never charted the gingival recession. If you don't do that you can't get a proper determination on the patients oral health you just can't do it so I like this new system, because it is all about the clinical attachment loss. If there's anybody here who doesn't understand clinical attachment loss, let me know but I will be talking about that a little bit as well so I'm just going to go through the first slides quickly because we did do a video on this actually twice, but I still feel like it's good to review if I move too fast or too slow you guys let me know so everybody can see my screen okay everybody can hear me if you can't please let me know I'm assuming if you couldn't hear me you would be typing something by now so that's good. Okay, so basically you guys as I said before know this new system, it is divided into staging, and then you have to pick either a grade A, B, or C, but there's also modifiers that you guys have to know. Is the patient a smoker? Is the patient a diabetic? Because if a patient is smoking a packet day all day every day, that will determine how you feel their perio is going to progress so that's where the grade A, B, and C come in. Okay, so you guys have this PowerPoint I'm not going to read out everything to you but feel free to read it of course on your own. I'm pretty much saying what's on this slide anyway but just in a different way. Okay, so staging and grading. Okay, next one. And this new system looks at implants and the gingival health around implants. So for those of you who do not know or you perhaps forgot. The gingival around implants can get gingivitis very very quickly and I should say you can get like perio around implants quickly because there's not that natural ligaments attaching everything because yes, it's the most like your natural tooth but it's not your natural tooth. Any disease that happens around the implant can happen very very quickly so we need to make note of that and we need to nip that in the bud as quickly as possible so that's another thing that I feel that the new system really looks at which is excellent. Okay, so I have the steps in a chart form but then I have also taken this from today's rdh.com they are excellent with just sort of providing those additional resources. Okay, so step one you are sorry so you basically want to determine okay does the patient have perio or not. If they do is it mild moderate is it severe so then you would know how to put them into stages. I will show you again on the chart but stage one and stage two is pretty much on one side of the spectrum and stage three and stage four is another side so you kind of go. Okay, does the patient have four millimeter pockets does does the patient have five millimeter pockets or does the patient have six seven eight millimeter pockets that would be severe so I will show you guys that later. So that's what I've said in step two here. But as I said again you guys it's more than just the pockets you need to calculate pockets but then chart every tooth, their gingival recession that is so important. You cannot. So, you know, kind of a good question on the board exam might be. If you don't chart gingival recession, can you do this perio classification will know you have to do that. If a tooth doesn't have any gingival recession awesome, then you would just look at the pocket depth because the gingival recession isn't there. Mackenzie yes. So you guys if you are a CDHA member, they do take students at a reduced fee so hope if you're obviously in Canada here, but if you are a CDHA member they have a great webinar. Oh, and it's free okay sorry even better. I, I think I had to pay when I was a student oh no I didn't I think it was free but anyways, I actually saw the webinar twice yesterday Mackenzie to just sort of refresh my memory it was very very good very very good. So everybody should check that out. There's a link for that later. Of course you have to be a member to watch it but it is a good, a good webinar. There's parts one and parts to you have to take quizzes to go to the second part, but it's really really good. And then you guys after you establish a stage so think about it easy like this try not to make it complicated. So how do you establish a stage right away so does the patient have mild moderate or severe perio. How do you know that by calculating the clinical attachment loss can also be called clinical attachment level so Cal. Okay, so you would first establish that. And then you would say, Okay, so let's look at the other factors. Does the patient smoke a pack a day. I'm afraid about this perio getting really bad really fast.   So I go through that in some case studies for you guys and a little bit. So I just kind of put the chart here in a different like way to look at it. Stage one and stage two you guys remember. Sorry if I sound like a broken record here but you're looking at the cow, not the pockets at the site of the greatest loss. Okay. So you're looking at Cal. Oh, I should mention when you guys are probing when you guys are doing all of this. It is like six sites you know what you guys should know but just in case they happen to ask that on the board exam. So you look at the greatest loss. Okay, this is Cal here so one to two millimeters of Cal three to four millimeters Cal so this is Cal, not pocket depth. Okay, is it greater than five so on and so forth. Okay, but also look at which again you guys we do talk about but I'm just sort of doing a quick review. Look at the bone loss definitely look at the bone loss and the age so when I took the CDHA webinar yesterday like I reviewed it I took it again or I took a couple weeks ago but I wanted to kind of review everything. They really talk about age you know look at the age of the patient and the bone loss kind of when I said if a 90 year old has bone loss we're not going to be as concerned than if a 14 year old does because for that 90 year old hey it makes sense they have lived their life they're they are doing a great job. It doesn't matter when they got the bone loss but that's kind of a better prognosis than a 14 year old. Okay, because that's not normal for a 14 year old let's say to have moderate bone loss but we do talk about it. And then they want you to look at of course have they lost any teeth. We're not talking about teeth because they had teeth taken out for orthodontics or teeth taken out because they have wisdom teeth. No, so that could be a question on the board exam. Do the fact that they don't have their wisdom teeth does that matter with tooth loss. No, it's tooth loss due to perio. So due to a tooth being lost because it was so loose they had to take it out. Does that make sense. Please stop me if something doesn't make sense you guys because I am kind of going through this quickly because it's more of a review. But then of course look at the probing depths also which would help you to determine Cal, but they do talk about probing depth they talk about forcation involvement. Another thing to note if a tooth has forcation involvement that puts them in stage three you guys they would not be a stage one or a stage two because it's not normal for people to have forcations. Something's going on the tooth isn't healthy. Now for generalized or localized that's the same if it's 30% that's localized if it's more than 30% it is generalized. Okay. And quickly again looking at the grading. So they like you again to look at the age of the patient. And to determine the bone loss that type of thing. Thankfully in the CDHA webinar which I have always thought but they did mention we won't have time to take out a calculator and do calculations. On the board exam they may ask you to do that Mackenzie I think you said you had to do that or somebody was telling me they had to do that you guys it's ridiculous. But oh no okay good then somebody was telling me trying to think somebody did have to do it but maybe it was a different type of exam I'll double check. Oh good so so Mackenzie is saying that they give you the bone loss in the age. Okay perfect that's nice because that's just what you need to kind of calculate those numbers. That's a key determining factor even if you guys don't remember anything else look at the bone loss and pick which grade they should be in. Okay, honestly, but hopefully you'll remember the other stuff too. Okay. And then the modifiers the risk factors so smoking and diabetes. Okay, that is definitely it. This is just the charts that I put in a link form for you guys to download if you wanted to just another look at those charts, the same charts. Remember how I said to determine a stage you know keep it simple first look at okay is it is it going to be mild or moderate period or is it going to be severe period. Down here again this will just kind of help you guys go through the different stages to know what to do. I like this it is on that website link that I have given you here. If you guys want to print that out it's just helpful to kind of go through the steps you do get used to it after some time. Your first few times kind of thinking of case studies and going through all of this you will be very confused. Okay, you will be very confused, but it takes practice like with anything it takes practice and it will get better. So the mild to moderate period is typically stage one or stage two. So so severe period can lead to the stage three and stage four, and then you have to say okay well how severe is it so mild to moderate stage one or two. This is just kind of a different way to look at things. They are just kind of showing you guys so if you're trying to determine okay is the patient healthy or not.  