TL;DR
A periodontal exam measures the space between each tooth and its gum at six points, notes where the gums bleed or have pulled back, and checks for loose teeth. Low-radiation digital X-rays show how much bone surrounds each root. Pockets of 1 to 3 millimeters that do not bleed are generally healthy; deeper pockets with bleeding point to periodontitis. Together these findings set the stage and grade of the disease, and that decides the treatment. At Stone Falls Dental Care, Dr. Prane goes over the chart with you so the numbers make sense before any plan is made.
How does a dentist diagnose gum disease?
A dentist diagnoses gum disease by combining three things: measurements of the gum pockets, X-rays of the bone, and your medical history. No single one is enough by itself. Gums can look calm and still hide deep pockets, and X-rays can show old bone loss that is no longer active.
The exam starts with questions about bleeding, sensitivity, loose teeth and changes in your bite, then your health and medications. Smoking, diabetes and some prescriptions change both the risk and the way the gums respond. After that comes the charting itself, which is quick and orderly once you know what is being recorded.
What do the numbers in a periodontal chart mean?
Each number is the depth, in millimeters, of the small space between a tooth and the gum around it. A thin probe with millimeter markings slips gently into that space at six points per tooth: three on the cheek side and three on the tongue side. You will usually hear them called out as a run of numbers while someone records them.
Readings of 1 to 3 millimeters with no bleeding are generally considered healthy. A 4 suggests early trouble or inflammation worth watching. Readings of 5 or more usually mean the gum has detached from the root and a true periodontal pocket has formed. Bleeding when the probe touches is recorded as well, because it shows the inflammation is active right now.
- Pocket depth at six points around each tooth
- Bleeding on probing, a sign of active inflammation
- Recession, where the gum has moved down the root
- Clinical attachment loss, the true measure of support lost
- Mobility, or how much each tooth moves
- Furcation involvement, bone loss between the roots of molars
What do dental X-rays show about gum disease?
X-rays show the height and shape of the bone around each root, which the probe can only infer. On a healthy image the bone sits just below where the crown of the tooth meets the root. With periodontitis it sits lower, either evenly across several teeth or in a sharp notch beside a single root.
X-rays can also reveal tartar on the roots below the gumline, infections at the tips of roots and old fillings with edges that trap plaque. We use low-radiation digital X-rays, which appear on screen in moments, so we can put today’s image next to an earlier one and see whether the bone has changed.
What are the stages and grades of periodontitis?
Periodontitis is described by a stage, from I to IV, and a grade, from A to C. The system comes from the 2017 classification agreed by the American Academy of Periodontology and the European Federation of Periodontology, and it is what most dentists use today.
The stage describes how much damage has been done and how complex the case is to treat. Stage I is early, with little bone loss; Stage IV involves severe loss and often missing or drifting teeth. The grade estimates how fast the disease is moving and how likely it is to progress, adjusted for risk factors such as smoking and diabetes. Two people with the same pocket depths can need different care because their grades differ.
What happens after your periodontal exam?
After the exam, Dr. Prane sits down with you and goes over the chart, tooth by tooth where it matters. Images from our intraoral camera let you see what we see along the gumline, which makes a number like 5 millimeters much easier to picture.
If the gums are healthy or only inflamed, a regular cleaning and closer home care may be all you need. If periodontitis is confirmed, the findings point to a specific plan, laid out on our page about treatment for gum disease. Our treatment coordinators can check your insurance benefits before anything is scheduled. If you are new to the practice, the periodontal registration form can be filled out online ahead of time from the registration forms page.