A periodontal examination is a specialized dental assessment focusing on the health of the periodontium, which comprises the gums and the underlying bone that supports the teeth. The primary purpose of this comprehensive evaluation is to identify the presence, severity, and extent of gum disease, known as gingivitis or periodontitis. This detailed check-up establishes a baseline of health to guide future treatment and monitoring, often utilizing the dental procedure code D0180 for a comprehensive periodontal evaluation.
Preliminary Assessments and Patient History
The periodontal examination begins with a thorough review of the patient’s medical and dental history. Systemic health conditions can significantly influence the risk and progression of gum disease. Conditions like diabetes, especially when poorly controlled, are known to increase susceptibility to periodontal breakdown by impairing the immune response.
Certain medications, such as some anti-epilepsy drugs, calcium channel blockers, and immunosuppressants, can contribute to gingival overgrowth, complicating hygiene and increasing disease risk. The dental professional will also inquire about lifestyle factors, particularly smoking status, which severely compromises the gums’ ability to heal. A preliminary visual inspection is performed to check the soft tissues for any obvious signs of inflammation, redness, or lesions before physical measurements are taken.
Clinical Measurement of Gum Health
The central component of the periodontal examination is the detailed physical assessment of the gum tissues, which involves measuring the space between the tooth and the gum known as the periodontal pocket. This is accomplished using a specialized instrument called a periodontal probe, which has millimeter markings to record the depth. Healthy gum tissue typically yields probing depths of 1 to 3 millimeters, indicating a shallow space easily maintained with routine cleaning.
Measurements of 4 millimeters or deeper suggest the formation of a periodontal pocket, indicating that bacteria and plaque have caused the gum tissue to detach from the tooth root. The presence of bleeding upon probing (BOP) is an important finding, as it indicates active inflammation within the gum tissue. While bleeding does not definitively confirm periodontitis, its absence is a strong predictor of stability and a healthy periodontal state.
The assessment also includes measuring gum recession, which is the amount of tissue that has pulled away from the tooth’s surface. This measurement is recorded as the distance from the cementoenamel junction—where the crown meets the root—to the edge of the gum tissue. Loss of gum tissue exposes the tooth root, which can lead to sensitivity and is a component in calculating the overall clinical attachment loss, a definitive measure of periodontal destruction.
Evaluation of Tooth Stability and Bite
Beyond measuring the gum tissue, the examination includes assessing the mechanical stability of the teeth, which can be compromised by advanced bone loss. The dental professional checks for tooth mobility, or looseness, by applying gentle pressure to the tooth using two instrument handles. Mobility is typically graded using a system ranging from Grade 1 (slight horizontal movement) to Grade 3 (significant horizontal and vertical movement).
A check is also performed on multi-rooted teeth, such as molars, to detect furcation involvement. This occurs when bone loss extends into the area where the roots diverge, and it is assessed by probing horizontally between the roots. Furcation involvement is classified by the depth of probe penetration, often using a grading system from Class I (incipient bone loss) to Class III (a “through-and-through” defect).
The occlusal analysis evaluates the patient’s bite, or how the upper and lower teeth come together. Uneven or excessive forces from the bite, known as occlusal trauma, can accelerate bone loss in teeth that already have reduced periodontal support. Identifying and addressing these discrepancies is an important part of the plan to stabilize the teeth and prevent further tissue injury.
Radiographic Analysis of Bone Structure
Radiographic analysis confirms the clinical findings, as X-rays reveal the supporting structures invisible beneath the gums. The definitive sign of periodontitis is the loss of alveolar bone, which cannot be accurately quantified by probing alone. X-rays allow the dental professional to assess the level and pattern of this bone loss.
The types of X-rays commonly used include periapical radiographs, which provide a detailed view of the entire tooth and surrounding bone. Bitewing radiographs are also essential as they clearly show the crest of the bone between the teeth, often the first area to show signs of loss. By comparing the clinical measurements with the radiographic evidence, the dental professional can accurately diagnose the stage and severity of the disease and formulate an effective treatment strategy.