Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination. This type of exam is part of your regular dental check-up.
A periodontal probe (small dental instrument) is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.
Diagnosing periodontal disease based on probing depths and bleeding is the most common and traditional method dentists use. In our practice, we believe this to be inadequate as it recognizes the disease only by it's signs and symptoms, long after the disease process has begun. Periodontal disease has long been recognized as a bacterial infection, but is rarely treated as such. Surgical approaches to reducing gun pocket depths address the effects of periodontal disease, but not the cause. Such an approach often leads to long teeth with exposed root surfaces that can become very sensitive to cold and hot foods and drinks, increased food retention between the teeth, and higher risk of tooth decay on the exposed root surfaces. The exposed root surfaces can also be very unsightly in esthetic areas of the mouth.
Our approach to the diagnosis of periodontal disease involves a combination of the traditional methods with a microscopic bacterial examination to determine the types and level of activity of bacteria present beneath your gums. Based on the findings of the bacterial examination, we assign you a periodontal risk factor, which reflects your degree of risk of developing periodontal disease. In this way, we are able to treat your bacterial infection before the signs and symptoms of periodontal disease surface in your mouth. For people who already demonstrate the signs and symptoms of periodontal disease, the bacterial examination provides a way to monitor the progress of treatment as we work together to eliminate your infection.
Your dentist and hygienist will use the bacterial examination, pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:
Gingivitis is the first stage of periodontal disease. Plaque bacteria and their toxic by-products irritate the gums, making them tender, inflamed, and likely to bleed. Very high levels of active, virulent bacteria may be present, putting you at high risk of developing periodontitis. This is the time to address the bacterial infection, before bone loss has occurred.
Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.
The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.