Periodontal disease is diagnosed during a comprehensive periodontal evaluation.
A periodontal probe (small dental instrument) 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.
The measurement of pocket depths, amount of bleeding, inflammation, tooth mobility, etc., are used to make a diagnosis that will determine the stage of periodontal disease:
Gingivitis - Gingivitis is the first stage of periodontal disease. Plaque and its toxin by-products irritate the gums, making them tender, inflamed, and likely to bleed.
Periodontitis - In this stage, plaque hardens into calculus (tartar). As calculus and plaque continue to build up, the gums begin to recede from the teeth. Deeper pockets form between the gums and teeth and become filled with bacteria and pus. The gums become very irritated, inflamed, and bleed easily. Slight to moderate bone loss may be present.
Advanced Periodontitis - The teeth lose more support as the gums, bone, and periodontal ligament continue to be destroyed. Unless treated, the affected teeth will become very loose and may be lost. Generalized moderate to severe bone loss may be present.
If the disease is caught in the early stages of gingivitis and no damage has been done, one to two regular cleanings will be recommended. You will also be given instructions on improving your daily oral hygiene habits and having regular dental cleanings.
If the disease has progressed to a more advanced stage, a special periodontal cleaning called scaling and root planning (deep cleaning) will be recommended. It is usually done one side of the mouth at a time while the area is numb. In this procedure, tartar, plaque, and toxins are removed from above and below the gum line (scaling) and rough spots on root surfaces are made smooth (planning) . This procedure helps gum tissue to heal and pockets to shrink. A home program including medications, mouth trays and an electric tooth brush may be recommended to help control infection and healing.
If the pockets do not heal after scaling and root planning, periodontal surgery may be needed to reduce pocket depths, making teeth easier to clean. A referral to a periodontist may be recommended.