Is there, you know, like overgrown gingiva look at that this is healthy so this is a good example of a healthy patient. Okay, yes, technically you guys I might see some gingival recession here actually no sorry I see a lot of gingival recession, but we're looking at the gums primarily yes there is gingival recession, but they likely don't even have a pocket there but this looks like the gingival recession of three or four though so that on so that so that automatically puts them into a cow of three or four, even if technically there's no pocket or something but you can't really have a zero pocket can you. So let's just say that this patient had a pocket of like two here and a gingival recession of a three. So that's three plus two is five so that puts them at a cow of five. This patient looks pretty healthy so for me to kind of say okay you guys there's a cow of five here. Are we going to put them in stage three I mean come on give me a break, but it will depend on if if all of the teeth are like that. Yes, or no. But what they want you to do is to put that patient in a stage three because that's what their cow is, but then bone loss, you would have to calculate the bone loss. Have they lost any teeth will know there's no tooth loss because it looks like that person had all of their teeth right so then they're now stage one or two so then you kind of have to determine okay what's going on here. Good question so with the new AP if the case study says a cow of three or four. So here you guys would you automatically refer them because that puts them in stage two. Yes, you would in the real world, we would not because that would be very easy to clean the team. No big deal, but the board exam wants you to know with moderate perio you do refer them so Mackenzie that's a great question. As silly as that might sound to refer somebody, but you would okay. Yes, I don't agree with it but the new system yes moderate perio automatically means to refer them. Obviously if they're severe perio you would definitely refer them same type of thing. And these are just sort of you need to know the three distinct forms. So there's periodontitis. We used to call it aggressive and chronic but then you would also have necrotizing periodontitis. And then period periodontitis as a manifestation of systemic condition so think if a patient's pregnant if oh goodness why can't I think if they're on a medication that's causing their ginger will overgrowth perhaps that kind of thing. Okay, so this is calculating Cal so remember, you take the probing depth plus recession. Okay, plus recession. If the gingival margin is is is above that CEJ I couldn't think of the word is above that CEJ then that's almost like a minus number. Okay, because you, you need to determine kind of that length. Okay, so if the pocket depth is six, like, look at the middle one here you don't see any gingival recession here. If the pocket depth is six, then that makes Cal six so who knows, they might try to be confusing for you and ask you a question on the board exam such as if a pocket is six millimeters and there's no gingival recession. What is the clinical attachment loss well it would be six it would be the number of that pocket. So does that make sense to everybody here. Just making sure just making sure. Just going through the different like implant cases again you guys. They want you to take x rays on implants, not you know every six months or something but consistently like like every year every two years, just to really determine how the health of that implant is just like a quick little side note there. Okay, so I like this slide because it kind of brings it all together doesn't it. So stage one, two, three and four this is a great slide, even if you guys just want to take a picture of this slide now with your phone. That can just sort of help you as you're going through things to just sort of go okay well let's kind of practice practice makes perfect let's determine what stage this patient could be in. So just sort of a little side note there. I like this slide. And then how they kind of calculate the bone loss you guys so I like that so Mackenzie was saying on the board exam, they will give you the bone loss percentage and the age right. Awesome so then it just shows you right now how to calculate that in the real world what we would do is just sort of look at the x-ray and kind of do like a little. Okay, well if if the bone levels here well that's pretty darn good if the bone levels here okay that's 35% bone loss if bone losses if that like levels here then that would be 70% you know, don't put lines of course on the x-ray or like you know these don't be there. Oh they give you the actual number Mackenzie. Oh, thank you that's good to know. Cool. Well, I guess that might be confusing for some people though I wish they would just not ask you guys those questions but I get it. So like on on an x-ray like we would just kind of look at it but it sounds like on the board exam they give you the actual number to help you calculate it which is really nice. So just simply doing those calculations will give you well is it grade A, B or C. So that's kind of nice and always look at the risk factors which we talked about in the case studies. Are they a smoker? Are they a non-smoker? Do they do they smoke a lot a lot? You know do they just kind of smoke a little bit a lot. So these things you guys do have to know. Again just another way to look at it. And guys I apologize I'll be right back my washer is beeping and it's not going to stop beeping unless I turn it off so I'm so sorry hold that thought I'll be right back. There guys sorry and you probably saw my my shorts that's what happens when you work from home. You wear shorts. Um okay good question. So Mackenzie has a question here. So if if they have a bone loss slash age actually here I'm going to copy that question and just kind of ask people. Let's see actually no maybe I don't have to. Let me see here. Actually Mackenzie that's a great question just hold that thought and I'm going to ask everybody. Oh come on. Why does this slide why is it blank? Okay guys I'm going to ask you a quick question. Let me do this here. So what do you guys think if if you have here let me get that chart as well. So I have a slide up here everybody if you don't mind answering for me. So if if somebody has a bone loss slash age of 0.75 but they smoke more than a pack of date. And that's a great question what grade would you put them in and Mackenzie you are right by the way I just want to see what everybody is thinking. So if you have calculated this and it's 0.75 which would put them here correct but they smoke more than a pack a day. What grade would you give them and I will give you guys a second to think about it. Don't you worry. Lindsay yes so it's kind of tricky. Stephanie you are correct. S you are correct. What are you guys saying because this is kind of tricky because remember how I said you can't go below in a grade, you can always go higher but you can't go below in a grade. I'm just waiting on a few more people I'm just because this is a good question. We do talk about them in the case studies to. So yes, it would put them in a grade C because they are smoking a lot. You would not you know like it just sort of means that they're constantly doing something to their mouth that's going to make things worse. So things are going to progress quickly. So that's a great question. We will talk more about those and the grading so a B and C, you would determine okay you guys. Is it going to be a slow progression, moderate or, you know, pretty fast. If a patient's 90 years old and yes they might have a higher cow. But are you worried about things progressing quickly because they're a non smoker they have no diabetes well that's just sort of how it determines it, but you do of course also have to look at the bone loss and things like that. This is just sort of showing you guys some not so nice mouths. Obviously, these things look pretty bad and that will give them a higher grade. We did do these case studies last time like this is an older one but let's just sort of go through them again. So you have a 50 year old patient.  He is he is receiving treatment for high blood pressure, depression, smoking cessation. These are the medications he's on smoking one pack of cigarettes a day for 35 years you guys that's a long time it's not like he just started smoking which would be weird but for 35 years. Um, you know his his meds he drinks alcohol his last visit was over 10 years ago. He only goes when he's in pain. So you guys hopefully you took a picture of like these things here okay of the sorry of the staging and the grading to this will help you determine these things. Okay, so. So he brushes once a day which is not enough he doesn't really floss. He has a lot of bio I'm sorry he has a lot of calculus, light biofilm know, which is good I guess but he has gingival or he hasn't generalized gingival recession bleeding index plaque free score. His mouth basically. Just from everything I've told you guys. So far, what stage and what grade are you guys thinking. Let me bring up another chart for you so that's like 23 I'll come back to that. Just from everything I've told you guys so far.  So what are you thinking. Let's do the stage first what's what stage just are you guys thinking so let me go back. So think of the stage as we're going through this here. So this is the patient he's 50 I mean this he's he's obviously not 50 I don't know why he's there but anyways, he's 50. He doesn't go to the dentist often so those are some key points. He doesn't brush a lot he does have generalized tartar which is moderate to heavy his biofilm is light. So even with just that information we haven't looked at, we haven't looked at his x-rays yet. We don't have it we don't know his probing depths, his clinical attachment loss but let's just say we're just thinking, you know, thinking about it. What stage are you guys thinking, even without, you know, so you should have a stage in mind like just to sort of have a stage in mind. Okay, and then moving on here. So we're looking at the clinical attachment loss, which is the bottom number here okay it's really hard to see even for me it's blurry. So the clinical attachment loss here okay the bottom number so look at these numbers you guys so clinical attachment losses of eights and sevens I think it's really hard to see eights and sevens okay so go back again to our favorite chart clinical attachment losses of eights and sevens we pick the highest number remember where was that on the probing depths we have three thousand fives threes and twos you know all of that. So, and thank you guys for you know thinking about it that is awesome. I will explain this. Okay, so feel free you guys to type in the in the chat box if you're thinking of something. Okay, so then having a closer look but guess what you guys they he also has some forcation involvement class three or sorry class three two forcation involvement. Oh yeah sorry so I was thinking like three four or five okay sorry I think I'm thinking of other things. So class two forcation involvement. Look, he has missing teeth you guys the wisdom teeth normal to be missing but why is he missing his sixes and sevens in some cases. Probably not just for the heck of it. So then we have to go back again. I kind of want to use this other chart right now. So staging. Okay, so we look at tooth loss. We look at cowl. We look at the pocket depths to of course but all of that. So hopefully everybody's thinking for now stage three or four right you might be kind of going oh is it stage three is it stage four is it stage three is it. So hopefully you're thinking about all of that he smokes it was a packet day correct or wasn't more than pack smoking a packet day so that's a great modifier. Okay. Just move down here. These are the x rays. Obviously you guys severe bone loss I'm sure I don't have to tell you that like you can just see it. Like I wouldn't even have to do calculations it's kind of right there. Okay. So bone loss vertical bite