Perio

Executive summary

Perio charts a full periodontal exam by voice: the clinician calls out probing depths, recession, bleeding and mobility while the assistant keeps their hands free. Charting involves no language model — speech becomes chart values through a deterministic grammar and live clinical validation. Staging and grading follow the published 2017 AAP/EFP classification implemented in code, and every AI-written summary is a reviewable draft.

Overview

ProductionCapture · Perio
Make a six-site periodontal chart fast and hands-free, with every value traceable to an utterance and no value written by a model.

Pipeline

The perio WebSocket streams audio to recognition tuned for probing grammar (Croatian and English).
A deterministic grammar parses each utterance into site-level commands: depths, recession, bleeding, suppuration, mobility, furcation, missing teeth and implants.
Live clinical validation checks each command; safe commands may apply on an interim transcript, while destructive, ambiguous or cross-tooth commands wait for the final one.
On completion the exam fans out to the timeline, patient memory, the digital twin, risk propagation and clinical facts.
Staging, grading, reports and patient explanations run on demand and land as review-required artifacts.

Data owned

Perio exams, teeth and sites
Holds
The chart: per-site measurements and per-tooth status
Voice learning profiles
Holds
Per-clinician recognition adaptation
Perio artifacts
Holds
Staging, reports and explanations as governed drafts

Store	Holds
Perio exams, teeth and sites	The chart: per-site measurements and per-tooth status
Voice learning profiles	Per-clinician recognition adaptation
Perio artifacts	Staging, reports and explanations as governed drafts

Models and engines

Charting
Model or engine
Deterministic grammar and validator — no model
Notes
Commands are parsed and validated in shared/services/perio
Staging and grading
Model or engine
Deterministic AAP/EFP 2017 implementation — no model
Notes
Computed from measured indices
Summary, report, comparison, explanation
Model or engine
Gemini 3 Flash (pro tier)
Notes
Review-required drafts

Step	Model or engine	Notes
Charting	Deterministic grammar and validator — no model	Commands are parsed and validated in `shared/services/perio`
Staging and grading	Deterministic AAP/EFP 2017 implementation — no model	Computed from measured indices
Summary, report, comparison, explanation	Gemini 3 Flash (pro tier)	Review-required drafts

Guardrails

A voice result updates the chart only after deterministic parsing and live validation (PERIO-01).
Destructive, ambiguous and cross-tooth commands are never fast-applied on an interim transcript (PERIO-02).
A negated finding never satisfies a positive rule; missing confidence is never treated as zero (PERIO-06/07).
Held commands make no write until the clinician confirms (PERIO-08); completion is always an explicit clinician action (PERIO-10).
Stopping capture keeps the final utterance; post-stop results face every live gate (PERIO-11/12).

Rollout and status

ProductionVoice charting and completion
Production engine with a recognition cut-over benchmark in CI
ShadowChart-write validation enforcement
Validator runs in shadow before blocking
ProductionPerio fact writer
Emits periodontal findings as facts
PlannedLive-assistant perio findings
Implemented behind a flag that defaults off

Interfaces

Consumes
What
Voice OS streaming recognition
Consumes
What
Encounter binding
Emits
What
Completed exams to timeline, memory, digital twin and facts
Emits
What
Staging and report artifacts
Emits
What
Perio sources for Clinical Documents

Direction	What
Consumes	Voice OS streaming recognition
Consumes	Encounter binding
Emits	Completed exams to timeline, memory, digital twin and facts
Emits	Staging and report artifacts
Emits	Perio sources for Clinical Documents

Invariants

PERIO-01… — deterministic parsing, interim/final safety, confirmation, explicit completion
ADR 0002 — perio index semantics

SOURCE OF TRUTH

shared/services/perio/
server/services/perio/
src/components/perio/
docs/clinical-invariants/perio.md
docs/perio-voice-engine-benchmark.md