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DIAGNOSIS OF GUM DISEASE

Periodontal diseases are serious bacterial infections that destroy attachment fibers and supporting bone that hold teeth in the mouth.  Approximately 15 % of adults between 21-50 and 30% of adults over 50 have this disease

Diagnosis

      We will first take a medical history to reveal any past or present periodontal problems, any underlying diseases that might be contributing to the problem, and any medications you are presently taking.

We use these elements to examine for periodontal disease:

1.  A comprehensive or recare exam is crucial in diagnosing periodontal disease. It is an easy, simple and painless exam.

2. X-rays will be taken to determine bone loss levels:

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3.  Your gum tissue will be measured around every tooth with a ruler to measure the periodontal destruction. This fine instrument calibrated in millimeters, will be used to measure pocket depth. It is held along the length of the tooth with the tip placed in the pocket.  At the very edge of the gumline, healthy gum tissue forms a very shallow V shaped grooves (sulcus) between the tooth and gums. The normal depth of the sulcus should be three millimeters or less. We will measure six points on each tooth -- three on the check side and three on the tongue sides. The tip of the probe will then touch the point where the connective tissue attaches to the tooth. These measurements enable us to determine the condition of the connective tissue and amount of gingival overgrowth or recession. Pocket depths greater than 3 millimeters indicate disease and infection.  The deeper the pockets the great extent plaque bacteria collects and infection and gum disease develop because this area is more difficult to keep clean. .

 Redness, puffiness, and bleeding upon probing indicate inflammation and INFECTION. If the gum formation between teeth is blunt and not pointed, acute necrotizing ulcerative gingivitis (ANUG) may be indicated.

Tooth mobility is determined by pushing each tooth between two instrument handles and observing any movement. Mobility is a strong indicator of bone support loss

After noting the general state of oral hygiene, we will ask about the quality of home dental care. Please note that aspirin intake of 325 mg daily for 7 days moderately increased the appearance of bleeding on probing . [J Periodontol 2002;73:871-876]

 

 By sliding the probe along the neck of the tooth to determine the depth of the floor of the crevice all around the tooth, we can determine the health of your gum tissue.    Gum Ruler to measure pocket depth

4.  Co-diagnosis where we involve you by showing you the conditions in your mouth with an intraoral camera, Warning Signs,  mirror and calling out probing numbers.  Your gum tissue chart will be printed out and provided to you upon request.

It is normal for the depth of the space to be 1-3mm.

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5.  All the results of this exam are placed into a detailed perio chart which is a

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bleeding sites which is a good indicator that you have ACTIVE disease

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swellings

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pus

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color, contour and texture of gingiva

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status of margins

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presence of inflammation

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recession

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mobility of teeth

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presence and degree of plaque and calculus

6.    In-dental-office screening for diabetes mellitus 

     Diabetes mellitus (DM) is undiagnosed in approximately half of the patients actually suffering from the disease. In addition, the prevalence of DM is more than twice as high in patients with periodontitis. Thus, a high number of patients with periodontitis may have undiagnosed DM.
During routine periodontal examination bleeding gums is a sign of periodontitis.  This blood may be used for diabetes mellitus screening in a dental office setting.  We will ask you if you would like this done.

7. We use plaque finding to help us help you by using Plaque Finder 
bulletSelective differential staining permits distinction between older and recent plaque deposits
bulletFades quickly from teeth, restorations and tissues with simple water rinses and brushing
bulletAllows you to visualize plaque and identify areas in need of more thorough daily plaque removal
bulletPlaque is a bio film that Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis
that cause periodontal infections.

8.  Juvenile periodontitis is now called aggressive periodontitis.

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Periodontitis will not go away by itself.  Left untreated, surgery may be needed to save affected teeth.  Preventing and treating the disease in the early stages are the best ways to keep your smile healthy

Goal of Treatment

Once periodontal disease has been identified, the goal of treatment is:
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 to arrest and control the progress of the disease.

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 to leave the periodontal tissues in an easily maintainable state.

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 to restore the supporting structures, which include bone, gum tissue, and ligaments.

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Benefits of Treatment:

bulletKeeps dental costs down by preventing future problems.
bulletResearch links periodontal infection to more serious health problems, 
such as cardiovascular disease, stroke, diabetes, respiratory  problems 
and pre-term, low weight babies.
bulletPrevent surgical intervention.

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Updates  

A BLOOD TEST MAY REVEAL SYSTEMIC FACTORS THAT RELATE TO PERIODONTAL DISEASE, ESPECIALLY IN MEN 

   This study reported  that a blood test may reveal indicators of periodontal diseases. Researchers examined and measured the oral health of 7,452 men and women, and tested their blood for 37 items used in general blood tests.  Some of the items tested for in the blood include cholesterol and C-reactive protein, commonly linked to heart disease; and diabetes.  The results of the blood tests were compared against the oral health scores of the participants. In this study they found that generally if the blood was “healthy,” the oral health was also healthy.  Conversely, if the blood test detected certain “red flags,” the person also had serious symptoms of periodontal diseases They also found that males were reported to have more serious symptoms of periodontal diseases than females of the same age group. These findings mean that in the future when patients visit their medical doctors for a routine check-up and annual blood work, they may also be referred to their dentist.  A specific reason could not be pinpointed as to why men were reported to have more serious symptoms of periodontal diseases than women.  One reason could be that men and women have different endocrine situations, and periodontal diseases are influenced by endocrine conditions. Since the treatment of periodontitis in this study appears to be effective in reducing levels of CRP, patients at risk for coronary heart disease may want to visit a dentist to control their periodontitis. Blood Test & Periodontitis Journal of Periodontology as reported by Jill Rethman, RDH, BA 2/04

*Pictures courtesy of Periowise.

Comprehensive Periodontal Exam Perio.org

What is Gum Disease?

Dentistry Today pg 36, September 2002

Parameter of Care for Periodontal Disease, Perio.org

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