Periodontics
Periodontics: measure attachment, not just depth
Periodontal diagnosis depends on more than pocket depth. Record probing depth, recession, clinical attachment level, bleeding on probing, plaque, calculus, mobility, furcation involvement, and radiographic bone loss. CAL is the sum of probing depth and recession at the same site; a 5-mm pocket with 2-mm recession represents 7 mm of attachment loss. Gingivitis is reversible inflammation without attachment loss; periodontitis requires attachment loss and bone loss. Staging and grading add severity, complexity, and progression risk.
Risk factors shape both diagnosis and treatment: smoking, poorly controlled diabetes, medications, genetics, and plaque control. Smoking reduces bleeding, so a smoker can look healthier than they are. Nonsurgical therapy-oral hygiene instruction, scaling and root planing, and risk-factor control-is the foundation. Re-evaluate after healing before considering surgery. Antibiotics are adjuncts, not substitutes for mechanical debridement.
Traps: diagnosing periodontitis from a single deep pocket without attachment loss; assuming occlusal trauma causes periodontitis (it does not, though it can worsen mobility); and neglecting peri-implant disease. Also, do not confuse a pseudopocket from gingival enlargement with true attachment loss.
Rule of thumb: when pocket depth and attachment level disagree, believe the attachment level. Example: a 6-mm pocket with 4 mm of recession has 10 mm CAL and suggests significant loss, whereas a 6-mm pseudopocket with no recession may reflect enlargement.