wings bone loss bone loss bone loss. So for those of you guys who have said stage four grade C that is correct. Okay. And Stephanie yes you are correct so he wasn't stage three for the most part, but then as soon as he gets tooth loss as soon as there's mobility is happening, then that puts them into a stage four. Okay, and great see I think everybody who answered did say great or sorry. Yes, great see, because that's, you know, it's not a good sign with all of the bone loss he has all of that. So then they put everything together for you again. So there's previous tooth loss from perio we didn't necessarily know that when sixes and sevens are missing it's kind of a good indication if there's one six missing. It could have been a fluke where like literally they hit themselves they had trauma it's not usually a molar though. If you see a molar missing it's probably due to perio. Okay, like usually. They talk about the cow they talk about the probing depth again. The bite wings obviously and then they just talk about how they would go about cleaning this patients teeth. Okay, so good for you guys. Great job. Okay, so and then they did some highlights. Oh, Mackenzie I like that so Mackenzie is saying so a good way to remember if something is generalized or localized. If it's greater than 30% it's the same as eight teeth being affected in 28 teeth in the mouth. That's really smart. I'm going to write that down. I like that. So if it's greater than 30%. Yes, eight teeth are affected I will repeat that I'm actually writing it down in a 28 mouth. Okay, so Mackenzie is saying that to remember if something is generalized or localized she was told that for it to be greater than 30% making it generalized. It's the same as more than eight teeth are affected in a 28 teeth mouth. Okay, does that make sense. That is so smart. So she's she is also saying in a case study. I'm going to use that for my own practice, so thank you. And I'm sure everybody has had some major like, ah, that makes sense. So thank you Mackenzie. That was great. So, so I'm see you guys so there was some stage three, there was some stage four areas here, put some into stage four just because there's more things happening in stage four. Okay, so this is another oh sorry why did they put the stage and everything there I want to cover that up but it's too late. Okay, so just to kind of think about it so so this is another patient type two diabetic. They are a smoker. She has a greater than nine level of the HBA one C her cowl is four to five millimeters bone loss 20%. I'm sorry, I'm talking about the probing depths here. So, stage two grade C. So I just kind of want to show you guys that for one second. Stage two grade C. So let me tell you why. So Cal is four to five millimeters. Let's see. Okay, so when Cal is four to five millimeters. So we're kind of looking at stage two and stage three here right so it's kind of like. Hmm, but the probing depths I believe my apologies I need to go back to that again the probing depths I believe they said were less than or equal to five so that's 31. So then that just puts her into stage two again you guys so there's more happening in stage two Cal did say from four to five millimeters but they still put her in stage two. So it could and and this is pretty much greater than five anyway. I think if it if it was a lot of the teeth affected were five millimeter Cal, then she would go into stage three but it could have just been the one tooth or something so that's why they're putting her into stage two and looking at the probing depth as well okay so they kind of did did both, but they put her in grade C so you might be thinking well stage two isn't that bad, but grade C is bad, and I'll tell you why it's because remember they mentioned where's that chart. So we mentioned the diabetes. Okay, so that is a great modifier. It's more than seven so that's grade C. So does everybody see that the smoking and the diabetes. Stephanie exactly sorry yes, exactly. So that's why. This is just sort of something to put everything together again for you guys looking at different risk factors look at the age. Oh boy things like that. Excuse me. This is just sort of how you would probe around teeth with implants. They might, I think it'd be pretty cool to have like an image like this on the board exam and then you have to say which is the right one to probe implants. I don't know. That would probably be too easy right but it's kind of different because you kind of have to go like straight up and down for the tooth you do have to angle it a little bit. I probably knew that but I just think that's pretty cool. This is just sort of showing a different color of perioprobe I love these they're amazing. I need to order more I just don't know where to find them. So again you guys looking at this chart looking at everything study it memorize it printed out look at it you know it's great. I do have some additional case studies for you. But let me tell you it was really hard to come up with case studies because I don't have like from actual patients. So I just kind of had to think of some and go from there. So let's see how we do. Okay, so, and I kept it simple for you guys. So Mary Ann she's age 78. These are her vital she's five foot five 165 pounds. These are her x rays. Okay you guys these are the x rays they're not actually her x rays I just pick them. I try to find some, you know, pertaining to the particular case study. So look at the bone levels you might not think it looks that bad in some areas, but then look at like the lower interiors look at like over here where there's a little bit more. You see calculus spurs so that can indicate okay it's not just little bone loss here and might be a little bit more so more about Mary Ann. Mary Ann's teeth. Okay, so her lower interiors like moderate to heavy deposits look at the like swollen gingiva on the bottom here. You might be looking at her from this way and saying oh it doesn't look too bad you know the gums actually look fairly healthy yes you do see some staining there, but look at the moderate to heavy charter even kind of showing up here. You see gingival recession, so that would put her in a higher cow. Hope I didn't give you guys the grading yet. No I don't think I did. So her cow is from three to nine millimeters. Okay, pockets two to seven millimeters. So three millimeters generalized the molars are four to seven millimeters so I kind of summed it down for you guys a little bit. But remember, look at the key points here. Is there for occasion involvement. Sorry, maybe I shouldn't be so obvious. Sorry guys, I'm probably being too obvious but I'm trying to help you. So you should automatically have a stage in your mind right now. Okay, so let's go back to Mary Ann again. This is Mary Ann she's 79 this is all of the information that I have given you I kept it simple, very very vague look at her x-rays. Look at her teeth. A couple other information here so I didn't have like a period chart to put things in all of this you guys so you are looking okay so stage three and I'll tell you guys why okay so this is not. Sorry, this is not a case study that I just made up on my own I took a course and I just changed the name I like I changed slightly the age things like that. Okay, so you were probably thinking stage three or stage four, but I didn't mention anything about smoking I didn't mention anything about diabetes. I'm considering her age. Okay, so in the course what they said to me was or sorry what they had said to everybody was she's 79 years old in some in some areas she has early bone loss in some areas she has moderate bone loss, but she's 79 years old she's doing pretty darn good for 79 years old. She's not missing any teeth for 79 years old that's pretty darn good and that's what they said in the course. They said she's not missing any teeth at 79 years of age, but there's forcation involvement so that automatically puts her into a stage three. But then you have to think is it a stage three or is it a stage four. So let's go back again. And a lot of you guys said stage three and a lot of you guys had said stage four so let's talk about it. So she's in stage three, not in stage four, basically because in the course they had said, does Mary and will complex rehabilitation be needed. Are there any teeth loose? No. Are there any dysfunctions in the mouth? No. Is she missing teeth? No. So that's what they said. Okay, that's why they said it's not stage four it's stage yeah it's not stage four it's stage three. Okay. So does that make sense so far to everybody? Shoot where'd that go? And it would be grade B. So let's go down to the grading again. It would not be grade A just simply because she has more bone loss than that. So that puts her in grade B or sorry did I say A or B. It's not grade A because hey she's 79 you guys but there is bone loss there and Cal. Grade B that's because of the bone loss that she had. Okay. Mackenzie that's a good question. What is a ridge defect? Can anybody tell me? Because that is a grade modifier. It's kind of like a stage actually so it kind of puts things into perspective. I'm just looking for that chart. Okay, so what is a ridge defect? Can anybody tell me? So Mackenzie you might not be the only one who doesn't know. Oops, I just put up a Facebook thing. What is a ridge defect? I'm going to try to find a picture for you guys. Does nobody know? What is a ridge defect? Tiffany yes you got it. Thank you. I kind of found some pictures here you guys. It's not super awesome but at least I can show you guys. So a ridge defect is basically think of your older patients and if they're missing teeth. If they're missing teeth they have not cared to get a bridge or a partial denture anything like that. So a ridge defect is just simply can everybody see this by the way I put up a picture. I might have to refresh my screen if you can't see it. A ridge defect is kind of when the avial or bony ridge is just not looking right. I'm probably not explaining it properly but when there's missing teeth okay that's why we tell patients I know you have one missing tooth or you're 80 years old you had just lost like three teeth this side three teeth that side you don't think it's going to make a difference. Your face will change. That ridge is going to change. So yes. So what it is you guys. Thank you. But that was a great question because you obviously weren't the only one Mackenzie who didn't know so thank you for asking that. Okay, so let's let's go through another one. Okay because case studies are awesome but it was really hard for me to make these case studies. I should say like picking the x-rays because I took a course I took the case studies from the course but I just kind of changed a couple things but I couldn't take the pictures from the course because it was like on the screen right. Anyways okay so for Joe 68 smoker a packet day so what does that mean when he smokes that puts them into a certain grade already probing three to nine millimeters whoa those are heavy pockets, clinical attachment anywhere from two millimeters to 12 millimeters holy moly for patients for teeth and guess what there's mobility. Honestly, even just looking at these x-rays I know what stage and grade he's going to be in to be perfectly honest with you.  