The first steps of the oral evaluation process are the cleaning and exam. During this first visit, we will clean, polish, and floss the teeth. Occasionally topical fluoride or desensitizer is applied when necessary. The examination consists of an oral cancer screening, a periodontal charting, a restorative charting and of course, the dental treatment planning.
The cancer screening has two stages: the first is to check the visible soft tissues for growths or suspicious lesions of the tongue, palate, cheeks, throat, and gums while the second entails reviewing the panoramic x-ray to evaluate the bone, nerve, sinuses and joint for pathology. We know that recognizing and diagnosing lesions in the initial stages can be life saving. If you have any areas of concern, please make us aware so that we can rule out any need for further evaluation.
The periodontal charting consists of making measurements of the gingival sulcus or pocket depth to determine the health of the periodontium. The readings are made in millimeters; the 1-3mm readings are considered normal and any reading greater than 3mm indicate areas of inflammation. Recession and mobility of the teeth, if any, are also noted during this time. With all this is completed, we can make an accurate diagnosis of the gingival condition. The following are the most common diagnoses: Health, Gingivitis, Chronic Periodontitis, and Aggressive Periodontitis.
Health is defined as firm, pink gums that do not bleed or show any signs of inflammation.
Gingivitis is literally “the inflammation of the gums.” Bleeding is the characteristic finding when scaling and probing the teeth. The redeeming quality of gum tissue is that it is resilient. This means that gingivitis is completely reversible with the proper professional cleaning and good home care, including brushing twice per day and flossing before bedtime.
Chronic Periodontitis is characterized not only by inflammation but also by bone loss and recession of the gums. It is diagnosed by looking at the pocket depths, the recession present and the bitewing x-rays to evalaute the level of bone loss. It can be further classified into mild, moderate or severe cases and is exacerbated by poor oral hygiene, smoking, diabetes, bruxism, use of some long term medications, changes in hormones, certain illnesses, and stress. Some say that genetics can predispose an individual to chronic periodontitis but is not a direct cause.
Aggressive periodontitis is the rapid loss of bone causing recession most likely in the first molar and incisor areas. It is typically seen in young adults that start to notice the looseness of the teeth. In some instances, teeth can be lost at a rapid rate if measures are not taken to control this situation. Bacteria are the main cause of this condition and often a periodontist along with the general dentist work together to help arrest the process. If you believe you may have aggressive periodontitis, contact your dentist immediately.