A Blog Apart

A periodontal probe is perhaps the simplest and most effective tool in the dental arsenal for capturing the true nature and topography of the bone surrounding the teeth.  Just like a two dimensional map does not give a traveler information about the contours of the terrain he is traveling, a radiograph does not give the dentist information about the contour of the bone.  If that same traveler wants to know the contour of each hill and each valley of a particular country, the best way for him to gain this knowledge is to walk it and feel these things for himself.  Even if this traveler did not have a map of the country he was walking, he could soon form one from the information gained during his journey.  In a similar way, a periodontal probe “walks” the country of the periodontium and gives the dentist first-hand knowledge as to the scope of the terrain that allows him to form a map of the health of the bone and gingiva. 

The probe itself looks like a half inch piece of paper clip attached to a long handle.  The probe portion is blunt and has markings each millimeter for 15 millimeters. These markings give information as to the level of health of the bone and gums.

Now, why is information about the level of periodontal health important?  In a healthy mouth, the gums, or gingiva, serve as a thin layer to cover the bone that anchors each tooth in place.   A dentist uses his periodontal probe by placing it in the space just under the gingiva between the gingiva and the tooth.  The probe is walked around the entire circumference of each tooth, and as he walks the probe, he should, in a healthy mouth, only sink 2 or 3 millimeters deep.  This tells him that all areas just below the gum line are able to be cleansed by a toothbrush.  In an unhealthy mouth, a dentist may sink his probe 4 to 10 or even 12 millimeters below the gum line.  A toothbrush can clean only a millimeter or two below and so you can imagine why a reading of 5, 6, or 7 millimeters can mean trouble.  Probing is the only means a dentist has for capturing the reality of the health of the gingiva and the bone. 

A comprehensive periodontal evaluation consists of a full mouth radiographic series, and a recording of all gingival probing depths (explained below). The need for an examination this in depth exists only among a percentage of the population.  A dentist determines the need for this deeper investigation based on a screening process known as a PSR™.  PSR™ stands for Periodontal Screening and Recording™ and uses a pass/fail set of criteria.  If you pass, you are periodontally healthy.  If you fail, then the more detailed, comprehensive probing is done.  During the PSR, the dentist takes a periodontal probe and examines your teeth in a less formal stroke than that of traditional probing.  The PSR is designed to eliminate the time requirements placed on a comprehensive periodontal examination and to save the patient from unnecessary treatment.

Every person with all their adult teeth should be probed at least once every check-up with using the PSR method.  This becomes even more important because as you age, the incidence of periodontal disease increases and the ability of your body to cope with that disease decreases.

*These articles are informational only and are not meant to supplement actual treatment.  The linked websites are not affiliated with A Blog Apart or its authors and the ideas expressed do not necessarily represent the views of this author.  Links were provided for definition or illustrative purposes only.*

Is there a dental subject that you’d like to know more about? If so,  we’d love to hear from you.  Leave your suggestions in the comments section along with your email address so we can contact you to let you know when to your question will appear on A Blog Apart. 

Each person has their own needs and desires when it comes to the personality and demeanor of their healthcare professionals.  These factors are crucial in creating an environment of comfort and safety during appointment times, but they are not at all determining factors in the competence and skill of a dentist or his staff.  In fact, I have met more great dentists who were not friendly than great dentists who were.

Just because a dentist is nice, kind, and compassionate doesn’t necessarily mean he is skillful, competent, or wise. However, no one wants high quality work from a stick-in-the-mud.  Balance is the key and educating yourself in these few easy concepts will ensure that you get nice and kind along with skill and competence.

 1. The Examination
The dental examination is the starting place for all dental patients and as such, is an important tool in helping you as a patient decide whether the dentist working in your mouth is doing a worthy job. 

First of all, a good examination should last more than just five minutes.  This is the time that the doctor uses to gather as much information about your mouth as possible and depending on the reasons behind your visit and exam could take up to 2 hours; a good average is 45 minutes.

Second, without a comprehensive understanding of your teeth, jaw joints, and surrounding tissue (muscles of mastication, gingiva, buccal mucosa) there is no foundation for treatment.  Even a simple tooth ache cannot be effectively diagnosed or treated without this vital information. Just remember this: there are reasons behind every pain or sensitivity, every joint pop, worn tooth, and headache.  If your dentist doesn’t know what the cause is, don’t count him out as long as he keeps searching for a reason.

With that in mind, here are some things that are included in a complete initial dental examination. 

• Appropriate Radiographs
• Oral Cancer Screening
• Periodontal Screening and Recording
• Tooth Exam
• Palpation of Masticatory Muscles and TMJ’s
• Occlusal Exam
• Impressions of both Upper and Lower Teeth
• Bite Registration Record and Facebow Transfer

*These topics will be discussed in detail in future articles.  For now, just familiarize yourself with the terms.*

2.  The Treatment
Gathering information is only one part to this equation.  The interpretation and use of this information is equally important.  There are two considerations when deciding whether the treatment being offered is valid and well planned. 

First, what reasons does the dentist have to support his proposed treatment?  Is he saying things like “We’ll try this and see if it works,” or “This will most likely take care of the problem”?  These statements are alright if reversible treatment is being considered but guesswork is never meant to take the place of a concrete diagnosis and should never be the basis for irreversible treatment.  The old saying holds true; once you’ve started, you can never go back.

Second, ask yourself if what the dentist is saying sounds right.  If you have any reservations about the proposed course of action, even if it is something simple, stop and get clarity.  Make sure your reservations are addressed.  If the answers don’t make logical sense, then it is silly to move forward.  You are autonomous and no one knows better than you what treatment is right.  Like I said above, there are reasons behind every dental problem and guessing just doesn’t need to be done. If your reservations cannot be resolved, then it is time to move on. 

Summary:
These are some elementary guidelines that have been generalized as a primer of sorts.  Future articles will educate you as to the specifics of harmonized dental function and a range of dental pathoses and will add to your knowledge allowing you to take control of your oral health and make decisions with all wisdom and confidence.

*These articles are informational only and are not meant to supplement actual treatment.  The linked websites are not affiliated with A Blog Apart or its authors and the ideas expressed do not necessarily represent the views of this author.  Links were provided for definition or illustrative purposes only.*

How do you know if the dentist that you are going to is competent?  What criteria do you use? As a dentist, I know how to tell if a fellow dentist is good, bad, or ugly, but how do you tell? 

As I was saying in a comment to my last post, most people today have a lot of knowledge of medicine from shows like ER, CSI, and House MD and from networks like Discovery and The Learning Channel.  We are constantly hearing new things about medicine because they are in our newspapers and magazines.  I bet if I asked you to define terms like cardiac defibrillation, sputum, pulmonary embolism, and neurovascular accident, you may not know all of the technical specifics, but you’d give a working definition.  But what about the dental term TMJ?  Most people think that TMJ is a problem with their jaw joints, but did you know that TMJ stands for TemporoMandibular Joint and refers to the joint itself, and that to say “I have TMJ” is akin to saying ”I have arm” or “I have stomach”?  Can you start to see the imbalance between medical knowledge and dental knowledge among the general public?

So, my questions stand.  How do you choose a dentist and what criteria do you use to trust him with your mouth?  Please leave specific comments and most importantly, encourage your friends and relatives to visit the site and do the same!

UPDATE:  I realize that insurance is an issue when finding a dentist.  What I am interested in is what keeps you at the dentist, not necessarily what brought you to him (though feel free to mention both reasons).