Does anybody know what's in a pack of cigarettes 10 to 15. I think so though that's what I've always. Oh it might depend on the brand. And Ali is saying 20 cigarettes holy cow somebody is seriously smoking 20 cigarettes a day even 10 cigarettes a day. How do you have time for that. Ew, that's gross. Anyway, sorry if anybody smokes here I apologize. Ali is saying that 20 is standard. Does anybody smoke here because I apologize for what I just said I was being very rude. Does anybody smoke here. I'm curious. Okay, so let's talk about Joe because he's a smoker. Sorry if I offended anybody I apologize. I'm so mean okay. So what's everybody thinking from a stage and a grade from everything I've said to you. Look at the cow so that should put you him into a stage smoker that's a certain grade Mackenzie good. What do you guys think like what are you guys thinking hopefully you're thinking stage three or stage four right. But there's mobility and there's tooth loss stage for automatically you guys stage for some of you guys might have thought grade B, but it's grade C because of his major smoking. Okay, and I put this here just to remind myself to say, since he's a major smoker that puts them into a grade C. Yeah, I know these bite wings insane so that's definitely more than 50% so you know it's going to be stage for hopefully you guys will have easy ones like this on the board exam seriously. But is anybody confused with that because there's one more to go through. Okay, so I don't think anybody smokes here that's good. If you are watching the the recording I apologize if I sounded rude I didn't need to do that. Okay, Lisa type two diabetes probing depths two to 10 millimeters clinical attachment levels, clinical attachment loss whatever two to 16 millimeters whoa. I don't think I've ever seen such bad clinical attachment. But anyways, mobility of three in some areas puffy papilla negative recession so that can make it a lower cal. What do you guys think, I'm not trying to confuse you but I know. Stephanie I was thinking the same thing but I wasn't going to say it pretty much automatically put somebody into a stage. For because of the mobilities. Oh, Mackenzie good question, you know what they didn't mention that in the course, they didn't mention anything else about the diabetes only that she was type two so I should have asked that. So I don't know if it's controlled or not so I'm sorry. I don't know that I think most of you guys said stage four and grade C. Did everybody say that good. So what's on this next slide I can't remember oh yeah sorry okay so great be a grade C so you know what, in the course, they did actually say that it does depend on a couple things so let's go back to the grading here where's my chart. They had actually said it does depend on a couple things. They were talking about her, her diabetes, and, but all they said was type two. We didn't know their HBA one C number on the board exam you have to know that you have to ask the patient what that number is and that would determine either a grade B, or a grade C.  I would put them in a grade C because of that bone loss it's not like the bone loss is going to get better right because remember for group for our grading. There's a lot going on percentage of bone loss.  So if you're and I put this in in here because if you're ever not sure oh is it grade B or grade C. Look at the x-rays and you know think about it this way it's kind of cheating but not really cheating. Oh sorry wrong person look at the x-rays that's not going to get better. So that puts them in grade C. Okay. So again, it was hard to do the case studies that's why I have those ones, but it kind of gives you guys a good indication okay practice makes perfect for the grading. Look at how you feel like it could progress, even just think about bone loss you know if that's easier for you think okay is this is, is there like heavy heavy bone loss then whoa. Yes basically so Stephanie is saying for the grading it is the prognosis I did have that in a slide somewhere. So basically how you feel the prognosis is you know is it good is it bad like there's not much we can do. So think about that when it comes to grading so can everybody see this slide it's slide 19. So think about that when it comes to grading the prognosis are things going to get worse are they going to stay the same are they going to get better. But that's why you can't go back in a grading because if they have perio they have bone loss, you can't bring the bone back so that's kind of a good way of thinking about it. So if you're just staging everybody that is looking at cow, you know pocket depth looking at cow, looking at the bone loss of course but then saying how they lost teeth is their vocation is their mobility. If there's vocation automatically stage three so hey to keep it even more simple for you guys. So if you're like oh my God this is so confusing, read the case study if there's vocation, you know it's at least stage three, it might be stage four or two, but at least you know it's stage three. McKenzie let's see so. Say a patient has diabetes but if they don't give their HBA one C, they might be a grade a. Yes, good point McKenzie. McKenzie actually saw you guys makes a great point I should have mentioned this. So thank you McKenzie you should be doing this class today clearly. So for diabetes let's see where can I find that if you don't know their HBA one C number perhaps it says in the case study you don't know the number, and the diabetes is controlled. Oh yes, Lindsay I see that too. So does not have diabetes. So grade a is if they don't have diabetes but the question for you guys is, if diabetes is controlled. In our minds, it means they're a healthy patient. Yes they have diabetes, but if it's controlled they're a healthy patient their numbers would be normal. Um, Stephanie, yes, yes, you were thinking exactly. We treat them as a normal healthy patient if it's controlled diabetes. But I hope on the board exam they will give you a number because that just makes things easy. If on the board exam, all they say is the patient has controlled diabetes. So think grade a. Okay, they might move into great be or grade C because of other things like maybe they do still have severe bone loss. Then they might be a great see anyway, but don't think oh they have controlled diabetes, but they have diabetes so they're automatically here or they're automatically here. No, if it's controlled diabetes, think grade a unless they give you the HBA1C number. But remember that doesn't just mean okay they're controlled they're perfectly healthy, maybe not. They might be a heavy smoker. Crazy, right. So then they might be a great see anyway. So Mackenzie, thank you for bringing that up. Since you guys. Clearly I was talking too loud because my throat is really sore. So sorry if I was yelling at everybody. I'm not a quiet talker, especially when I talk dental I get very excited. So does this help you guys. I am actually probably going to upload this video on YouTube because I want other people to see it too because I feel like this was very helpful. Oh, that's smart. Stephanie was saying that she was listening to a podcast that said never treat a stranger you want to get to know them as much as you can. Which podcast, because I want to start listening to podcasts again. Yes, I'm Ali I am so I am so happy that this helped is everybody okay though. It's there now how do you listen to podcasts you guys like is there an app to download I think right. Oh Spotify I have Spotify no way I can listen to it in the car. Because as you guys know I'm a mobile hygienist so I travel. I'm going to Woodstock tomorrow and that's about an hour away from me. Oh my god. Oh, maybe I should be doing podcasts then. Oh there's podcasts about boarding fans. If I don't have enough to do. Does anybody know how to make a podcast. Is it easy like I just have to download the app or something I'll figure this out one day. Didn't even think about that all that would be so good. Okay you guys. So I hope that helps I will actually upload this onto YouTube, you will have it inside your course as well. Of course, I'm going to put this in our private Facebook. Oh, thank you. Yeah, this is a toothbrush bracelet need a. I can give you guys the link for it if you guys want it.  So if you guys want I can give you the link to that. Actually I can type it in the chat box right now. It's tooth life.ca but make sure to enter in the promo code dental L. I like I have like three bracelets to necklaces I need to get earrings yeah. I have the watch which is so cool I wonder if I have it here. Sorry guys if you guys don't want to see the watch or hear me talk about my tooth accessories you can definitely go. I will be uploading this later on. Any questions though about our session today sorry guys I can't find the watch I probably have it in my washroom somewhere. Sometimes I put it here. But is there any questions everybody's okay with everything. Practice makes perfect just study practice. You guys will have this PowerPoint as well to go through the case studies just basically remember grade modifiers oh yes you guys. For those of you who are taking the board exam tomorrow good luck Mackenzie good luck I know you're nervous that's normal. You know I kind of feel like at this point just keep reading there's nothing new I can tell you guys I really can't. I you know if you guys don't know something now I'm not saying you won't know it tomorrow but don't stress about things you don't know. Just try to know a little bit about everything read your notes do all of that you can do this you can do this believe me I still remember like it was yesterday. Me taking my board exam, but I felt so good afterwards it was like this huge weight was lifted off of my shoulder I had no idea if I passed or not, but it just felt so good afterwards. You guys are so welcome anytime I am very happy that this helped I did upload a lot of videos on you or I'm sorry on our private Facebook page yesterday. So definitely have a peek at that. I did some medical emergencies because Sonya was asking about it I did eating disorders. Look at all of that. Mackenzie look at that video about eating disorders because we didn't really talk about that too much. Oh, and sorry I can't see who's typing because the names are cut off since I'm not sharing my screen anymore which is weird. But somebody just said they had a question about