How is Periodontal Disease Diagnosed?

Periodontal disease is diagnosed by your dentist or dental hygienist during a periodontal examination.

This type of exam should always be part of your regular dental check-up and involves several key diagnostic components.

The Periodontal Examination Process

Visual examination of the color and texture of the periodontal tissues, assessment of plaque deposits, periodontal probing assessments, and diagnostic imaging enable the collation of information to make a periodontal diagnosis. The examination typically includes:

Periodontal Probing: 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.

Comprehensive Assessment: 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. Your dental professional will also assess:

• Bleeding upon probing (indicating inflammation)
• Gum recession and tissue appearance
• Tooth mobility and stability
• Plaque and calculus deposits
• X-rays to evaluate bone levels

Advanced Cases: If periodontitis is identified, full periodontal assessment is required, involving recording of full mouth probing and bleeding data, together with assessment of other relevant parameters such as plaque levels, furcation involvement, recession and tooth mobility.

Diagnostic Categories

Your dentist or hygienist will use pocket depths, amount of bleeding, inflammation, tooth mobility, and other factors to make a diagnosis that will fall into one of these categories:

Gingivitis Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed. Pocket depths typically remain at 3mm or less, but bleeding and inflammation are present.

Periodontitis Plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets (4-6mm) 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, visible on X-rays.

Advanced Periodontitis The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Pocket depths exceed 6-7mm, and unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss is typically present.

Modern Diagnostic Tools

Today's periodontal diagnosis may also incorporate newly emerging diagnostic approaches, namely: the ultrasonographic probe; cone-beam computed tomography; optical coherence tomography; optical spectroscopy, and proteome analysis, which complement traditional examination methods and provide more detailed information about tissue health and disease progression.

Early detection through regular periodontal examinations is crucial for successful treatment and preventing tooth loss.