April 10, 2021
A routine dental check-up to a dentist every 6 months is a must. When you go to a dentist, a thorough inspection of the teeth, tongue, gums, palate and the mucosa (lining of the skin in the oral cavity). Apart from this, the health of structures that are not visible clinically can also be evaluated using certain diagnostic instruments. These structures are the ones that support the tooth. These are the periodontal ligament, gingiva, alveolar bone and cementum. This procedure of evaluation of the health of the tissues under the tooth structure is called bleeding on probing (BOP).
BOP is performed using an instrument called periodontal probe. This instrument is moved along the surface of the teeth in the area where it meets the gums (marginal gingiva). The amount of force with which BOP is performed should not be too extensive. This is because a grrater force can traumatize the healthy tissues that ultimately bleed and give a false positive result. If there is a loss of attachment between the gums and the tooth surface, a "pocket" can be felt. This pocket is a gateway for the microorganisms that can further lead to infection in the periodontal region. In case of an infection, the tissues surrounding the teeth can weaken, eventually degrading the prognosis of the affected tooth.
In the process of BOP, a pocket formation can lead to bleeding when the deepest part of the pocket is triggered. This indicates the possility of an inflamed tissue underneath. The inflammation can be in the gingiva or the periodontium. When the probe is moved in the pocket till its depth and later along the rest of the wall of the tooth, bleeding can occur spontaneously or after 30 to 60 seconds. The severity of the inflamed tissues in the oral cavity can be infered by the bleeding point index. This is calculated by counting the total teeth that witnessed BOP and the total surfaces that were evaluated. These results are put in a formula that show the outcome in terms of percentage. If the total bleeding points are less than 10%, then it is considered as a fairly acceptable condition of the oral tissues. Rarely, a 0% score of ideal is attained.
BOP is usually seen in cases when there is accumulation of debris, plaque and calculus. These are home to a range of pathogens that cause inflammation of the gingival and periodontal tissues. Decayed teeth, malpositioned teeth, braces and denture wearing are some of the factors that aggravate the chances of BOP. Overzealous toothbrushing or flossing can also irritate the gingival tissues which eventually bleed.
BOP can be suggestive of an underlying condition as well. It is usually seen in patients with a deficiency of Vitamin C and Vitamin K. Moreover, platelet (cells responsible for clotting of blood) disorders can also be there if BOP is present for a prolonged period of time. Patients of diabetes, hyperthyroidism, dengue fever and leukemia are at a great risk of exhibiting BOP. Moreover, an overdose of iron and malnutrition are other common causes for BOP.
Since BOP represents the presence of inflamed and infected tissues, the first step is to get the teeth rid of plaque, debris and calculus. This can be done by the dentist with the help of an ultrasonic scaler. A mouthwash can also be prescribed for maintaining the oral hygiene. Patients are taught the correct method of flossing as an incorrect technique can damage the gingiva between two teeth. Patients are also advised to use a soft bristle toothbrush to reduce the chances of inflammation. They are also advised to prohibit the intake of any tobacco products as it can aggravate the already existing condition. If an underlying systemic condition is diagnosed, then treatment is targeted towards that condition as a priority.
BOP is one of the most reliable diagnostic procedures for gingival and periodontal diseases. However, it is always advised to couple BOP with x-rays in order to confirm the diagnosis. In case of a possible underlying condition, the needed investigations should be done accordingly. A relatively painless procedure, BOP is a great indicator of the oral health status and disease progression.