inhalers. Yes, you guys are so welcome. So we recommend to rinse their mouth after using an inhaler because it could cause thrush. Yes, that's true. Is that just regarding corticosteroid inhalers because they suppress the immune system actually it is any inhaler the reason why we do that is because it can dry out the mouth, which can cause thrush. This is a fungal infection even in some cases. So you want to have the patient rinse with water afterwards like just to get that out of the mouth. So it doesn't cause any bad like gingival reactions or something like that. So that's a good question. There are two different types actually which you probably don't have to know for the board exam but there's two different types of inhalers. There's a corticosteroid one that you would get but then there's also yes one that dilates everything. So there are two different types. So you would still you would still have the patient rinse with water after every inhale. Yes, in our private Facebook group you guys here, let me bring that up. I hope you guys are in it because I send emails, I put the link on top of your courses to make sure you guys are in it. If you're not, it could just be because when you had requested to join you didn't answer the questions and it automatically doesn't allow you to join. So just answer the questions I do that because I get like 20 people daily wanting to join our private group and they're not students so it just kind of helps me we know which ones are students or not. Can you guys see my screen this is our private students of dental L tutoring group for you guys only so for students only. This is facebook.com slash groups slash dental L. Let me put that in the chat box for you guys if you can't see it. I did upload a lot of videos yesterday I'm going to do more today don't feel like you have to watch them if you feel like you know the topic, but it's for people who have been sending me a message saying can you talk more about this can you talk more about that my exam is like tomorrow. See you guys I did. I'm see 20 member requests and that is just from this morning. So make sure to answer the questions if you are a student so I can let you get. So I did one on like special needs eating disorder some of these these videos are older but it's because the information doesn't change. Okay, and I like to focus on the harder topics for the newer ones but I should update some of those. I did I should do it HIV AIDS session. It's a good one to review because they might have a question on the board exam you want to know it. I had uploaded a board exam boot camp session which just kind of goes through questions medical emergencies the whole works. So definitely check that out you guys I'm going to upload more videos today so not to overwhelm people, but just to really help you guys study for the exam. Okay. Please email me tomorrow after you take the exam and let me know what you thought. Okay. I really want to know in fact all of you guys whoever's taking the exam tomorrow please like even just post if you would prefer post in the Facebook group email me whatever and please let us know how you felt you did. It's you know it is a private student group only let us know how you feel. Let us know what types of questions you had let us know. Yeah. It's pretty crazy. But at least you won't have to study anymore Mackenzie that will feel very good.  So forget for lately. Doing a lot of tutoring. Oh boy, if I forget. Email me and yell at me please. It's okay somebody has to. Mackenzie on people are wondering if you're taking the exam at home. I'm not sure if you want to answer that or not yeah. Yes she is you guys. I think everybody is correct. I believe so. Yes, so crazy. Things have changed so much. I think you more stressed out but that would probably stress me out more. I don't know, like I would prefer to. I don't know. Oh, so some people have to go to a testing center in Florida so probably if there's bigger spaces and things, then you do have to go to a testing center. Hi there guys yes the the session is done I apologize we aren't going to go through anymore so if you have things to do go right ahead. I will let you guys go because I do actually tutor in about 20 minutes. So I do have to go myself anyway.  I'm so happy to help you guys. Again, I don't want to overwhelm you guys too much but I will be uploading a lot in our Facebook group today. Don't look at it if you feel you know the topic please don't worry, but if there's any last minute questions post in the Facebook group, so that that way other students can see it too. I can answer them and everybody can see it because emails can be hard sometimes, just because I get so many all the time that I check it like once in the afternoon once in the evening but if I miss your email, then I'm sorry I do apologize so posting in the Facebook group is usually better, because others are like other people probably have the same questions. In fact, maybe I'll do another YouTube video today since I put makeup on today and stuff I should probably do some more videos. Yes, I will be uploading this video like right now. It might take a little while to process because this was a little over an hour session but I'm going to actually upload it right into YouTube so I'm going to make it private. Or I'm sorry public and in the Facebook group to because our sessions aren't usually public but this one will help a lot of people you guys so I'm going to make it public. Any questions though let me know in the Facebook group I will be checking it throughout the day a lot of tutoring today. So I apologize if I don't get back to you guys right away but if if a student has a question you guys feel free to comment feel free to comment and help to answer the question for them. Even if you get the wrong answer, I will say no this is the right answer but it can't hurt to just try. In fact, hey you guys I have an idea I have an idea shoot I should have mentioned this earlier because there's only three of you left. I suggest everybody post questions in the Facebook group post questions and like a BC or D and then give everybody the the answer say tonight. I don't know I think that's kind of cool. So that way we're just thinking of a bunch of questions kind of like we're doing this big study group. I'm not. Is that cool or not cool. Can somebody help me get that started just post random questions you guys, because I feel like I can't post any more random questions because I just feel like I said them all but I probably have it post questions. I don't know if you guys want to give the answers right away in the comment section so you don't forget to give the answer, but then when somebody comments on your question they might see the answer and you don't want that right. So maybe if you guys don't mind just posting a question whoops, as they almost dropped this. I'll post some later. Okay, I'll post some later and then I'll post the answers later on tonight. Yeah, I don't know Mackenzie I think that's a good idea. If you have any questions in the Facebook group. I think that would be a lot of fun. Okay, this YouTube video is going to be public and people are going to think I'm crazy. They're going to be like we don't want to sign up for her sessions she's making us post questions. Have a good day. Have a good lunch breakfast whatever time it is for you guys have a good coffee Mackenzie good luck everybody good luck who's taking the exam tomorrow good luck good luck good luck believe me I am going to be nervous as heck. As well I get very very nervous for my students almost to the point where I feel sick. So I'm seeing patients tomorrow to try to distract me. Hey guys, good luck good luck good luck okay. Bye, I will post the video soon soon soon hopefully within the next 45 minutes. Bye guys, bye see you guys later next week I think I have to check the schedule but I'll see you guys later. Bye. Oh, actually you guys wait, we will wait I have something oh no I just lost everybody.  Okay, I'll post it in the Facebook group. I will. Okay guys see you soon. Bye.


Good morning campers. I'm Chris. I just want to thank you very much for joining me for this talk today about responsive images I know that this is at least one of two today. I'm going first and Kevin Hoffman is going later and he's gonna be able to tear apart anything that I do wrong right now So please take it easy on me So basically I wanted to talk about today kind of responsive images the value of them Get into kind of just the kind of basics of responsive images But I really take it a few steps further and just talk about how you can optimize those images to make them really really High performance get your website in in basically as good of shape as possible for quick page load and and Taking it as far as you can So first of all why optimize? Obviously, we know this is all about performance and the different impacts that performance have on your website your conversion rate your engagement of your users and the Just all the aspects of you wanting people to be on your website performance has a huge impact on that so You know first of all just to quote Google sites that live in five seconds versus 19 seconds Observed 25 percent higher viewability and 70 percent longer average sessions 35 percent lower bounce rate So you're getting a whole lot of people or a whole lot more people looking at your site looking at it for longer and Not leaving your site as quickly And then since the dawn of web 2.0 You know quite some time ago sites have gotten larger and larger as they've gotten more interactive so Get part of that interactivity has been you know much more advanced JavaScript many more images and interactive images in different ways of engaging with those images and Because of that the page load has gotten larger For quite some time there for a number of years it was getting exponentially larger on a yearly basis It was accelerating in how much bigger images were or the overall size of the page load was getting And then it's kind of at this point still growing year by year Not quite as largely but the end result is that websites keep getting larger the page load of the assets keeps getting larger and at some point You know you need to start to account for that Alongside that same trajectory more and more people have been using mobile devices to load the web page content that you have Google now indexes mobile first so That's indicative of the fact that they know that more of your traffic on your website is coming from mobile devices now than it Is from desktop computers You know obviously different websites have different statistics for that But I think it's just kind of an important to keep in mind that Most people are kind of on the go browsing your website on their phone. Maybe not the best internet connection Maybe not the you know super high horsepower processor that