Gum disease is diagnosed and charted by your dental hygienist and doctor. When your hygienist performs your routine cleaning they will check for signs of periodontal disease such as bleeding from the gums. They will also perform what is called periodontal probing and charting. There is a natural pocket between your teeth and the surrounding gums, your hygienist will use a small ruler, called a periodontal probe to measure that pocket in millimeters. In checking the size of these pockets and charting the findings, we are able to evaluate your gum health. During this probing, you may hear your hygienist calling out numbers as she measures and charts your pockets. A normal, healthy pocket is a maximum of 3 millimeters deep, numbers such as four, five and six, along with bleeding from the gums, could be red flags. Pockets that are around 4 millimeters can indicate early stages of gum disease such as gingivitis, the higher the number the more advanced the periodontitis. It could mean that the gum tissue is either swollen or it could mean there is bone loss around the tooth causing a deeper pocket. Once a year, as part of your routine cleaning and exam, x-rays are also taken, which can aid in identifying and diagnosing periodontal disease.
Should abnormal pocket depths, bleeding and noticeable x-ray findings be present, the doctor may recommend what is called scaling and root planing, or SRP. This is a process that takes place over 1-4 visits depending on the extensiveness of your disease and may require a local anesthetic. This deep cleaning has two parts. Scaling is when your dental professional removes all the plaque and tartar (hardened plaque) above and below the gumline, making sure to clean all the way down to the bottom of the pocket. They will then begin root planing, smoothing out your teeth roots to help your gums reattach to your teeth.
Depending on how comprehensive the periodontal disease is, it may also be recommended that a locally delivered antibiotic called Arestin be placed. Arestin consists of small spheres of minocycline, a derivative of tetracycline. The spheres, which look like a fine powder, are contained in a small blunt plastic needle, and are injected into the pocket. This requires no anesthesia. The spheres are bioadhesive, and stick to the pocket wall where they slowly release minocycline over a 14-21 day period. Because the spheres are also biodegradable they do not require removal. If an antibiotic can be delivered directly to the pocket, without the patient having to take systemic doses, there are far fewer side effects, and fewer chances of resistant bacteria forming. In addition, with direct local delivery, the concentration of the antibiotic at the diseased site can be 100 times greater than taking the medication orally.
Should the doctor find that your periodontal disease is too extensive, they may refer you to a periodontist. This is an oral health professional that specializes in gum health.
If this all seems a bit overwhelming, keep in mind that the first step in avoiding periodontal disease is prevention. While prevention should begin at home with twice daily brushing and flossing, our office also plays a significant role. Depending on how quickly your mouth develops plaque and tartar, your hygienist will recommend that you see us usually between two and four times a year for routine cleanings, x-rays and exams. Ensuring that you follow the recommendations means that any gum issues will be recognized and handled early on, so to hopefully avoid more in-depth treatment.