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Diagnosing Periodontal Disease: How Dentists Do It

An accurate diagnosis of the patient’s periodontal condition is of paramount importance in the subsequent management of the disease.

It is the first step towards the development of an appropriate treatment plan that when implemented, will lead to the resolution of the infection and restoration of the patient’s periodontal health.

In this article, we will give you an overview on how dentists accurately diagnose your periodontal problem.

Medical and Dental History

The first most important thing in coming up with an accurate diagnosis is obtaining detailed information regarding the patient’s medical and dental history.

According to studies, periodontal disease affects and can be affected by a variety of systemic diseases and conditions. These include diabetes, heart disease, pregnancy, chronic stress, and smoking to name a few.

Dental history, on the other hand, will give your dentist an idea as to what must have contributed to the periodontal problem, how it will progress, and which of the treatment options may or may not suit the patient.

Gum Tissue Inflammation

After history-taking, your dentist will now rely on visual examination of your overall oral condition. This method will only assess whether or not the gum tissue is inflamed.

This assessment is done by examining the color (coral pink, red, or red-purple); consistency (firm or soft); and texture (stippled or smooth) of the gum tissue.

A healthy gum tissue is coral pink, firm, and stippled, while an inflamed one is red, soft, and smooth. Your dentist will inspect the gum tissue on the cheek side and tongue side of every tooth and compare it to what healthy gums should look like.

Plaque and Calcular Deposits

Periodontal disease is mainly caused by accumulation of plaque in the gum line and in-between teeth. Plaque contains bacteria that can induce host response, resulting to the inflammation of the gum tissue. If left for a long time, it will eventually harden, forming what is known as calculus (a.k.a. tartar).

Calculus has a rough surface that further facilitates plaque accumulation. Plaque and calcular deposits can be detected via visual examination or through the use of plaque disclosing agents. Disclosing agents contain dye which is absorbed by plaque, allowing them to be more easily seen by the dentist.

Periodontal Disease

Bleeding on Probing (BOP) and Periodontal Pocket Depth (PPD)

Bleeding on probing and measuring periodontal pocket depths provide a more objective and detailed assessment of the patient’s existing periodontal condition.

BOP confirms the presence of inflammation, while PPD determines the extent of destruction. Both are measured using a special instrument called periodontal probe, which has millimeter calibrations.

To measure PPD, your dentist will insert the probe into the groove between the gum tissue and the tooth. Normal PPD is 1-3mm, while more than 5mm is indicative of periodontitis.

Tooth Mobility

If periodontitis is suspected, your dentist will also assess the mobility of the involved teeth.

Mobility is usually a sign of bone loss. It is evaluated by pushing the tooth between two fingers or instrument handles and observing any movement.

This movement may be slight or severe (almost as though the tooth will pop out of its socket) depending on the amount and extent of bone loss.

Bone Loss

Periodontal disease that has been left untreated for a very long time results to bone loss, which your dentist can detect by taking dental x-rays.

Some dentist would take x-rays of the involved teeth only, while others prefer a full mouth series.

A full mouth series is a set of 18 x-rays that covers the entire dentition. It is recommended for cases where periodontitis seems to involve almost all of the patient’s teeth.