PERIODONTAL EXAMINATION AND PROBING

The periodontium is the name for the specialized tissues that surround and support the teeth. It is composed of gingiva (gum), the periodontal ligament, cementum, and alveolar bone. Periodontal disease is a disease of one or more of these components.

A periodontal examination and probing are used to assess the health of your gums and teeth. They can help your dentist diagnose gum diseases like gingivitis (mild form) and periodontitis (advanced form.) They also can reveal receding gums, exposed roots, tooth grinding (bruxism) and other problems.

The exam and probing include taking measurements of the spaces between your teeth and gums. Any dentist or dental hygienist can measure these gaps. If your dentist has concerns about your gum health, you may be referred to a periodontist. This is a gum disease specialist. This specialist will take measurements during your first visit.

Here's what your dentist will evaluate during a periodontal examination:

• Any lumps or other abnormal areas in the mouth — These may include changes in the color of the gums, inner cheeks or tongue. Changes could have several causes, including:
• An infection
• Trauma
• Oral cancer
• A condition that could lead to cancer

Your dentist may be able to diagnose your condition in the office. If not, you may be referred to a specialist.

• Whether any of your teeth are missing or loose, and how loose they are — Loose teeth can be a sign of periodontal disease. Other possible causes include a problem with your bite (the way your teeth come together) or tooth grinding (bruxism).
• The color, texture, size and shape of your gums — Healthy gums are firm and pink. Diseased gums may be:
• Reddish or bluish-red
• Puffy or spongy
• Enlarged or swollen
• Shaped differently than normal
• Whether you have any fillings, crowns, bridges, dentures or implants
• How much plaque is on your teeth — Plaque is a coating on the teeth that contains large numbers of bacteria. These bacteria can cause decay and/or periodontal disease. The amount of plaque gives your dentist an idea of how well you brush and floss your teeth.
• The depth of the space between your tooth and gum — This space is known as the sulcus. It is the spot where the gum attaches to the tooth. When the gums are healthy, the sulcus is usually no more than 4 millimeters deep. If it is deeper than this, it is called a pocket. A pocket indicates that you have gum disease. To measure these spaces, the dentist uses a periodontal probe. This is a tiny millimeter ruler with a blunt tip. Your dentist slides the probe between the tooth and gums at various places around each tooth. Healthy gums cling tightly to the tooth. Diseased gums tend to swell and detach from the tooth. Pockets can become deeper over time. In advanced forms of periodontitis, the pocket can be more than 10 millimeters deep. If a pocket is this deep, it means that much of the soft tissue and bone that anchor the tooth in place have been lost.
• Whether your gums bleed during probing — Bleeding during probing is an indicator of inflammation and gum disease.
Receding gums — Normally, the roots of your teeth are covered by gum tissue. Many factors may cause the gums to recede, leaving a portion of the tooth root exposed. These factors include inflammation, badly positioned teeth and hard brushing. Dentists use periodontal probes to measure how far gums have receded. They do this by measuring the distance between the crown of the tooth and the edge of the gum. Teeth with exposed roots can have several problems:
• Sensitivity to changes in temperature
• Increased risk of decay
• Unattractive appearance
• How your teeth come together when you bte — This is also called the bite, or "occlusion." If teeth meet with too much force, it can affect your teeth and gums. Excess force can result from the way your teeth come together when you bite, or from habits such as grinding and clenching your teeth. Your dentist will notice some problems simply by looking at your teeth. That's because excessive force can cause tooth wear. Or the dentist may use special wax or a special blue paper. The wax or paper is placed on the biting surface of your teeth. Then you tap your teeth together or grind them slightly. The wax shows an imprint of your teeth. The paper leaves marks on your teeth that help your dentist see where they may be meeting with too much force.

Besides the examination, you also may need X-rays of your teeth. A periapical X-ray helps to show the extent and pattern of bone loss around each tooth. These X-rays show the entire tooth, from the crown (top) to the end of the root, which anchors the tooth in your jaw. You also may need an X-ray of your entire mouth. This is called a panoramic radiograph. This type of image shows other important structures in your skull. They include the maxillary sinuses and jaw joints.

Many dentists check all of these factors at every dental visit, but X-rays are taken less often. Repeating these measurements helps your dentist track the progress of treatment. You may have a common treatment called scaling and root planing. If you do, your dentist will record your measurements before the treatment and again several weeks or months later to see if the treatment was effective. The goal is for deep pockets to become shallower after treatment.

Having a complete periodontal exam is important for several reasons. Periodontal disease has also been linked to many systemic diseases. An association exists between periodontal disease and cardiovascular disease, preterm birth and diabetes mellitus. Good periodontal health is important to help you maintain your teeth and the health of the rest of your body.

Last updated June 30, 2021

References:

• Liccardo P, Cannaro A et al. Periodontal Disease: A risk factor for diabetes and cardiovascular disease. Int J Mol Sci. 2019 Mar;20(6)14-17. Doi:10.3390/ijms20061414. PMID:30897827
• Sanz , astillo A, et al. Periodontitis and cardiovascular disease: Consensus report. J Clin Periodontol. 2020 Mar;47(3):26-28. Doi:10.1111/jcpe.13189. PMID:32011025