October 06, 2020
The periodontium is that part around the tooth that supports it and maintains the integrity of its functioning. This is comprised of the periodontal ligament, gingiva, alveolar bone and cementum. The periodontal ligament is a bridge between the tooth and the underlying bone, the gingiva acts as a protective membrane for the lower portion of the tooth, the cementum is a covering of the roots and the alveolar bone fixes the tooth in its place.
A visit to the dentist involves a basic check-up that involves periodontal examination. A dentist uses two instruments for this purpose: a mouth mirror and a WHO probe. The mouth mirror helps in a better visibility around the tooth whereas the WHO probe is what helps us in grading the condition of the teeth assessed.
The human dentition is divided into six regions (sextant): upper front teeth, lower front teeth, upper right back teeth, lower ight back teeth, upper left back teeth, lower left back teeth. Each of these regions must have at least two teeth in order to qualify for a periodontal examination. If they do not qualify for the same, that means that region is automatically considered a region with a poor periodontal health.
The WHO probe is an instrument that has a ball tip (0.5 mm) and has a black band from the height of 3.5 mm to 5.5 mm. The probe is inserted in the gap between the tooth and the gums with a very light force (20-25 grams). It is then walked around the tooth in a similar way. The amount of black band visible when the probe is inserted is what gives the clinician an idea of the code to be assigned to the sextant. Here is what each code corresponds to:
Code 0: Black band entirely visible, no plaque or calculus, no overhangs and no bleeding after probing.
Code 1: Black band entirely visible, no plaque or calculus, no overhangs, bleeding after probing is present.
Code 2: Black band entirely visible, plaque and calculus present either above or underneath the gingiva
Code 3: Black band partially visible, indicating the formation of a pocket (abnormal deepening of the gingiva margin due to loss of gingival attachment)
Code 4: Black band not visible at all, indicating a pocket depth of 6mm or more.
Code 5 or ‘star’ (*): This code is assigned when the lower and upper back teeth (molars) have lost the gingival attachment to the extent that the area where the roots of these teeth bifurcate is visible.
A code of 0 ,1 or 2 means that the oral health status is adequate. The patient is advised to maintain his or her oral hygiene through a proper brushing and flossing technique and should be explained the proper use of mouthwash. Patients with a code of 3 or more need a radiograph to better view the periodontal condition of the teeth. The treatment plan is formulated based on the findings of the radiograph. Basic Periodontal Examination should not be done in teeth which are replaced by implants.
A basic periodontal examination does not diagnose any condition. It is simply a screening tool that shows you the basic mirror of your oral health condition. The above-mentioned procedure is a standardised format for adults. When it comes to children, who can either have a dentition full of milky teeth or as a combination of milky and permanent teeth, the basic periodontal examination changes fractionally but significantly.
To begin with, children below the age of 7 years rarely show any signs of developing a periodontal condition that warrants treatment. It is from the age of 7 years when children’s periodontal condition needs to be examined. Unlike adults, not all teeth are screened. There are six chosen teeth whose condition would represent the periodontal condition of the entire dentition. These teeth are: upper right first molar, upper right central incisor, upper left first molar, lower left molar, lower left central incisor, lower right first molar.
Pocket formations are uncommon in children. Hence, the codes assigned for children between 7 to 11 years of age are 0, 1 and 2. It is in children in the age range of 12 to 17 years when all the codes can be assigned to the selected 6 teeth. Based on the codes, the children are advised and recalled as needed. Accordingly, parents are explained about the periodontal condition of the child and if at all he or she would be needing an orthodontic treatment in the near future. An individual should get a periodontal examination done at least once a year which can keep them in check with their oral health status.