Diagnosis: Advanced and Complete
• Biochemical: MMP-8 activity
• Genetic: individual risk assessment
• Microbiological: polymicrobial infection
• X-rays panoramic, periapicals, cone beam
• Clinical probing and periodontal charting
The aetiology, that is the analysis of the cause, shows what a fundamental role bacteria play in the onset of periodontal disease. The majority of bacterial species present in the oral cavity have been skilfully arranged by colour into families or groups.
A specific group of bacteria correspond both qualitatively and quantitatively to to each stage of periodontal disease, which can be mild, moderate or severe.
Periodontitis: symptoms and diagnosis
The detection of high levels of aMMP-8 at salivary or clevicular/sulcus fluid level, is an early indicator of tissue damage in the oral cavity that allows the specialist to take a prompt action to prevent periodontal and peri-implant damages. This is the first and quickest step to carry out in order to investigate the presence of periodontal disease
Hence, to accurately diagnose periodontitis, it is clear how crucial it is to identify the type of bacteria, and, above all, the quantity of bacteria lurking in the pockets within the mouth. To have a confirmed diagnosis, it is useful to conduct two tests: one microbiological and the other for detecting the risk of periodontal disease. Both tests are completely painless and require the collection of two specimens from the mouth, which are then analysed in a molecular biology laboratory. It is recommended to repeat the microbiological tests several times – at least two, or three depending on the case, as this represents an objective indication not only of the initial situation, but also of the effective improvement as treatment continues.
With the microbiological test, the laboratory analysis provides a report illustrating the presence of the main bacteria. The data is grouped together into two diagrams per sector, one on the left and one on the right: the former represents the percentage of pathogenic (bad) bacteria as a percentage of the total bacteria present in the mouth, while the latter associates the pathogenic bacteria to their group, thus identifying the predominant category. Upon reaching a threshold of less than 1% of total pathogens, the patient can be considered healed in microbiological terms.
On the other hand, the periodontal disease risk test, which is only completed once, calculates the subject’s personal predisposition to periodontal disease. This test is conducted by wiping a swab inside the cheeks, on the tongue, and in the saliva, to collect the exfoliated cells normally present in the mouth. Based on the risk, which can be low, medium, high or very high, treatment is planned with the aim of restoring the balance in the host’s saprophytic bacteria and immune system that is compatible with oral health.
Every individual has a well-defined microbial balance that is highly variable from one subject to another. In fact, the same is demonstrated by the fact that the same quantity of bacteria in one mouth can cause disease, whilst in another it is compatible with good health.
Periodontal probing to prevent pyorrhea
Another extremely useful method for making a diagnosis is the periodontal probe, which reveals the presence of bleeding, pus, the degree of mobility of the teeth, and measures the depth of the pockets and receding gums. The data collected from the probe are recorded in the periodontal chart, which is updated during the course of treatment.
Furthermore, an X-ray image technique, which establishes the bone levels of the maxillary (upper) and mandibular (lower) bones, called orthopantomography, or a series of sixteen more-detailed intraoral “plates” (peri-apicals) that also highlight the structures inside the mouth.
For a proper diagnosis, it is also important to have a general picture of the contributing factors that must be kept under observation or eliminated as they could compromise full recovery from the disease, which include:
- Poor oral hygiene
- Diabetes mellitus
- Autoimmune diseases
- Occlusal trauma
- Severe stress episodes
- Improper restoration of dental prostheses or fillings
- Anatomical abnormalities (frenulum and roots)
- Menopause, pregnancy, breastfeeding
After collecting all this data, the Dentist and Dental Hygienist will have a complete and detailed picture of the situation, and thus will be able to customise the treatment by repeating these examinations and monitoring the course of the periodontal disease during treatment.