you have in your computer and For all those reasons kind of optimization for those different platforms and those different devices is super key If that's where people are viewing your website that you need to make sure that you're providing the best possible experience for them on those devices and Huge huge part of that is that your page loads really really fast Um to take it a little bit further if you have an e-commerce Yeah e-commerce website It's super key to have that page load quickly again when you're talking about conversion rates and people actually purchasing what you're trying to sell them There's a huge huge drop-off Kind of right after the two and a half three second mark where your conversion rates suffered drastically As you get past a certain point You know on average you could have up to kind of 2.4 Sorry about a 2% conversion rate if your page loads as quickly as 2.4 seconds And that really really drops off to kind of about a half percent conversion rate or 25 percent of what you could have had Once your page gets to about the six second mark. So, you know, that's a huge huge impact that that could meet That could make the difference if you're selling You know thousands of dollars of products you stand to make or lose thousands of dollars on a monthly basis Because of that. So it's really I mean for from a content perspective from a sales perspective Whatever you're trying to accomplish with your website It's so so paramount that people are unable to engage with that content as quickly as they possibly can and So why do we go to images? I think is obviously the next question Images on average composed about 64 percent of the average pages payload So that's a huge huge part of it.  It's a great way to To kind of start and make your website as performancy could possibly be So kind of and again We're just kind of starting with kind of the baseline type things just because I think these things are important And I think it's worth considering before you even get into making your images responsive for your website You really want to think about how you're sending those images to People using your site in the first place and kind of the three main file types that everybody's interacted with start with you know Jpegs for things like photorealistic pictures Pings for if you need transparency or for kind of lower-way illustration So it's an illustration with a limited number of colors not photorealistic Great place to use pings also, and I think that's one thing that I've noticed a lot of people think okay We'll always use lossy JPEG format for basically any image that doesn't need transparency a lot of times If you actually you know take a look at the file size if you export a ping image that is something with relatively limited colors relatively You know Simple design you'll oftentimes get a totally lossless picture that in fact weighs less than that JPEG So again if it's photorealistic or something like that absolutely do JPEG export at a reduced quality But if you you know do have seen it's a little bit more limiting colors I'd say try exporting as a ping see what happens And of course don't we have SVG which are scalable vector graphics coming out of something like Adobe illustrator Those are for you know pretty much the simplest of different types of images low visual complexity You know still has transparency and a huge benefit of that also is that they're infinitely scalable and they look perfect You know all the time as well as having a really low file size So between those three I mean before you even start you need to make sure that you're saving out your files in the correct format You know that fits the occasion Great starting point and like it's something definitely worth considering because there's a lot of Kilobytes that you could save in just in just considering which one is most appropriate So just to go into kind of like a basic responsive image setup And this is not the way that we're gonna do this by the end of this presentation, but this is kind of the foundational responsive images with a few things worth considering and really it is Inherently a part of you know where we're gonna end up But just just to kind of break it down in a very simple way So first of all we have a source set of different images What that allows the browser to do is pick what? Image is most appropriate for the situation And use that image so it only downs downloads the most appropriate image for the viewport for the size of the image That's going to be showing up there The second rule here are the sizes and that's where you're actually telling the browser the browser the logic of What images to use so in this case? It's saying you know if your viewport has a max width of 320 pixels this image should be serving the 280 pixel version of the image You know which which you're saying then in that situation is the most appropriate So those two things are kind of the Instructions and the rules that the browser uses to make that determination and as you resize your window or scale or tip your phone from portrait to landscape mode Those different rules come into effect and apply and it might load a different version of that image So those are all good things and what it really enables is a combination of the Smallest file size and the highest image quality for a given size that the image is being displayed And I think those two things are important to consider to you It's not only that we're making it fast, but we're making it so that it looks great on whatever device The person is using and really if you can accomplish both of those with this type of solution That's the ideal the ideal situation So already Obviously that last slide where it considerably more complex than an image tag with the same single image in it Definitely a little bit more of a pain in the butt already That said there are kind of a couple different pieces that can make this way easier So the first challenge again being kind of the multiple versions of the images if you have to be able to serve multiple versions of an image you have to have all of those versions to serve in the first place and You know if you have to save each one of those at a Photoshop or whatever photo editor you're using that could be Not very fun at all You could end up instead of having to save out one image and they end up having to save out ten or however many you need for that set So that's not fun, but we can optimize optimize those programmatically either using word presses You know built-in functionality or we can use a task automation tool like Gulf or grunt to do that So you save out that one version of the image and then you have one of your systems Automatically make all of the other versions for you The second piece of it is first of all figuring out all those different break points and then figure out all the sizes that make sense for Your site and in that regard what I would say is first of all the the end result in the tool We're going to use here does a lot of that for you, which I think is really cool But the other thing is when you think about your website There's really only so many different sizes of images You're probably likely to use unless you have a super super complex design on your site Typically if you're using a grid layout You're gonna have images to take up half the screen a lot of cases You'll have images to take up the full screen or a quarter of the screen But you know you're looking at maybe a set of you know five or six I would say on a on a moderately complex website that you're actually using so you do need to figure out You know the size that it fits at that break point and then also kind of accommodate for when things get fluid at kind of mobile sizes But it's really not that many and really you can kind of just start using those over and over again Probably want to figure it out or at least consider it for every site but um You know at a certain point when you're implementing images and all of your different page templates it Becomes a big copy paste job, which really isn't that bad So let's go into a little bit more why you really want to optimize so this is Google Lighthouse It is a tool now built into Google Chrome and it is awesome if you haven't checked it out yet. I highly recommend it It's basically like all those website speed test websites kind of rolled into a single package That's right there in your browser analyzes your site right there and Gives you tons and tons of information about all the different things you could be doing to get really solid performance on your website nine times out of ten if a website is is particularly slow or Even just not as fast as it could be some of the main things that are going to come up are shown here First of all serving images in next-gen formats, and that's basically serving things in webp Which chrome can use Android browsers or chrome on Android phones can use I think that's about it right now But that's still a huge part of your your target market And it's really good to have a much smaller kind of image size for those people that can use it so webp is you know a compression algorithm that works for both jpegs and pings and Has a greater reduction in file size than both jpeg and ping formats So you want to make those available and we'll get into that a little bit The other piece is off-screen images So when somebody loads a web page they see what you have at the top of that web page And they don't see what you have at the bottom of that web page That's important because if you if you're not lazy loading your images You're going to end up loading all of those images that they're not looking at that's going to be the Whole weight of your web page and all the things that they don't even need yet Happening all at once right at the beginning that makes your website slow, and that's not good So lazy loading is a huge component of this as well. You really want to be able to serve people images when they're When they need them and not before Properly sizing images another thing that's very much helped by using responsive images again if you have You know an image that's twice as big that needs to be loaded on the page Twice as much information twice as much page load. That's not good You may never get to a hundred percent perfect in every situation without maybe using some kind of Heavy kind of JavaScript library to kind of resize things on the fly But you can get so so close that it will you know have almost no no additional waiter impact So responsive images allows for all those different All that type of sizing So again, that's under the audits tab in Google Lighthouse, which is built into Chrome super useful One thing I've noticed if you are using Lighthouse You kind of get different results in Current stable version of Chrome versus Chrome canary I would say I think they're working out all the time. I think it's a