When to refer to a periodontist
- Tonetti MS, Sanz M Implementation of the new classification of periodontal diseases: Decision-making algorithms for clinical practice and education. J Clin Periodontol. 2019;46:398–405.
- Papapanou P, Wennstrom JL. The angular bony defect as an indicator of further alveolar bone loss. J Clin Periodontol. 1991;5:317–322.
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- Hempton T, Dominici J. Contemporary crown-lengthening therapy: a review J Am Dent Assoc. 2010;141:647–655.
Evaluating Probing Depths By Timothy J. Hempton, DDSTraditionally, probing depths of 3 mm or less are consistent with periodontal health. The potential for periodontal attachment loss is associated with probing depths of 5 mm and greater. Probing depths of 4 mm could be considered a middle ground between health and disease. Fortunately, Stambaugh1 demonstrated that the ability to keep a 4 mm pocket free of plaque and calculus is predictable. This is not necessarily true, however, for probing depths of 5 mm or greater. All probing depths should be recorded at six circumferential points around the dentition. These measurements establish a recording of the patient’s periodontal baseline. It is not only in the best interest of the patient to create an accurate charting of probing depths, but it is also in the interest of the practice from a medical-legal standpoint. Accuracy has another advantage: If multiple clinicians in the practice are seeing the patient at different times, the math is easier when the numbers are more precise. For example, when a subsequent reevaluation of the patient occurs, a 2 mm change is not likely a major concern if the initial probing depth is 1 mm. A 3 mm probing depth that becomes deeper by 2 mm is, however, worrisome, as it is now a 5 mm pocket. A 5 mm pocket is more difficult to debride. In addition, this change over a short time indicates an increased rate of attachment loss. Periodontal charting must also record the level of the gingival margin. This relates to gingival recession, which is a manifestation of periodontal attachment loss. The combined measurement of recession and probing depths reveals the true amount of periodontal attachment loss. Probing depths around a given tooth may not change over time, but the gingival margin may recede more apically, resulting in additional root exposure. The American Academy of Periodontology recommends probing six points circumferentially around every tooth at every prophylaxis or recare visit. Any changes in periodontal measurements should be charted, as well as the presence of no changes. This record will be beneficial in risk management and for reimbursement if the patient needs more advanced periodontal therapy.2 REFERENCES
- Stambaugh R, Dragoo M, Smith D, Carasali L. The limits of subgingival scaling. Int J Periodontics Restorative Dent. 1981:1:30–41.
- Hempton TJ. Periodontal charting. Dimensions of Dental Hygiene. 2017;15:60.
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