When you come in for your periodic hygiene appointment (notice we didn’t call it a cleaning), a lot happens before we even pick up “the scraper.” The exams begin the moment we call you back to the chair. We are assessing your gait, symmetry, and even your speech. All of this gives us clues to your overall health. Once we have you seated and reviewed your medical history, taken vitals, performed an oral cancer screening and airway assessment, and caught up on all the latest news of your life, we focus on your teeth.
One of the exams we perform is a periodontal screening. You might remember it: we call out all kinds of numbers, and it might feel like we are just poking your gums. But we are doing way more than what you hear and feel. This exam tells us a lot about how we will proceed with the rest of your appointment and future recommendations. It’s like hooking your car up to a computer to see how all the systems are running.
There’s a lot we are looking at!
This is where the numbers I mentioned come in. We take a tiny little ruler called a probe and measure the space between your tooth and gum. You know that spot where the popcorn shells love to hide?
This area is called a sulcus when healthy and a periodontal pocket when the measurement exceeds 3mm. Each tooth gets measured six times. We take three measurements on the outside and three on the inside. We record the area between your teeth and directly on the front or back. These measurements tell us where the bone that holds your teeth in is in relation to the edge of your gums. Deep pockets are the perfect environment for bacteria. They are nice and hot, and it is easy to hide and cause destruction.
As we take these measurements, we are paying attention to how your gums respond. Healthy gums are firm, pink, and stippled, like the outside of an orange. As you move away from health, the tissue becomes puffy, loses that nice stippling, and starts to bleed when we gently probe. It might be hard to believe, but it’s not bleeding because we poked you. It’s bleeding because there’s inflammation. Sometimes, the bleeding happens right away; other times, it’s delayed as it comes up from the base of the pocket. This explains why it doesn’t always bleed when you clean your teeth at home.
Healthy gums don’t bleed. A bleeding spot could mean you have something trapped in that area, like food or tartar. It could be an autoimmune response that something is happening somewhere else in your body. Or it could mean that the biofilm in your mouth is unhealthy, and we need to make a plan to get you to health. Any bleeding, regardless of the cause, can signal an infection that needs to be treated.
Other numbers you might hear are measuring the length of the root that you see. Ever heard the phrase “long in the tooth?” As we age, our gums often migrate south due to various factors. It’s essential that we take measurements so we can confidently assess if the recession is getting worse or staying the same. And take action if it’s getting worse. Ignoring it can lead to bigger problems.
Clinical Attachment Loss
This is where math comes in. There’s a joke in the hygiene profession that we chose hygiene because we hate math. So bear with us here. Attachment loss adds the depth of the pocket to the recession to determine how much of the tooth’s foundation has disappeared. This matters because you could have a 2mm pocket, which seems healthy, but if you have 4mm of recession, that would mean there’s 6mm of attachment loss. If you lose too much attachment, there’s not enough left to hold the tooth in!
Remember when your tooth got loose when you were little, and the tooth fairy came and left money? Well, adult teeth can get loose, too, but the tooth fairy doesn’t usually leave money, and in fact, it can cost a lot of money to replace that lost piece of your anatomy. When teeth lose all their supporting structure, the bone and the gums, they have nothing to hold onto and might need to be removed so they don’t harbor disease that can spread to the rest of the teeth.
Staging and Grading
Once we have gathered all the data above, if we determine you have periodontitis (loss of bone), we move on to staging and grading. Staging classifies the severity and extent of disease in your mouth based on our clinical findings. Grading takes into account your risk factors (like smoking or diabetes) and how you respond to therapy. This allows us to personalize your care based on all the collected data and easily track your progress from visit to visit to know what’s working.
The shocking thing is the entire exam might take ten minutes tops. But there’s no denying that this critical data can directly affect your health and wellness. With consistent and thorough periodontal examinations, early signs of diabetes or even cancers have been detected. The mouth tells us a lot when we take the time to see what’s happening. Addressing inflammation and infection is essential to your overall health.
Let us repeat it: Healthy gums don’t bleed! And brushing and flossing might not be enough to keep you healthy. If you are concerned about the numbers you hear or the bleeding you see, ask us about Perio TrayTM therapy. It’s an affordable, comfortable, and easy way to deliver medication deep into those pockets, treat the infection, and get you reliable results. And bonus, it’ll whiten your teeth too!!