Dental Care in Barrie: The periodontal diagnosis, or “What’s wrong with my gums?”
Posted: September 30, 2013
In a previous post, we gave you an overall idea of our approach to a complete oral exam, and how it is conceptually broken down into four diagnostic categories: dental (teeth only), periodontal (gums), functional (TMJ/jaw joints and the bite), and aesthetic (the appearance of the teeth). In this post, we will review the periodontal diagnosis.
Understanding gums is like understanding other chronic diseases such as heart problems or diabetes. They typically do not hurt even when damage is being done, until things reach a critical stage (high blood pressure / cholesterol doesn’t hurt until you have a heart attack or stroke, diabetes probably won’t hurt but leave it long enough and you go blind or lose a foot). In all these cases, it’s far better to control the disease before the more serious complications arise, and in the case of teeth it is no different. The periodontal diagnosis aims to identify the threats to the gums so one can minimize the loss of teeth.
Here are some of the things that we look at:
1) bone levels – this is the most telling indicator of gum disease risk. In another post, we said that there are people who seem not to get gum disease despite poor oral hygiene and others who seem to have aggressive disease with good hygiene. By looking at bone levels around the teeth on dental X-rays, we gain some good predictability on one’s individual gum disease risk. People who have lost bone will tend to lose more, and conversely, people who have not will not often start to lose bone suddenly (this of course excludes people who are at risk but who have not started to lose bone because they are still young).
2) periodontal pocketing and bleeding – by using a periodontal probe, we can measure the depths of the “pocket” of gums around each tooth. We measure six points on every tooth and record the depth in millimetres, and also record the presence of bleeding on probing. “Normal” numbers should be 1-3mm with no bleeding. Higher pocket readings and more bleeding are signs of active inflammation of the gums.
Additionally, people with aggressive gum disease will have patterns of gum pocketing and bone loss that suggest the need for more complicated and involved care, and often more vigilance.
3) recession – this measures the number of millimetres of gum loss that has occurred. Using a periodontal probe, we record the amount of recession from the CEJ (cementoenamel junction) where the gum level should be. Generally, the gum levels follow bone levels, so receded gums are suggestive of problem areas. Areas of recession that expose hard-to-clean areas of tooth roots become hygiene problems, and will merit more frequent hygiene visits.
4) missing teeth from gum disease – if one has lost teeth due to gum disease, it is a definite sign that there is an increased risk of further gum disease.
5) abrasion on the teeth- these wear marks on the sides of teeth at the gumline are a sign that excessive force may be being applied when toothbrushing. When this happens, the gums/bone will recede. Although this is not typical inflammatory gum disease, it is nevertheless loss of gum and bone tissue.
6) soft tissue pathology – this is again not typical gum disease or even toothbrush abrasion-caused gum loss. We are trying to identify soft tissue abnormalities that may affect the gums. These can range from more common things like autoimmune diseases manifesting in the mouth (lichen planus comes to mind, along with a host of others), all the way to things such as oral cancer. Often a biopsy is required in order to confirm the identity of these findings.
Once we obtain the necessary information about an individual’s gums, we can put all the information together and formulate some periodontal recommendations. While we are aiming to save as many teeth as possible, we also have to be realistic and suggest predictable (read: treatment that will work) measures that prevent delaying the inevitable. Often our recommendations will include:
– visits with the hygienist sufficient in number and duration to adequately disinfect the teeth
– a certain frequency of hygiene visits thereafter
– possibly referrals to periodontists for grafting or management of other more complicated gum defects
Contact us if you have problems with your gums, questions about gum recession, need advice about home care for your gums, or are seeking a place for regular maintenance! We’d love to be your dentist in Barrie.