A guide to Periodontal examination and probing
A periodontal examination and probing is one of the ways your dentist will use to evaluate the health of your teeth and gums. The examination will help your dentist diagnose gum diseases like periodontitis, gingivitis, receding gums, bruxism or tooth grinding, exposed roots, and other problems.
Periodontal measurements can be taken by anyone in the dentist’s office. The dentist, dental specialist, or the dental hygienist can take these measurements. If you are referred to a periodontist then these measurements will be taken on your first visit.
Here are some of the things your dentist will evaluate during your periodontal examination
- any lumps or lesions in the mouth, changes in the colour of your gums, changes in the colour of your inner cheeks, or changes in the colour of your tongue. Changes could indicate some form of oral cancer or precancerous condition. Sometimes infections cause these changes. Your dentist should be able to diagnose your condition at the dental clinic. You may be referred to a specialist afterwards
- whether any of your teeth have fallen or become loose. Loose teeth are an indication of periodontal disease. It could be the result of a problem with your bite or with a problem with your tooth grinding
- the colour, size, shape, and texture of your gums. Healthy gums are firm and colour pink. Reddish, purplish, puffy, and spongy gums are an indication of gum disease. Enlarged gums, swollen gums, and gums that are shaped differently are also indications of gum disease
- whether you have any restorations like fillings, crowns, bridges, dentures, or implants
- the amount of plaque on your teeth. Plaque is basically a coating that forms around your teeth. It contains a lot of bacteria which can cause tooth decay or periodontal gum disease. The amount of plaque will give your dentist an idea about your oral hygiene because these are the parts where you miss out when you brush and floss
- your sulcus which is the space between your tooth and your gums. Spaces or pockets that are deeper than normal indicate some form of gum disease and its severity, from gingivitis to periodontitis. These spaces are measures using a periodontal probe. It is a tiny millimetre ruler with a blunt tip that is slid between the tooth and gums. The depth of the gums attachment to the tooth is measures. Healthy gums are tight with the tooth and the probe only penetrates from about one to three millimetres. Gums with disease will swell and detach from the tooth, forming pockets. These pockets could reach more than ten millimetres deep so the probe could reach the root of the tooth already. If this happens then it means that so much soft tissue has been lost and the bone anchoring the tooth in place has been lost as well
- bleeding of your gums during the probing stage. When your dentist has measured the depth of the gum tissue around your teeth, another thing your dentist will look out for is whether your gums bleed or not. If your gums bleed then you may have gum disease
- receding of your gums – the roots of your teeth are normally covered with gum tissue but there are numerous factors that could cause your gums to recede. These factors include inflammation, overly aggressive tooth brushing, and teeth that are not in good position. When the roots of your teeth have been exposed, the teeth become sensitive to changes in temperature. They are now more prone to tooth decay and may not look aesthetically pleasing anymore. Periodontal probes are used to measure the extent of gum recession by measuring the distance between the gum margin and the crown of the tooth.
- your bite or occlusion. How your teeth come together is important. If there is too much tooth to tooth force then it could affect your gums and your teeth. When your teeth come together during your bite, grinding and clenching may occur. By simply looking at your teeth, your dentist can see where excessive tooth wear has happened. Special wax or special blue paper may be used to understand the way you bite. The paper or the wax is placed on the biting surface of your teeth and you will be asked to grind on them slightly. The wax will show an imprint of your teeth while the paper will leave marks on your teeth. These marks will be used to identify how your teeth meet and whether too much force is wearing down the teeth
X-rays may also be needed aside from the periodontal examination. Periapical x-rays can be done so that your dentist can find out if there is any bone loss around your teeth. These x-rays will show your entire tooth from the crown to the root. A panoramic radiograph may also be performed. This will show an x-ray of your entire head. The picture will provide information about important structures in your skull like the maxillary sinuses and the jaw joints or temporomandibular joints.
Dentists will check all of these factors on your visit. They will repeat measurements so that they can track the progress of your treatment. For instance, in scaling and root planing, your dentist will chart the measurements before the treatment and the measurements as you progress. After several weeks or months, you and your dentist will be able to see if the treatment is effective. Every dentist will have their own method of keeping track of these periodontal measurements although some methods are similar. Computers are being used nowadays to keep track of these measurements.