As an integral part of the general assessment of both new and existing patients, the periodontal evaluation is a series of steps the dentist follows in order to determine the health of patients’ gum tissues. Depending on the results of the examination, the dentist will diagnose any existing periodontal disease, establish the periodontal prognosis and, if necessary, determine the treatment requirements.
First, the dentist will determine if the patient has a specific reason for the visit, such as, if he or she is in pain. Next, the dentist will review the patient’s medical and dental history and any available past dental treatment records in order to identify any pre-existing conditions that may affect future treatment.
The dentist will then check the extra oral tissues by palpating the areas around the joints and the lymph nodes of the jaw, including those around the ears and neck. This is followed by an assessment of the intra oral soft tissues such as the tongue, cheeks, salivary glands, muscles and the floor of the mouth, as well as the back of the mouth and tonsils.
The condition of the gum tissues, or gingiva, is visually evaluated by assessing their colour, contours and texture. Healthy gingival tissues appear pink, have a stippled surface and don’t bleed. Early signs of gingivitis are when the tissues become inflamed, appearing red and swollen and when they bleed easily with little or no provocation. When inflamed, pus may also extrude from the gums.
Next, the dentist will determine the percentage of tooth surfaces affected by plaque build-up. In order to visually see this, the dentist will have the patient rinse with a coloured disclosing solution, which stains the plaque on the teeth making it easily identifiable.
Using a periodontal probe, the dentist will then determine if the patient has gingival pockets and /or recessions. Measurements are taken at three sites on the facial aspect of each tooth, and three sites on the lingual aspect. The probe is inserted into the pocket gently but firmly until it meets with resistance. It is ‘walked’ around each tooth and the deepest pocket measurements are recorded. The recession measurements are recorded as positive numbers, or as negative numbers, when the gingiva is extending above the junction between the root and the crown of the tooth. Sites where the gums bleed during probing are also recorded.
Using a different measurement probe or an explorer, the presence, location and extent of furcation defects are examined. A furcation is where the gums and underlying bone around a molar tooth have receded so as to expose the portion of the tooth where two or more roots meet. Furcations are noted as one of three classes depending on their probing depth.
With the handles of two instruments, the dentist will proceed to check each tooth for signs of mobility. If present, mobility is noted as slight, moderate or severe. Teeth with severe mobility are both horizontally and vertically mobile. If present, the dentist will determine the cause of the mobility, such as trauma or loss of periodontal support.
As part of the intra-oral examination, the dentist must also check the patients’ occlusion, or bite, the presence of caries, evaluate the condition of the patient’s restorations and, if present, the condition and fit of any fixed or removable prostheses. The need for, and suitability of dental implants placement should is also assessed.
Radiographs are used in conjunction with the clinical examination for the identification of abnormalities otherwise not clinically visible. In addition, dental casts and laboratory tests provide valuable information in the diagnosis of the patients’ dental status.
It is important that the dentist accurately document all relevant findings in the patient’s chart. The record should also include any referrals made to other health care providers.
After the evaluation is complete, the dentist will determine the patient’s treatment plan. If disease is present, the dentist will inform the patient about its extent, available options for treatment, potential complications and expected treatment results. Depending on the diagnosis and treatment recommendations, the dentist will also explain the need for post-treatment maintenance, the consequences of no treatment and the patient’s own responsibilities during and after treatment.
If periodontal treatment such as surgery is to be performed, this periodontal evaluation is repeated after a period of healing, to determine the outcome of the treatment and the need for further post-surgical maintenance.
The dentist will perform a full comprehensive periodontal evaluation at least once a year for all patients.
The results of this evaluation will be compared to previous findings. In addition, during maintenance appointments, a shorter screening method called a PSR, which stands for periodontal screening and recording, can be performed as an initial step. This is completed with a special probe. When a measurement deeper than 5mm is recorded a comprehensive periodontal evaluation is required.
Periodontal evaluations are an important part in the overall dental management of patients’ dental needs. These examinations must be thorough in order to monitor and maintain the patients’ periodontal health.