Periodontal diagnosis, risk, and long-term stability
For dental hygiene preparation, the following shared science supports assessment, prevention, safe care and referral. Dentist-directed diagnosis, biopsy, restorative, surgical and sedation decisions remain with appropriately qualified clinicians. This chapter does not grant a hygienist authority for those procedures.
Establish what has been lost
A periodontal diagnosis starts with a medical and dental history, full clinical assessment, and appropriate imaging. Record probing depth, the gingival margin relative to the cementoenamel junction, clinical attachment level, bleeding, mobility, and furcation involvement. A deep probing measurement is not automatically attachment loss: a swollen margin may form a pseudopocket. Conversely, recession can expose considerable attachment loss despite a shallow sulcus. Describe both the current inflammatory condition and the historical supporting-tissue destruction before interpreting treatment need.
Interpret measurements in context
Probe gently with consistent technique. Compare the present chart with a reliable baseline rather than treating a single measurement as proof of progression. Radiographs help assess bone levels and patterns, but they do not replace soft-tissue measurements. Smoking can reduce obvious bleeding while increasing disease risk. Glycemic control, plaque access, restorative overhangs, and adherence can modify the clinical picture. Risk assessment should lead to a practical plan, not a label that excuses ongoing inflammation.
Treat causes and reassess
Nonsurgical instrumentation disrupts subgingival biofilm and removes retentive deposits while conserving root structure. Effective daily cleaning is an essential partner to professional treatment. Choose interdental aids that fit the actual spaces; open embrasures may need appropriately sized brushes. After healing, reassess the tissue response and persistent sites. Residual inflammation may reflect deposits, difficult anatomy, inadequate self-care, or systemic influences. A decision about surgery or regeneration should follow this reassessment and an appraisal of defect anatomy, tooth prognosis, and the patient's priorities.
Include implants and maintenance
For implants, distinguish soft-tissue inflammation from inflammation accompanied by progressive supporting bone loss. Compare with baseline records and expected remodeling whenever possible. Do not diagnose failure from bleeding alone or assume that a retained implant must be healthy. Supportive care is individualized according to stability, risk, access, and the ability to maintain effective cleaning. In an examination answer, connect the finding to its meaning, identify the missing information, and explain how reassessment would change the plan. This approach is more defensible than selecting an invasive procedure solely from one pocket measurement.