The best way to control periodontal disease and to help prevent tooth loss is
with early detection and treatment. Three out of four people are
afflicted by periodontal disease at some point in their lives, so everyone should
be tested. After reviewing a patient's dental and medical history, the dental
care provider or periodontist will conduct a thorough clinical intraoral exam called a
periodontal charting.
This
consists of taking a series of measurements around each tooth.
Unless the gums are very inflamed and sensitive, the periodontal
charting causes minimal discomfort.
The space between the gum and the tooth is measured using a periodontal
probe. This space is called the probing or pocket depth. In a healthy mouth,
this space should be between 0 and 3 millimeters.
The amount of recession or loss of gum around each tooth is measured. In
healthy mouths, the gum tissue should be at the junction of where the crown of the tooth
meets the root. The two measurements (pocket depth and recession) are then added
to calculate the amount of attachment loss around each tooth. The greater the
amount of attachment loss, the more advanced the
periodontal disease.
While completing the periodontal charting, a dentist will evaluate the
conditions of an individual's gums. Healthy gums are pale pink, firm, and
immobile. The gums should not bleed during the probing exam. Bleeding gums during
this exam are a sign of gum inflammation, gingivitis or periodontitis.
The dentist will also measure tooth mobility. Under normal functional
conditions, teeth should not move. Tooth mobility is a sign that there has been
bone loss around the teeth or that the biting forces are too strong. If so, the
dentist may also assess a patient's occlusion, or bite. If the bite has
changed or if the forces on the teeth are too strong, there may be an
acceleration of bone loss around the teeth.
A full mouth series of X-rays (approximately 20 films) are also indispensable
in a periodontal examination.
In addition to identifying areas with cavities, bone infection, tumors, or
developmental abnormalities, X-rays help reveal if bone loss
has resulted from periodontal disease. The crest of the teeth's
supporting bone is normally 2 mm below where the crown of the tooth meets the
root. A greater distance indicates a history of bone loss.
Although bacterial samples are not usually taken for diagnosis of periodontal
disease, under certain circumstances, it may be necessary to take a bacterial
culture from a plaque sample. This is especially valuable to help detect sites
at high risk for disease progression or if conventional treatment is not
working.
The culture is analyzed in a laboratory for the presence of certain bacteria
that are known to contribute to gum disease. Actually, of the more than
300 different types of bacteria normally found in the mouth, there are only
about 13 that are known to be associated with causing periodontal disease. After
identifying the specific disease-causing bacteria, the laboratory can test to
determine what antibiotics they are susceptible to.
Depending on the risk factors
(see article "
Risk Factors for Periodontal Disease") involved and a person's specific situation, other tests
may also be required. Under certain circumstances, a dentist may require
diagnostic casts (molds of one's teeth), medical laboratory tests, medical
consultation, or genetic testing.
After completing the periodontal examination, the dentist will be able to
discuss with the patient the diagnosis, treatment alternatives, potential
complications, and expected results. The key to long-term periodontal health is
early diagnosis and treatment. Because everyone is at risk of developing
periodontitis, everyone should be routinely tested.
