Periodontal Disease Diagnosis

Periodontium

• Consists of four components: gingiva, cementum, periodontal ligament, and alveolar bone
• Gingiva is the mucous membrane that covers the jawbone and surrounds the base of the teeth

Clinical Attachment Loss (CAL)

• Refers to the loss of attachment between the tooth and the surrounding tissues
• Measured from the cementoenamel junction (CEJ) to the base of the pocket

Healthy Periodontium

• Characterized by a normal sulcus (0 to 3mm) with the junctional epithelium (JE) attached to the CEJ
• No evidence of bone loss or inflammation

Biofilm-induced Gingivitis

• Inflammation confined to the gingiva, no evidence of bone loss
• Characterized by a false pocket (hypertrophied gingiva), oedema, redness, and loss of architecture

Periodontitis

• Characterized by true pocket formation, loss of attachment, and apical migration of the JE
• Radiographic evidence of bone loss, recession may be detected

Probing Force

• A light probing force of 25 g is used when probing the periodontal tissues, equivalent to the force required to blanch a fingernail

Bleeding on Probing (BOP) Index

• Used to assess the presence or absence of bleeding in each quadrant
• Calculated as a percentage score for the whole mouth: % BOP score = (Number of surfaces with bleeding x 100) / (Total number of teeth x 6)

Case Definitions

• Healthy periodontium: BOP < 10%, PPD ≤ 3 mm, CAL: No (intact), Radiographic bone loss: No (intact)
• Gingivitis: BOP ≥ 10%-30% (localized), > 30% (generalized), PPD ≤ 3 mm, CAL: No (intact), Radiographic bone loss: No (intact)
• Periodontitis: Interdental CAL ≥ 2 in non-adjacent teeth, or Buccal or Oral CAL ≥ 2