Procedures - Diagnosis

Diagnosis

Periodontal disease is diagnosed by your general dentist but most probably your periodontist during a periodontal examination. Thistype of exam is either part of your regular dental check-up with your general dentist or you would be referred to a periodontist.

Only a precise radiographic survey of the bone supporting the roots of your teeth through a series of digital radiographs (up to 14 radiographs) and a precise periodontal examination could detect the periodontal bone loss before it leads to advanced bone loss.

At the Dental Treatment Center, we only use digitalized long-cone radiographs to detect the early periodontal bone loss.

Using digital radiographs helps us reduce by more than 90 percent the dose of radiation, thus not only protecting the dentists but also the patients.

If requested, the digital radiographs are sent by email to patients without any additional charges.

Apart from radiographs, a clinical examination is performed. This is done using a periodontal probe (small dental instrument) that is gently used to measure the sulcus (pocket or space) between the tooth and the gums. The depth of a healthy sulcus measures three millimeters or less and does not bleed. The periodontal probe helps indicate if pockets are deeper than three millimeters. As periodontal disease progresses, the pockets usually get deeper.

Your general dentist but most probably your periodontist will use special digital radiographs, pocket depths, amount of bleeding, inflammation, tooth mobility, etc., to make a diagnosis that will fall into a category below:

There are several types of periodontal disease:

Gingivitis

-Gingivitis is the mildest form of periodontal disease. It is caused by bacteria in plaque, which produce substances that can harm the gums. Gingivitis is quite common. Almost 3 out of every 4 adults over age 35 have some evidence of this condition.

Some groups of people are at increased risk:

Gingivitis doesn't usually cause discomfort. However, gingivitis can get worse. It can lead to a more serious form of periodontal disease, called periodontitis.

Gingivitis can be reversed with a combination of professional and home care. You will need a thorough cleaning in your dentist's office either by a general dentist or a specialist dentist (periodontist), including removal of plaque below the gum line. Then you must practice good oral care at home.

-Chronic Periodontitis

Periodontitis is a more advanced disease than gingivitis. Periodontitis involves all of the tissues that support the teeth. This includes both the gums and the bone.

Chronic periodontitis is the most common form of periodontitis. The older you are, the more likely you are to show signs of periodontitis but many patients already have periodontitis before the age of 30.

If you have periodontitis, your gums become detached from your teeth. Spaces form between the teeth and gums. These spaces are called periodontal pockets. Bacterial plaque builds up in the pockets. Eventually, this destroys the bone that supports the teeth. In more severe cases, teeth can become loose and even fall out.

Periodontitis usually is not painful. Some people notice that their gums are bleeding. The gums may recede (move back away from the teeth). People also may have bad breath or a bad taste in the mouth. However, periodontitis may not cause any symptoms that you would notice. Your specialized dentist can diagnose it during an examination, however. The condition usually gets worse quite slowly, over several years.

Unlike gingivitis, periodontitis can't be completely reversed. That is because the lost supporting tissues usually can't be rebuilt. However, treatment and proper brushing and flossing can improve your oral health. This can stop periodontitis from getting worse. Stopping the disease in this way can help prevent tooth loss and other serious problems.

Treatment for periodontitis typically includes a thorough cleaning called scaling and root planing. In certain cases, you may need other steps, such as antimicrobial therapy and/or periodontal surgery.

-Aggressive periodontitis

Aggressive periodontitis gets worse faster than chronic periodontitis. Aggressive periodontitis tends to run in families. Recent research suggests that people can inherit an increased risk of this disease. It also is more common in smokers.

Aggressive periodontitis used to be considered a young person's disease, but it is no longer classified this way. However, it is more common in younger people than in older people. Bacteria found in dental plaque also cause this form of periodontitis.

The treatment generally is the same as treatment for chronic periodontitis. However, antibiotics and periodontal surgery are needed more often. In certain situations, aggressive periodontitis can be difficult to treat. These patients do not get better with treatment.

-Periodontitis Caused by Conditions of the Body

Periodontitis can be a symptom of diseases that involve the whole body. These include certain types of leukemias, neutropenias and genetic disorders. This type of periodontitis can vary, depending on the medical condition. However, it sometimes looks and acts like aggressive periodontitis. These patients often are young and do not have large amounts of dental plaque.

Treatment involves controlling the medical problem first. This is followed by treatment similar to that for chronic or aggressive periodontitis.

-Other medical conditions can make all forms of periodontitis worse. Examples include diabetes and HIV infection. People with these conditions usually have a fair amount of dental plaque and/or calculus (tartar) on their teeth. They are more prone to developing severe periodontitis.

How to detect the periodontal bone loss?

At the Dental Treatment Center, we only use digitalized long-cone radiographs to detect the early periodontal bone loss.

Using digital radiographs helps us reduce by more than 90 percent the dose of radiation, thus not only protecting the dentists but also the patients.

If requested, the digital radiographs are sent by email to patients without any additional charges.

How are X-rays Used?

X-ray images, also called dental radiographs, are among the most valuable tools a dentist has for keeping your mouth and teeth healthy. By understanding what the structures of the mouth look like normally on an X-ray film, dentists can diagnose problems in the teeth and jaws. For adults, radiographs can:

Show areas of periodontal bone loss, commonly known as gum disease, which is the main cause of tooth loss in adults
Show areas of decay that your dentist may not be able to see with just a visual examination, such as tiny pits of decay that might occur between teeth
Find decay that is developing underneath an existing filling
Find cracks or other damage in an existing filling
Reveal problems in the root canal, such as infection or death of the nerve
Help your dentist plan, prepare and place tooth implants, orthodontic treatments, dentures or other dental work
Reveal other abnormalities such as cysts, cancer and changes associated with metabolic and systemic diseases (such as Paget's disease and lymphoma)
For children, radiographs are used to watch for decay and to monitor tooth growth and development. Dentists will use periodic X-rays to see whether a space in the mouth to fit all the new teeth, whether primary teeth are being lost quickly enough to allow permanent teeth to erupt properly, whether extra (supernumerary) teeth are developing or whether any teeth are impacted (unable to emerge through the gums). Often, major problems can be prevented by catching small developmental problems early and then making accommodations.

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