Periodontal Examination Steps

[Yahaira Petrov]

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With the exception of gingival indices, it is evident that there have not been great changes in the methods used in clinical practice. Rather, the changes made are in the categories of integration of methods and interpretation of data. We know that the extent of periodontal disease cannot be ascertained from any single diagnostic aid alone. The date obtained from the many diagnostic methods described must be evaluated together before an accurate diagnosis can be achieved. A periodontal examination should include a periodontal probing, a radiographic analysis, a gingival index, mobility charting, and an evaluation of the amount of attached gingiva. These clinical exercises require simple instrumentation and a minimal amount of clinical calibration on the part of the examiner. These exercises, however, do not eliminate the need for a general examination that includes the location of caries, plaque index, and medical and dental history. Probing is still considered the single most important examination method in detecting periodontal disease and evaluating therapy. However, probing becomes a great deal more meaningful when combined with data from a gingival index and radiographic analysis. Because the significance of the pocket depth depends not only on the height of the alveolar bone but also on the degree of gingival inflammation, a gingival index should be used as an integral part of a routine examination. A radiographic examination supplements probing by providing information on root length and shape and width of the periodontal ligament space, and aids in determining the configuration of a bony defect. Yet radiographic analysis is of little value without the knowledge of the pocket depths, position of the gingival margin, and mobility patterns. Many forms of sophisticated instrumentation and indices for a periodontal examination have been introduced in the past decade. Unfortunately, many of these new instruments are not practical for clinical practice in their present form. Future trends will no doubt be directed toward simplifying these instruments and indices so that they can be more easily adapted to the clinical practice of periodontics, by both the general dentist and the specialist.

An examination by the dentist is the only way to correctly assess the condition of the gums. In addition to the clinical assessment with a periodontal probe, X-rays must also be taken to assess the condition of the bone.

Self-assessment of the gums, for example at home in front of a mirror, is not sufficient for a correct evaluation because it is impossible to determine on your own whether the anchoring structures of the tooth have already been damaged by inflammation of the gums. Gum pockets can also not be detected on your own.

Only a proper clinical examination in the dental practice with what is called a gum probe (periodontal probe) can provide information on whether the gums are healthy, whether there is gum inflammation (gingivitis), or whether a disease of the anchoring structures of the teeth (periodontitis) is present.

After this short examination, further investigations are carried out only there is evidence of damage to the structures holding the teeth in the jawbone. These further investigations include what is called the periodontal status and additional X-rays.

Every tooth must be assessed individually. For probing with a graduated periodontal probe (markings at 3, 6, 8, and 11 mm), only slight pressure of 0.25N (25 g) should be applied. The tip of the probe (diameter 0.5 mm) is inserted gently along the axis of the tooth into the gingival sulcus. The probing depth (PB) is read from the markings on the probe. Four sites are examined at every tooth; implants are not included in the BPE.

In the clinical examination with the gum probe (periodontal probe), the penetration depth of the probe into the gum pocket is measured at up to six sites per tooth to within a millimeter. Specifically, the length between the gum line and the bottom of the pocket is measured. This is called the probing depth. At healthy sites, the probing depth is 3 mm at most. At sites where the periodontitis has already led to a breakdown of the tooth anchoring, the probing depth can be 4 mm or more.

In addition, in what is termed a periodontal chart, the height of the jawbone (attachment level) is recorded precisely. A periodontal chart is indispensable for the diagnosis and planning treatment. The periodontal chart can be recorded online in any dental practice and reused: www.periodontalchart-online.com.

The objective of making a periodontal chart is to record the probing depth and attachment level precisely at six sites per tooth or implant for the entire dentition. For all measurements made with the periodontal probe, the value read on the probe is rounded up. At each site, the following is measured:

The diagnosis of periodontitis can be definitely confirmed only with the necessary X-rays. The selection of the X-rays necessary to diagnose periodontitis can be made only after the clinical examination. This can prevent excessive exposure to radiation.

In the simplest case, an X-ray finding consists of 2 images (bite wing images) and in the most extensive case, it consists of what is termed an X-ray study with up to an additional 14 X-ray images or a panoramic X-ray. The X-ray images made must show the jawbone surrounding the tooth and make it possible to estimate the severity of bone loss.

In 1999, the first international workshop for the classification of periodontal disease was held in the US. The most important new feature compared with the European classification of 1993 was that the forms of the disease were no longer defined primarily based on the age of the patient at the time of the first diagnosis, (e.g. juvenile and adult periodontitis). The new forms chronic and aggressive periodontitis were introduced, as well as, for example, periodontitis that can be associated with systemic diseases.

Many dental offices often overlook the periodontal re-evaluation exam. Yearly monitoring of periodontal health is suggested for adult PORs. Yet, hygiene services are frequently limited to intervals between 3 and 6 months when nonsurgical and surgical interventions are needed.

The needs of periodontal patients often require more intensive care than what can be offered in 3-month intervals. The steps outlined in this article lay out a practical course of action to take when your patients seem to be stuck in a rut. This knowledge should enable you to provide your periodontal patients with better care.

We also focus our examination of the final aesthetics of the teeth, gums and smile. To help us give you the optimal final outcome, we use our cosmetic periodontal assessment. A beautiful smile is not just cosmetically enhanced teeth; it is often a combination of the correct gingival architecture and proper lip support.

We facilitate the achievement of an aesthetic gum appearance that allows the teeth to give the illusion of correct alignment and position. We have a whole host of cosmetic periodontal procedures that we can draw from to achieve your desired results.

After we have completed our assessment, we are able to diagnose your condition accurately. The results enable us to make sure we offer viable treatment options for you. We thoroughly explain in-depth the conclusions of your assessments, why we offer specific treatments and the fees associated with these options.

Our signature periodontal examination is designed to identify and highlight any risk of gum disease. The periodontist will carefully examine your mouth and will offer the right choice of treatment, such as laser gum surgery, to improve your oral health.

Our London periodontist is home to our award-winning laser gum surgery that eliminates gum disease while promoting gum and bone regeneration. Al-FaPerio is here to provide leading gum disease treatments for patients across London and Essex.

Our cosmetic periodontal assessment helps us consider many factors and specific parameters are also taken into account when establishing treatment protocols. We work very closely with your cosmetic, restorative dentist to make sure that the gum-tooth combination is perfectly matched.

The disease begins when plaque starts to build up around the gum line and actually attacks your soft tissue. This negative bacteria embeds itself into the gum and, if left untreated, can cause common symptoms such as:

Gum disease not only impacts the mouth but can be evidence of whole-health issues such as heart disease, diabetes, and respiratory diseases. By keeping your gums healthy, we can build a solid foundation for your overall well-being.

As with general dental visits, we start all our treatments with a comprehensive oral evaluation. However, our main focus is your periodontal health and addressing your primary concerns. Your general dentist typically outlines the issue you are facing when they refer you, however, we still spend some time getting to know you before starting any procedure.

We may recommend a professional cleaning as well. Dr. Laro or Dr. Poston will walk you through your exam and provide insight into the ideal solution to your specific problem. They employ a gentle approach that utilizes modern technology for a more accurate diagnosis.

After discussing all of your treatment options we will create a custom-made plan that fits your specific needs and desired results. One of our experienced Treatment Coordinators will meet with you and help you navigate these steps to return you to optimal dental health.

The first line of defense against periodontal disease and eventual tooth loss is a solid at-home hygiene routine. Combining daily brushing and flossing with regular dental checkups, you can prevent gum disease. However, if gum disease has started, a professional cleaning may be needed to restore your smile.

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