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Periodontal Diagnosis Six months ago, when I sat down to write my bi-monthly dental-themed article I decided to take a new patient’s dental experience and really get into the nuts and bolts of everything your Dentist and Dental Hygienist do in that initial visit. The first type of data gathering we do is capturing dental x-rays so, six months ago, I decided to write about dental x-rays. A few paragraphs into that first article and I realized I was going to need more than 2 pages in a magazine to be as thorough as I thought warranted. It turned out I needed 6 pages and that initial topic turned into a 3-part dental x-ray saga. I gave the reader a very good education on the why, how, what, and when of dental x-rays and why they are so important to my profession. So now the new dental patient, still in the hygiene chair, has just completed having the necessary x-rays taken and the Hygienist will move on to the next part of the Comprehensive New Patient Examination…the Periodontal Diagnosis. Periodontics is the branch of dentistry concerned with the structures surrounding and supporting the teeth, and for the lay person the structures supporting our teeth are the jaw bones and our gingiva (aka gums). A thorough periodontal diagnosis is obtained objectively by reviewing the freshly taken x-rays, by looking directly for signs of plaque build-up and/or inflammation, and by probing around the teeth to measure the gingival pocket depths.
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by Dr. John F. Miller DDS - SMILE MONTANA
2. What can we learn from a direct visual exam about a patient’s periodontal condition?
The three conditions we would rather not see are red, puffy gums that bleed easily (aka gingival inflammation or gingivitis), the presence of visible plaque build-up, and gum recession which indicates loss of bone. Or any combination of the three.
Posterior Bitewing Showing Radiographic Calculus.
1. What can Dental X-rays inform us about a patient’s periodontal condition?
Since you are all x-ray experts after my last 3 articles, I will tell you that posterior bitewings and anterior periapical x-rays can give us a pretty good assessment of bone level, and whether or not there is any hardened plaque/tarter hiding underneath the gum tissue. We refer to this calcified plaque as Calculus. The bitewing provided is a great example of this condition with the obvious calculus “spur” attached to the bottom tooth.
Visible Plaque Build-up.
Perio Probe with Healthy Pink Gums.
3. What the heck is periodontal probing?
Everyone who sees their Dental Hygienist regularly should be familiar with this process. As the image portrays, a periodontal probe is a thin blunted instrument with demarcation lines indicating one millimeter. A proper probing will result in 6 measurements per tooth and should not be uncomfortable. The hygienist is measuring pocket depth and also the amount of gum recession present if any. The combination of these two measurements gives us a “Clinical Attachment Loss” value. In other words, it tells us if any bone loss has occurred.