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The Periodontal Examination
assessing the severity of gum problems


Some people mistakenly believe that teeth are supported in the gums. This is
not the case. Teeth are supported in bone. The gum, or Gingiva, is a protective covering over this bone. In a healthy mouth, the gingiva hugs the teeth like a tight collar to prevent bacteria and food debris from invading the bone. Simply put, the gingiva protects the bone, and the bone supports the teeth.

Many thousands of fibres, called periodontal fibres (Perio = around; dontal = tooth), go from their origins on the roots of the teeth into the gingiva and the surrounding bone. The great majority of these fibres go from the root into the bone and attach the tooth to the bone. The fibres going from the root into the gingiva, pull it tightly against the crown, producing a tight protective collar
around the tooth called the Gingival Margin.

There is a small crevice between the Gingival Margin and the tooth that you don’t see when you look in your mouth. This area, where the gingiva lies against the crown, is called the Gingival Crevice (or sulcus). The depth of the gingival crevice
is of major importance. Normal healthy crevices measure 1 to 3mm in depth. This depth is impossible for you to assess yourself, which is why it is important to
have a regular Periodontal Examination.

At the Periodontal Examination, your mouth will be assessed for the various stages of Periodontal Disease. There are four stages of periodontal diseases – Gingivitis and three stages of Periodontitis. You cannot accurately diagnose periodontal diseases yourself because:
• They most often start between back teeth where you can’t see them.
• They will almost always be painless.
• There is usually no “pink toothbrush” (bleeding) to warn you.

Your dentist can spot disease early, when it is the easiest, and least costly, to treat. This early detection is possible only with a measuring instrument called the Periodontal Probe. Using this device the dentist can find periodontal diseases
long before they show up on X-rays. The crevice in this drawing is 2 mm deep.
The markings on the periodontal probe are 3 mm apart.

During the periodontal examination, the periodontal probe is used to measure
the depth of the crevices. The examination will also include assessment of plaque retention, bleeding from the gingiva, any mobility of the teeth and an assessment of the bite, to see if bite trauma may be affecting periodontal health. These investigations are important for the sake of the health of your teeth, and for keeping your teeth for life, however recent research has shown a much more sinister consequence of periodontal diseases.

Studies at the University of Buffalo have shown that those with periodontal disease have a much higher level of fibrinogen (a blood clotting factor) in the blood. Since the presence of a chronic infection like periodontal disease stimulates the production of fibrinogen, it is believed that this is one of the pathways linking periodontal diseases with heart disease.

Chronic infection also produces an increase in free radicals in the blood as by-products of the inflammatory process. The free radicals in the blood work in conjunction with excess Low-Density Lipoproteins (“bad” or LDL cholesterol), which further increases the likelihood of coronary artery disease, which causes heart disease.

Further studies at UB show a link between periodontal disease and Type 2 Diabetes (also called “Late Onset Diabetes” or “Non Insulin Dependent Diabetes Mellitus”). The bacteria from periodontal diseases seem to interfere with fat metabolism, leading to elevated LDL cholesterol. It is believed that this increases insulin resistance, thus disturbing sugar metabolism producing hyperglycaemia (increased blood sugar levels). It is clear that there are very good reasons to
take care of your teeth and gums.

The proper care is not really difficult - it simply requires daily flossing, twice daily brushing and regular dental and periodontal examinations.
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