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Diagnosis and Treatment Planning

Periodontal disease is diagnosed by your Periodontist or General Dentist during a periodontal examination.  This type of exam should always be part of your regular dental check-up.  A thorough diagnosis of your condition is made and then a course of therapy is recommended.  This course of therapy is known as a treatment plan.  The treatment plan is also sequenced and prioritized.  Treatment plans include treatment for periodontal disease as well as restorative recommendations.  A clinical and radiographic evaluation is done and often models of the mouth are taken so your case can be further evaluated.

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.  As bacteria collects in the sulcus it begins to destroy the fibers and bone that hold in the tooth.  The more bone that is lost, the deeper the pocket becomes.  The deeper the pocket becomes, the more bacteria is held.  The more bacteria that is held, the more bone loss that occurs.  As you can see, it is a viscous cycle.

Your Periodontist or Dentist will use pocket depths, amount of bleeding, inflammation, tooth mobility, amount of recession, amount of bone loss, number of missing teeth, etc., to make a diagnosis that usually falls into a category below:

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

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.  Many times teeth are non-treatable and require extraction.  We will work with your General Dentist to help determine a restorative treatment plan to replace the missing teeth.

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