A Periodontal Assessment
When someone says periodontal exam we think of periodontal probing. Measuring pocket depth is an important part of the examination but it’s not the whole story. In my opinion, it isn’t even the most important part of the story.
What are we attempting to do at the examination? Breaking it down to the bare minimum, we want to make a periodontal disease diagnosis and we want to develop a plan of attack.
When you think of it, the diagnosis is fairly easy. By selective probing, making a visual inspection of the gingival condition and checking the radiographs to determine if bone loss has occurred, are about all you need to do for a basic diagnosis. Of course, if you are going to assume the periodontal care for this individual you need to dig deeper (no pun intended).
When digging deeper, one of the most critical assessments is the extent of furcation involvement. Furcation exposure opens many unwanted doors. First and foremost, furcation exposures create plaque control problems for the patient. Furcation exposures create access problems for the operator. Furcation exposures make it difficult or impossible for the operator to determine if root debridement is complete.
The “quality” of the calculus, not the quantity is important. Some calculus is easy to remove, some very difficult to remove. During the exam, you need to pick up a curette and find out. This information is a big player in treatment planing.
Mobility needs to be evaluated. Very simply, have the patient tap their teeth together and check for fremitus. Then, have them bite together and slide from side to side. If the teeth move, mobility is a player and needs to be addressed. Teeth need to be stable for good treatment results to occur. Bite adjustment, splinting, and or a bite splint will be needed.
We have talked about a basic diagnosis; now let’s consider a basic treatment plan. If you find that your patient has little or no furcation involvement, calculus that is easy to remove and no evidence of traumatic occlusal issues, you will likely have success with non-surgical treatment. Note, I didn’t mention pocket depth. On smooth flat surfaces (no furcation exposure), using sharp curettes, I’m confident you can predictably root plane moderately deep pockets without visual access.
If your patient doesn’t meet the above criteria a more comprehensive periodontal disease treatment plan will be in order. If this is out of your comfort zone, refer.