very much in development It's probably worth at least trying out both and kind of comparing the results that you get and kind of just regular Chrome and from canary And to kind of get a little bit further into why you want to optimize The some key Perspectives from Google are that there are kind of these different points at which people feel like they're engaging your site And it's all about how their perspective of that kind of initial engagement with your site Really really matters. So it's not just that your page loads. That's you know baseline the page has loaded It's a little bit more segmented than that So the first point is the first meaningful paint which is when there's something of value there on the screen And that means that you know not everything might be loaded You can't actually interact with it yet But you do see it there and that's important because you want people to see something to see that you're doing something with them You know as quickly as possible Then the time to first interactive that's when somebody can actually start engaging with your website And then consistently interactive is when sites rate of the pages ready to go They can start interacting they can do a number of things on the page and that's good So Google has this thing called perceptual speed index which Which which gives you an idea of how people are perceiving the speed of your page And that's that's a really important kind of metric to be taking a look at So to get into the full depth of what I'm here to talk to you about today Basically, it's that we want to do responsive images But then we want to do a bunch of other stuff to to make it as fast as possible to meet all those metrics That you're going to see in Google Lighthouse And to even maybe take it a couple steps further, so it's responsive images Images served as both regular images for browsers that can't handle web pay and then also as web pay for browsers that can Lazy loading your images so that you're only loading the content that people need when they need it and not loading everything at the very beginning of the page Another really cool tool which is SVG placeholders so that the first image that gets loaded on the page Is in fact an SVG representation of the of the actual image that you're going to use And I'll go into a little bit more about that and then setting up your site to leverage caching So you you want for people when they're accessing your They've already accessed it keep those resources local so that you don't have to send those across the network again Makes it much faster much speedier for them Okay So first of all just to talk about the different ways that you can create those responsive images Um, basically a kind of easy first step is in your themes functions file You can make use of word presses add image sizes Function to create the different sizes that you might need Here's an example of how I might lay that out in one of my theme files for a specific website taking into consideration the different sizes that those images are going to show up and Here you might want to consider both, you know regular standard definition screens as well as more retina displays which Present images at two times size three times size different sizes I think you do kind of want to consider that if you have a Million sources might be a little bit overkill You want to kind of have the least number of different sizes that you can that really meets the breakpoints of your site and has a good-looking and just about right sized image for each screen to again optimize both performance and The quality of the image, but you probably don't want a thousand of them either. I think I've had people critique me for using too many This is kind of a standard set that I would use But to me I feel like having When you're talking about the different sizes of images you're talking about kilobytes or tens of kilobytes or sometimes hundreds of kilobytes of difference You do have you know that extra block of code that and all those extra references in the code of your site But I think the savings that you have kind of warrants Somewhere in between there. So, you know, I might have you know, eight or ten different sizes And I think that that that's kind of a reasonable point right or wrong Another way of going about this is if you're gonna use a task automation tool like gulp or grunt I have used both and I think they're both great from what I hear all the cool kids are using gulp and It is a little bit more readable. So that's you know, that's a Nice benefit of it what that will do is you can just have kind of a watch task running in your larger gulp task and Whenever you add images or add an image to your source images folder will automatically run whatever processes you have set up to optimize that image so In a situation like this, this is just generating all of the different responsive images image sizes And optimizing things like JPEGs things and webp images. So, you know, that's that's one possibility I'll hop out of the presentation in a little bit and actually take you through my whole kind of gulp task that goes through these It does a bunch of other things also But yeah, I think it's it's a pretty cool way to do it So that's the example of the gulp responsive plug-in So then as far as webp is concerned and this is kind of a There's there's kind of two ways to go about this as well either with a plug-in because there are basically services that will generate webp images for you Or you could do it again as a gulp task using kind of libraries hosted on your own computer As the services go these all seem really good. I don't use them personally But I this would definitely make it simpler and you could just basically have this plug-in running and use word presses own image functionality and Basically have all of your webp images and optimized and different size responsive images So there's the eweb image optimizer and That one's really good. I think it allows you it's set up so that you can either Optimize images locally using your own server and different libraries on your server to optimize the images or you can use their Their servers to do it and if you pay some amount they will Offer a couple additional options jetpack is another great one jetpack has their image CDN, which is 100% free But they will they end up hosting the images on their own CDN Which you may or may not want depending upon how your server architecture is set up You might want you know your own CDN kind of hosting those things to limit the number of outside calls the server is making to You know outside websites, so it kind of just depends but good solution built into jetpack And and also short pixel and optimists again, they do either have an annual fee or You know this kind of per image fee, which is like a fraction of a cent It could end up being like five bucks and really not costing you very much to use any of these services And it does make it, you know considerably simpler to just install a plug-in and do something like that Yeah, and basically, you know just an example of the image optimizer will basically convert to WebP for you Save those files in your uploads directory next to where the you know different image sizes of the original file are So likewise something you could do with a gulp task or grunt task Basically just generating different WebP options for you and there's something called gulp WebP that does that for you So if you start thinking about kind of your gulp task as a series of processes that are running automatically That are automatically optimizing your images for you It really just does a whole lot and all you have to do once you've got it set up It's just in your command line, you know Start with gulp tasks and it's just watching for you as we're working on the site Trying to think if I want to show you anything outside of this Okay, so the next the next step is Lazy loading your images and this I really can't recommend enough.  It automates and does a whole lot of things for you That you that means you don't have to think about it. So for instance In addition to allowing you to serve either Regular, you know JPEGs pings or WebP. It also will automatically determine the correct image size for the place So that you don't have to set those responsive break points You do still have to set what size the browser should see that image as So for instance when we're back at our previous example with the responsive images We're still setting the width That's like the native width of the image right there So you still do you need to tell the browser that but as far as this whole sizes section here You don't need to do that because the plug-in figures it out for you. So that's a really really cool You know advantage right there. It also does a lot of other really nice things with You can set it up for background images. There's a lot of extendability and a lot of kind of add-ons that make it super super functional, so So for lazy loading and just kind of the optimization of this whole process I highly recommend it the second piece you're gonna want with that is going to be the rest image polyfill and that makes These kind of responsive images for image formats things like the picture element things like Determining whether WebP or will work or not for older browsers more compatible So between these two things it's about 25k when it's served via gzip over your You know over the server that's minified down to about 5k pretty small And again with all the functionality and the potential You know hundreds of kilobytes of savings that's giving you and loading those images on the page I'd say it's super worth it. You do need to load it in the header of your site However, obviously because it affects the loading of content display on your website You don't want that to be happening after all the images are already there, so it does have to be in the head All right, so here is kind of a basic responsive images implementation using lazy sizes And this would be using those images that were saved using that WP add image sizes function From your uploads directory. So as you can see here, there is no more Having to define the sizes we are inside of a picture element And you'll see why we're inside of a picture element rather than just a regular source set in a little bit But basically what this does is first loads your source image, which is going to be the smallest image that you've got There are the smallest version of image that you've got for that display In this case, it's only 180 pixels wide. You're talking about an image. It's maybe 5k 6k something like that on your website So that's the first thing that's going to load which again as far as that perceptual speed index with Google goes You see a low quality image. It's not great, but it gives you some context You give you some idea of what's going to show up there in that