Periodontal Disease Diagnosis

Periodontal disease is diagnosed by your dentist during a Periodontal Examination.  This type of exam should always be part of your regular dental check-up.

A periodontal probe (small, blunt dental instrument) is gently used to measure the sulcus (the natural 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.  The latest research has shown that a toothbrush bristle as well as dental floss can only reach 3mm under the gum, so only our special hygiene instruments can reach below 3mm to remove any plaque biofilm, food debris or hard calculus so as to prevent further destruction of the gingiva and bone.

Dr. Ford and your hygienist will give you a thorough evaluation in your periodontal assessment.  We will use our technologically advanced fiber-optic camera to show you any inflammation, pocket depths, gingival recession, amount of bleeding (hemorrhage), and any tooth mobility (movement).  Once the complete assessment is done and hygienist is able to do an initial hygiene visit for you, we will be able to determine if additional visits are needed to restore your periodontal health or create a proper interval for your future hygiene visits to maintain your healthy gingival status.

When plaque and calculus are not removed completely and thoroughly, both from above the gumline and from below the gumline, then the plaque biofilm begins to destroy the ginigiva (gum), the periodontal ligaments (natural fibers holding the gum to the tooth) and the permanent jaw bone (alveolar bone).  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.  Periodontal disease is usually a slow, gradually progressive disease that begins at its earliest stages beginning with inflammation and infection with the gum tissue itself and then it goes deeper to destroy the ligaments and alveolar bone.

	Gingivitis (Mild, Moderate, Severe) When plaque biofilm has had the ability to stay on the gumline for longer than 24 hours and not be removed with a toothbrush and floss this irritates the gingiva (gum) and often times you don't feel any discomfort or see any inflammation or color changes.  However, after several days of the soft plaque biofilm being left behind it begins to mineralize and harden and the gingiva begins to change in color (going from dark pink to red)  the gingiva becomes inflammed (swells), and becomes shiny (healthy gums are matte with stippling/orange peel surface).  This Moderate Gingivitis stage is usually slightly uncomfortable and is noticed when trying to brush the gum and the gums will bleed.  Severe gingivitis is a most infllammed stage of gingivitis with more plaque present, more inflammation and bleeding.  However, the good news is that gingivitis is reversible with the proper hygiene visits and homecare management aids with you at home.  We need to catch the gingivitis now prior to the plaque biofilm entering deeper under the gums and reaching the alveolar bone and causing permanent bone loss.
	Periodontitis (Mild, Moderate) Once the plaque biofilm is left for an extended period of time (a couple of days) it hardens into calculus (tartar).  As calculus and plaque continue to build up, the gums begin to recede from the teeth.  Once the gum begins to pull away from the tooth and the measurement becomes 4mm the bone is in the initial phase of destruction, this is Mild Periodontitis.  If the plaque biofilm once again is left and it penetrates into the deeper pockets, the tissue becomes more irritated, more inflammed and deeper pockets form between the gums and teeth and sometimes pus forms this is Moderate Periodontitis.  The pocketing depths are 5mm and deeper and bone loss is evident on the x-ray images--we can show this to you.  It's always easier to treat periodontal disease at its earliest stages, before the permanent bone loss has occurred.
	Advanced Periodontitis (Severe) The plaque biofilm along with the hard calculus has imbedded itself even more deeply into the root of the tooth and down deeper into the periodontal pocket, so the teeth have lost even more support as the gums, bone, and periodontal ligament continue to be destroyed.  At this state, surgical treatment is usually necessary to try to save teeth, depending upon the extent of bone loss and your personal, systemic health saving the teeth imay be futile.  We will discuss other options in detail catering to your indivudual needs and vision of what you would like your ultimate smile to be for YOU!