Gingival health—periodontal assessment

Dental Assistant, The, July-August, 2002

* lack of buccal and lingual views of the alveolar bone

* the variation in appearance of periodontal ligament space

* two-dimensional distortion of overlapping anatomical structures

* inability to locate soft tissue margins

Radiographs also do not reveal minimal losses of bone. In fact, for bone loss to be diagnosed from a radiograph, 40% bone loss must have already occurred.

The use of high kVp produces a longer scale of contrast and is often preferred in detecting periodontal disease.

Periodontal Evaluation for Disease

When performing any part of the periodontal examination, it is very important to look for the early signs of disease activity. Bleeding on probing is one of the manifestations of the possibility of periodontal disease at its onset.

Disease activity is a frequently misused term. It is defined as a disease process resulting in attachment/bone loss. Active destruction of the periodontium is occurring. Bleeding on probing may be present with or without disease activity and the absence of bleeding upon probing does not necessarily indicate an inflammation-free site or a healthy oral environment. Pocket depth measurements are essential for providing the baseline assessments from which treatment plan, treatment progress, and continue care maintenance can be monitored.

Periodontal Probes

Various types of periodontal probes can be used to measure pocket depths. Most clinicians use their own personal preferences in determining which probe to use.

Most traditional probes are marked with 1-millimeter increments with the 4 and 6 mm marking absent. The probe reads 1, 3, 5, 7, 9, and 10 mm. Some probes have a black band indicating the 3, 5, 9, and 10-mm markings. Some clinicians prefer probes that are color coded because they are easier to read.

The Naber's probe or the Furcation probe is a blunt ended instrument that is used buccally and lingually on the periodontal structure to locate possible furcation involvement.

Since periodontal probing is such an important aspect of the periodontal examination, the technique must be systematic and consistent. The operator, when probing, will:

1. Use a lateral "walking" approach

2. Use only one brand of probe to achieve standardization

3. Dictate findings to the dental assistant who will chart data on a form that allows comparison of readings over time

4. Record six (6) regions around each tooth

Probing Technique: A Review

1. The probe is placed under the contact area between the line angles; making sure it is located at the interproximal area of the tooth.

2. The shank is rested between the teeth against the contact and the probe is angled under the contact area--always watching the angulation.

3. Round up to the next highest reading if the numbers on the probe are between one another.

4. Record the deepest reading in each segment.

5. Use all three measurements on the buccal and all three measurements on the lingual for accuracy.

6. Radiographs are utilized to allow double checking of reading.

7. Forcing the probe can create penetration of the periodontal tissues resulting in inaccuracies in the pocket depth and discomfort for the patient.