How is periodontitis diagnosed?

If your dental professional suspects you may have periodontitis (irreversible gum disease), they will take a detailed examination to check the health of your gums and the supporting structures.

What happens during the assessment?

Your dental professional will take a series of measurements to understand how healthy your gums are. These measurements may include:

• Probing pocket depth (PPD) – checking the depth of the space between your gum and the tooth
• Gum recession – measuring if your gums have shrunk, which can expose the roots of your teeth
• Furcation involvement – checking for bone loss between the roots of teeth with multiple roots (molar teeth and some premolars)
• Tooth mobility – assessing if any of the teeth are loose, which can occur if the bone supporting them is affected
• Full mouth bleeding score/ Full mouth bleeding on probing (BoP) – checking how much of your gums bleed when gently probed, which provides an indication of the level of inflammation in the mouth
• Full mouth plaque score – an assessment of the amount of plaque biofilm (bacteria) on your teeth

What else is needed?

Once the clinical measurements are complete, your dental professional may take radiographs (x-rays) to take a closer look at the bone level supporting your teeth. It is important to note that radiographs produce a 2-dimensional image of the teeth. This means they are most useful for assessing bone loss between the teeth (interproximal bone loss).

How is periodontitis diagnosed?

Using all of the above information, your dental professional will classify your periodontitis using these key parameters:

• Extent – How much of your mouth is affected?
  • Generalised – more than 30% of teeth are affected
  • Localised – less than 30% of teeth are affected
  • Molar-incisor pattern – this mainly affects the first molars and incisors
• Staging – How severe is the bone loss? The stage reflects how much bone has been lost due to periodontitis. It is assessed by looking at the worst-affected tooth on your radiograph.
  • Stage I (early/ mild): less than 15% of bone loss
  • Stage II (moderate): Bone loss within the coronal third (initial third) of the root
  • Stage III (severe): Bone loss within the mid third of the root
  • Stage IV (very severe): Bone loss extending to the apical third (final third) of the root
• Grading – How fast is the disease progressing? The grade gives an idea on the rate of progression of the disease process by comparing the amount of bone lost with your age:
  • Grade A: Slow rate of progression
  • Grade B: Moderate rate of progression
  • Grade C: Rapid rate of progression
• Current status – How are your gums right now? Your dental professional will be able to inform you of the current status of your gum health to see if your condition is stable, in remission, or still active:
  • Currently stable: PPD ≤4mm (with no BoP at 4mm sites), BoP <10%
  • Currently in remission: PPD ≤4mm (with no BoP at 4mm sites)
  • Currently unstable: PPD ≥5mm or PPD 4mm with BoP
• Risk factor assessment – Your dental professional will assess risk factors which are likely to be contributing to the periodontitis (e.g. smoking, sub-optimally controlled diabetes)

Understanding the extent, stage, and progression of your periodontitis is essential for creating a treatment plan tailored to your needs.

It is important to understand that periodontitis is a lifelong condition. While the disease itself cannot usually be cured or fully reversed, it can be effectively managed with the right care and maintenance.

References

BSP flowchart implementing the 2018 classification. Available here (Accessed: 05 January 2025).