A periodontal examination is a specialized assessment focused on the health of the gums and the underlying structures that support the teeth. This detailed check-up detects and classifies periodontal disease, which ranges from simple inflammation (gingivitis) to a serious condition involving bone loss (periodontitis). Identifying the presence and severity of this disease early is crucial for treatment planning, preventing tooth loss, and maintaining overall oral health.
Initial Assessment and Visual Inspection
The process begins with a review of the patient’s history, as systemic health and lifestyle choices influence gum health. This includes discussing medical conditions, such as diabetes, which increase susceptibility to infection, and reviewing medications that can cause gum overgrowth or dry mouth. Smoking status is an important risk factor, as tobacco use can mask signs of inflammation and accelerate tissue destruction.
Following the history, a dental professional performs a visual examination of the oral tissues using a light and a mirror. They look for obvious signs of inflammation, such as color changes from pink to red, and noticeable swelling of the gum margins. This inspection also identifies visible deposits of hardened plaque, known as calculus or tartar, and signs of gum recession, which is the pulling away of tissue from the tooth surface.
The Measurement of Gum Health
The most detailed part of the examination involves systematically measuring the space between the tooth and the gum tissue. This measurement is taken using a thin, blunt periodontal probe, which has millimeter markings along its tip. The probe is gently inserted into the space, known as the sulcus, to determine its depth.
In a healthy mouth, the sulcus depth measures between one and three millimeters, reflecting a tight seal of the gum tissue around the tooth. A reading of four millimeters or greater suggests the formation of a periodontal pocket. This indicates that the attachment of the gum to the tooth has been compromised by bacterial infection, and deeper measurements signify more advanced disease stages.
During probing, the clinician records the presence of Bleeding on Probing (BOP), a powerful indicator of active inflammation and infection within the gum tissue. Bleeding occurs because the lining of the inflamed pocket is ulcerated and delicate, showing that the body is actively fighting the bacterial presence. The absence of bleeding in a non-smoker suggests the tissue at that site is stable and healthy.
Assessing Structural Integrity
Beyond the soft tissue, a comprehensive exam assesses the integrity of the hard structures that support the teeth. This involves checking for tooth mobility, which is the movement of a tooth within its socket due to loss of surrounding bone support. Mobility is graded on a scale where Grade 0 signifies normal movement, and higher grades (like Grade 2 or 3) indicate increasingly severe looseness and significant bone damage.
Gum recession is formally measured as the distance from the free gum margin to the cementoenamel junction (CEJ), where the enamel meets the root. This measurement indicates a physical loss of gum tissue and often corresponds to a loss of the underlying bone. The overall amount of tissue and bone loss is summarized by calculating the clinical attachment loss, which combines the pocket depth and the recession measurement.
The full extent of supporting structure damage is visible through Radiographic Assessment, which involves taking dental X-rays. X-rays provide a two-dimensional image of the alveolar bone, the jawbone that anchors the teeth. They confirm the presence and pattern of alveolar bone loss, the definitive characteristic of periodontitis.
Interpretation and Next Steps
The culmination of the periodontal examination is the interpretation of all collected data to form a diagnosis and treatment plan. The clinician combines the patient’s risk factors, the severity of probing depths, the extent of bleeding, and radiographic evidence of bone loss. This information is used to classify the disease according to a modern staging and grading system, defining the severity of the damage and the patient’s risk profile for future progression.
The findings dictate the appropriate next steps in the patient’s care, serving as a roadmap for intervention. A diagnosis of simple gingivitis may lead to a recommendation for routine professional cleaning and improved home care. However, deeper pockets and bone loss necessitate more intensive treatment. This may include deep cleaning procedures like scaling and root planing, or referral to a specialist for surgical intervention.