Diagnosis of periodontitis

Periodontal disease refers to a group of inflammatory conditions that affect the tissues around the teeth.

The mildest form of periodontal disease is gingivitis and, if left untreated, gingivitis can progress to periodontitis.

Now, the goal of diagnosis is to detect early signs of periodontal disease, treat the condition, and prevent further complications.

The diagnosis of periodontitis is a systematic process subdivided into several parts, including the patient’s medical and dental history; radiographic evaluation, extraoral examination; intraoral examination; and additional diagnostic tests and procedures.

Let’s start with the medical history which is used to identify systemic factors associated with an increased risk of periodontitis.

These include systemic conditions, such as diabetes mellitus, pregnancy, and HIV infection; environmental factors, such as stress, smoking, and inadequate nutrition; and the use of medications associated with gingival enlargement, such as phenytoin, nifedipine, and cyclosporine.

On the other hand, dental history covers important information about the patient’s oral hygiene habits, the regularity of dental visits, previous dental conditions, and current concerns.

Individuals with periodontitis typically complain of swelling, and bleeding of the gingiva; tooth mobility; and bad breath.

After the history is taken, the next step is a radiographic evaluation with a full mouth radiographic survey.

This survey should include periapical radiographs showing the apices of all teeth and appropriate bitewings.

The purpose is to identify and measure the loss of alveolar bone, but also to detect local factors that can complicate the course of periodontitis, such as caries and furcation involvement.

Now, switching gears and moving on to the extraoral examination, which refers to the evaluation of the temporomandibular joint, the symmetry of the face, and regional lymph nodes.

This is an important part of the diagnosis because in severe cases, periodontitis can cause facial swelling and enlargement of submental, submandibular, and cervical lymph nodes.

The enlargement of regional lymph nodes is typically associated with severe necrotizing gingivitis and acute periodontal abscess.

The rest of examination is further subdivided into the examination of the oral mucosa, teeth, and periodontium.

Now, let’s start with the oral mucosa examination, which is used to detect abnormal changes of the buccal and labial mucosa, tongue, floor of the mouth, palate, tonsils, and oropharynx.

Additionally, when evaluating the condition of the oral mucosa it’s important to note the presence of oral malodor, which is also known as halitosis.

Next, we have the examination of teeth.

Here, it’s important to identify four main mechanisms of tooth wear, which include erosion, abrasion, abfraction, and attrition, .

Erosion refers to tooth lesions caused by acids that are not produced by oral bacteria.

For example, erosion can be caused by soft drinks or gastric acid.

The next one is abrasion, which is defined as tooth wear caused by mechanical forces such as tooth brushing.

On the flip side, abfraction is tooth wear caused by forces that are associated with chewing, biting, and eating, and it’s typically found at the cementoenamel junction.

The last one is attrition, which refers to lesions of a tooth caused by functional contacts with opposing teeth.

Other important features of the person’s teeth that should be considered during the teeth examination include dental decay, stains, and calculus, hypersensitivity, tooth mobility, missing teeth, open contacts, occlusal traumas, furcation involvement, and misalignment of the teeth.

Now, moving on to the periodontal examination, which is the most important part of the diagnostic process.

When inspecting the periodontium, it’s crucial to be systematic, so no areas are skipped.

First, it’s important to detect the primary cause of periodontitis, the dental plaque.

Additionally, make sure to note the presence of subgingival calculus and supragingival calculi.

The next step is the evaluation of the patient’s gingiva, which includes visual inspection and palpation.

The goal is to identify changes in size, color, contour, consistency, surface texture and position.

Normally, the gingival margin lies slightly coronal to the cementoenamel junction, but with gingival recession, it shifts apical to the cementoenamel junction.

On the other hand, in gingival hyperplasia, the gingival margin shifts even more coronal to cementoenamel junction.

Now, switching gears and moving on to the examination of the periodontium and detection of periodontal pockets.

The most accurate way to detect periodontal pockets is with a periodontal probe.

This is a dental instrument that can have small calibrated millimeter markings or color bands which generally represent 1 to 3 millimeter length.

Now, the dental probe is routinely used to measure clinical parameters including periodontal probing depth, clinical attachment loss, gingival recession, and bleeding on probing.

Periodontal probing depth measures the distance from the gingival margin down to the base of the periodontal pocket or sulcus.

In healthy individuals, the pocket depth is one to three millimeters.