Diagnosing periodontitis

Self-assessment of the gums, for example at home in front of a mirror, is not sufficient for a correct evaluation because it is impossible to determine on your own whether the anchoring structures of the tooth have already been damaged by inflammation of the gums. Gum pockets can also not be detected on your own.

Only a proper clinical examination in the dental practice with what is called a gum probe (periodontal probe) can provide information on whether the gums are healthy, whether there is gum inflammation (gingivitis), or whether a disease of the anchoring structures of the teeth (periodontitis) is present.

The basic periodontal examination is done to determine quickly whether there are any gum problems. It is a simple way of determining if there is gingivitis or detecting periodontitis.

Using a gum probe (periodontal probe), the depth of penetration at the gum line is measured gently and precisely.

After this short examination, further investigations are carried out only there is evidence of damage to the structures holding the teeth in the jawbone. These further investigations include what is called the periodontal status and additional X-rays.

In the clinical examination with the gum probe (periodontal probe), the penetration depth of the probe into the gum pocket is measured at up to six sites per tooth to within a millimeter. Specifically, the length between the gum line and the bottom of the pocket is measured. This is called the probing depth. At healthy sites, the probing depth is 3 mm at most. At sites where the periodontitis has already led to a breakdown of the tooth anchoring, the probing depth can be 4 mm or more.

In addition, in what is termed a periodontal chart, the height of the jawbone (attachment level) is recorded precisely. A periodontal chart is indispensable for the diagnosis and planning treatment. The periodontal chart can be recorded online in any dental practice and reused: www.periodontalchart-online.com.

The diagnosis of periodontitis can be definitely confirmed only with the necessary X-rays. The selection of the X-rays necessary to diagnose periodontitis can be made only after the clinical examination. This can prevent excessive exposure to radiation.

In the simplest case, an X-ray finding consists of 2 images (bite wing images) and in the most extensive case, it consists of what is termed an X-ray study with up to an additional 14 X-ray images or a panoramic X-ray. The X-ray images made must show the jawbone surrounding the tooth and make it possible to estimate the severity of bone loss.

In each X-ray made on the dental practice, the dentition must be checked for caries as well as for periodontitis.

With modern microbiological tests, the composition of the dental plaque is tested for the following harmful kinds of bacteria:

• Prevotella intermedia
• Porphyromonas gingivalis
• Aggregatibacter actinomycetemcomitans
• Treponema denticola

The cost of this additional diagnostic effort is justified if the information obtained leads to improved treatment or if unnecessary treatment can be avoided.

In 1999, the first international workshop for the classification of periodontal disease was held in the US. The most important new feature compared with the European classification of 1993 was that the forms of the disease were no longer defined primarily based on the age of the patient at the time of the first diagnosis, (e.g. juvenile and adult periodontitis). The new forms chronic and aggressive periodontitis were introduced, as well as, for example, periodontitis that can be associated with systemic diseases.

However, the new classification since 2018 no longer differentiates between chronic and aggressive periodontitis. Periodontitis is now described – in line with the classification of diabetes – using staging and grading.