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. 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. We are not able to treat a patient unless we have adequate x-rays.
The exception is gingival grafting, which normally does not require x-rays. There are a number of different types of dental x-rays, each with a specific purpose, but for periodontal treatment a full series of periapical films is generally required.
Below is a list of the commonly taken x-ray views, and the indications for each. Click for a more detailed discussion and examples of each type of x-ray. Many people have a legitimate concern about the amount of radiation they receive with dental x-rays. It's un-nerving to watch the technician set the machine and run out of the room to expose the film! However, recent advances in dental x-rays make this an unnecessary concern.
The film "speed" has improved dramatically, meaning that very little radiation is needed to expose the film. In fact, it is estimated that the amount of body radiation received with a full mouth series is much less than one would receive at a day at the beach. Diagnosis Once the clinical data is gathered and correlated with the x-ray findings, your periodontist is able to organize and systematically evaluate the results to make a diagnosis.
This is critical, for while there may be various approaches to treat a problem, there can be only one correct diagnosis. Once the diagnosis is determined, various treatment options can be formulated.
With this information the periodontist and the patient can determine which treatment plan to follow. The first step of treatment is to eliminate all of the known causes of the periodontal disease. Mouth bacteria found in saliva forms colonies on the teeth and tissues, which is called plaque. This clear film of bacteria is the primary cause of periodontal inflammation and breakdown.
Calculus also known as tartar is formed when salts from the saliva precipitate into the plaque. This forms a hard substance, which adheres tightly to the tooth, similar to barnacles on a boat's hull. Both the calculus and the plaque must be removed to achieve a successful result. The patient is taught to remove the plaque, while the dental professional must remove the calculus. Initial preparation also includes creating an environment that makes plaque removal by the patient as easy as possible.
The following outline lists factors that may be addressed during initial preparation. Following Initial Preparation, the tissues are re-evaluated after they have a chance to heal to determine if more periodontal therapy is needed. If the disease has been arrested, the optimal periodontal maintenance cleaning schedule is determined for the patient.
If the disease persists, further non-surgical treatment may be performed. If surgery is needed to eliminate pockets that persist, a surgical treatment plan is formulated. Initial Preparation generally produces shrinkage of the inflamed gum, and thus a reduction of the pocket depth. Diagnosis To determine whether you have periodontitis and how severe it is, your dentist may: Review your medical history to identify any factors that could be contributing to your symptoms, such as smoking or taking certain medications that cause dry mouth.
Examine your mouth to look for plaque and tartar buildup and check for easy bleeding. Measure the pocket depth of the groove between your gums and teeth by placing a dental probe beside your tooth beneath your gumline, usually at several sites throughout your mouth.
In a healthy mouth, the pocket depth is usually between 1 and 3 millimeters mm. Pockets deeper than 4 mm may indicate periodontitis. Pockets deeper than 5 mm cannot be cleaned well. Take dental X-rays to check for bone loss in areas where your dentist observes deeper pocket depths.
Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Overview of periodontal disease. Merck Manual Professional Version. Accessed Sept. Gum disease: Causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research. Caton JG, et al. Journal of Clinical Periodontology.
Periodontal gum disease. Periodontal disease.
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