Diagnosis of periodontitis. To correctly diagnose periodontitis, it is necessary to know the disease and their characteristics. According to the European Federation of Periodontology, periodontitis is defined as: A multifactorial chronic inflammatory disease associated with dysbiotic bacterial plaque biofilms and characterized by a progressive destruction of the tooth-supporting apparatus.
It is characterized by inflammation that leads to a loss of periodontal attachment. While bacterial biofilm formation initiates gingival inflammation, periodontitis disease is characterized by three factors:
- The loss of periodontal support tissues (to hold the tooth), through clinical attachment loss (PIC/CAL) and alveolar bone loss (through RX).
- The presence of periodontal pockets.
- Gum bleeding.
Onset of periodontitis
Periodontitis or periodontal disease usually begins in gingivitis, the inflammation of the gums due to an accumulation of bacterial plaque for a substantial time. The most common clinical signs of gingivitis are bleeding, edema (swelling), erythema (redness) and enlargement. Gingivitis is a reversible condition, if the damage is treated, it can be repaired.
However, if this condition is not resolved, it will evolve into periodontitis, which will imply a loss of support for the tissues around the tooth (gum and bone).
Diagnosis of periodontitis
When making a diagnosis, it is likely that a history of gingivitis appears in the patient’s medical history, in which case the level of attachment loss will be looked at, if there is loss of support and bone. For this, it is necessary to carry out a thorough probing, and it is very important to take X-rays to be able to assess whether or not there is bone loss, and if there is, to be able to see what type of loss it is.
The scientific literature explains that a patient is a periodontitis case when clinical attachment loss is detected interproximal (between teeth) in 2 or more non-adjacent teeth.
In case that an interproximal attachment loss cannot be detected, it will also be considered a case of periodontitis if it presents recessions with an attachment loss of at least 3mm in at least 2 teeth. Once the disease has been diagnosed, it is necessary to define its stage, degree and extent or distribution.
The stage corresponds to the severity of the disease and the complexity of treating it. There are 4 types of stadiums:
- Stage I: initial periodontitis.
- Stage II: moderate periodontitis.
- Stage III: severe periodontitis with the possibility of tooth loss.
- Stage IV: severe periodontitis with loss of 5 teeth or more.
To classify a patient in these stages it is necessary to take into account bone loss, tooth loss, probing level, furcation defects (bone loss between roots), dental mobility and oclusal trauma.
The grade indicates the possibility of progression of the disease that is determined by risk factors as if the patient is a smoker or diabetic, and that will cause a faster progression. It should also be taken into account whether there is evidence of progression in recent years, and the percentage of bone loss with respect to the patient’s age. There are 3 degrees:
- Grade A: risk of slow progression
- Grade B: moderate risk of progression
- Grade C: risk of rapid progression
Finally, the extension or distribution of the disease must be determined, which can be:
- Localized (less than 30% of teeth are affected)
- Generalized (more than 30% of teeth are affected)
- Molar-incisor type.
Periodontitis is a chronic and irreversible non-transmissible bacterial disease, therefore, the goal of the dentist and the patient should be to maintain a state of health within the disease.
For this, it is necessary to go through the treatment in steps: infection check-ups, rehabilitation (if necessary) and the final maintenance step (necessary for everyone), in which the patient must follow the instructions recommended by the dentist to maintain a rigorous oral hygiene and get the bacterial biofilm on the teeth professionally removed.
We look forward to seeing you at our Nart Barcelona Dental Clinic where you can get a periodontitis diagnosis!