first, you know Few milliseconds as the page is loading before whatever the exactly, you know, appropriately sized image for that space is And then you're offering it this Data source set in this case because again the plugin is optimizing some of these things for you So it uses a data source set attribute rather than a regular source set That is offering all the other sizes and again the browser then chooses which one is the right one And it takes that image and it puts it in there And then you have again an image that's optimized both for size and quality for the situation on the page With that plug-in also you do need to add a class Lazy load that's all you need to do if you have that class amongst your classes on the image The plug-in knows to act on it and you're in good shape Also that data sizes auto attribute there that is what is basically enabling you to not have to To not have to specify the different break points and sizes in your code here That's keeping it a lot simpler, which is really nice There are a lot of ways you can manage that with that in the plug-in though So again it's worth exploring for different situations. You might want to not just have it automatically Determin the sizes. I don't know what those are, but maybe you have a reason So taking it a bit further now, we're getting into a situation where we have our images from both the regular versions in this case pings or that bottom section there and Webp images being served so that you're providing options for browsers that both Can handle webp and that's are going to be loading smaller file sizes But also for browsers that can't you're loading whatever that original format would be in this case a PNG image Still loading at the beginning there for your image source The smallest version of that ping file, but again, that's going to be very low white low weight compared to you know Trying to cover all browsers and loading something much larger So this is kind of an example of those two pieces together again You've got a big block of code here, but for the sake of performance and the sake of Really kind of reducing that image file size. It's a really Really functional as well You'll also notice as far as this layout goes. These are pulling from my theme template directory This is how I typically set it up. But again Because I process everything using gold beforehand as I'm building the site But then also apply apply kind of optimization to the upload directory as well, but you'll just see that this is Pulling from from my theme directory because they've already all been optimized minified And the different responsive breakpoints generated in my gulp task as I was building the site so this is really cool piece and Something that I'm kind of excited to share with you so Another really cool way of doing this and what we've been talking about with that initial image that loads your your source image That shows up in the code So far we've had a small Png or jpeg or whatever the kind of baseline image that you need to show up in that first place showing up there They're small, but they could be smaller also In almost every situation, you're not going to have the user actually Looking at that image for more than a split second when the actual image is going to show up there works So you want to minify that as much as possible you want to make that as As as small as it could be because it's in between What they're initially seeing and what you actually want them to see so there's a really cool optimization technique Using sqip or skip. I don't know. I don't know how you pronounce it, but basically it takes your image your input image makes a SVG image out of primitives that somehow resembles that image that you have and then layers over that a big Gaussian blur so that it's like if you were looking at the Blurriest version of your image ever but in vector and and You know not not jagged looking or anything like that still very smooth looking Which is like a blurry version of your image that weighs almost nothing. That's the first thing you load in its place instead So And I can show you kind of what that looks like Yeah, so so just to show you kind of how this tool works if you feed it You know a picture of a fox in a field. It's gonna give you this like Just woke up in the morning first second you're cracking your eyes open blurry pick view of that and again Because it's not what you eventually want them looking at It's it's what you it's what you are just showing them in the meantime and you're giving them that Perception of things we're showing up on the page To have a super super small file that does that and to be able to automate that is super valuable So I highly recommend looking into that again. It's something that you can run with a gulp task And kind of go through the whole just add it to your kind of build workflow And and that makes everything even smaller and even more optimized And as you can see here, you know, we've updated that instead of now your source image being a Pinger JPEG. It's that SVG instead As far as WordPress plugins that do that by the way, I haven't seen anything I'm not sure that there are any WordPress plugins that do this at this point Maybe one of us will write one sometime soon, but but it but it is cool and again, you can do that with that with gold And the last point, okay, so now we've made our images as small as You know, I think it's really functioning possible at this point The other thing though is you don't want to be sending people images You don't want to be making them use the network if they don't need to so Some things you can throw in your HT access file that really help performance Allow the browsers to catch as much of the content as possible are these types of headers So first you want an expires header, which is the kind of legacy version of what browsers use to Take a look at different file types and say I'm gonna store these in my local cache So for older browser types, you would use this very list of kind of expires headers You can set the expiration time for as much as you want really depends kind of how often the content shows up on your site and the More modern version of that is cache control headers again, which we're sending kind of a max age Send the type of cache. That's what the public or private piece is there The types of different servers that can cache it. So for instance there you can specify is your CDN caching it or only people's individual computers So so that's that's a great way to set that up as well another cool thing you would want to do in your hdxs file or your your comp file if you're A server admin, you know, you're doing I mean these could all go in either place Turn off e-tags which improves performance slightly browsers have their own methodologies for Cache control this says no don't listen to the browser one listen to what I'm telling you here in this Which makes things a little bit quicker as well and enable compression Really no reason not to do that. You've probably seen this in you know every website speed test You've ever looked at it's like oh, it's not compressed with gzip do that. This is the thing. That's the code right there and You can choose again set kind of what types of files are going to be compressed And and it makes everything obviously much much smaller as it's transferred over the network Greatly improving speed So a bunch of little bullet points basically we have a solution that serves images That are best sized for the device for the viewport that's using them Optimizing both performance and quality Beyond that we're serving images next gen for browsers that can handle it and web pay making those images even smaller And and you know as that's positive lazy lazy loading images for just in time reducing the initial page load, which is huge hugely important And greatly improving the perceptual page speed we're loading an extra small representative svg image first and Reducing that perceptual space page speed even more and finally we're telling browsers to cache Whatever content we think is valuable from the cache Which usually images is a great thing to use that for so that repeat visitors aren't downloading a Whole bunch of additional content that they've already downloaded before And I guess that's the methodology You guys have any questions? Yeah, so it's so the question was How much would it help to have the svg representations of the images like what's the difference there? So it really just depends upon what your smallest version of the file would be if you didn't do it Across every image file on your website, so if your 180 pixel version and the examples I gave of your ping was 15k or 20k and the SVG version was three or five k which is you know I'd say kind of a reasonable differential in size there and obviously that scales depending upon What size the images? You know it could make it the decent difference if it's 10k for image number one And it's 10k for image number two and you've got 50 images on the pages on the page You can end up saving a megabyte. It really just depends kind of on the page layout and everything But you know again to me I just feel like wherever you can optimize There's value there and 180 pixel image that's actually displayed on the page it You know 500 pixels wide or 800 pixels wide.  Oh, yeah, I'll talk to you after this week. Any other questions? Yep Yes, so the question was are there any good solutions for Optimizing responsive CSS background images Yes, that plug-in lazy sizes does something for background images I can't remember if You implement it in your html code or if it will actually work with your CSS file But there is Basically something that works in a very similar way to the kind of source set thing that we're looking at here as like an on page image That works for background images as well. So I'd say I mean again the documentation for that plug-in is super Broad and really, you know helpful and they definitely have things for background images specifically anyone else Yeah, yeah, so webp does not work for all browsers It only works for Google Chrome and Google Chrome on Android as far as I know right now I'm sure there's a possibility that will be adopted more broadly by other browsers But again really the only you know You obviously have the references to those webp images But the way this is set up in this plug-in the browser taking the file format that works with it That's the best size for the situation So you're offering webp if the browser doesn't know what to do with webp just ignores those the code is there But it's pretty minimal compared to all the filibates you're saving by optimizing as much as you can Cool. Um, any other questions? We're done. Okay. Cool. Yeah, so if you want to download the PDF It's right there or if you have more questions feel free to email me be happy to share some code whatever. Thank you