Diagnosis of gingival recessions
The diagnosis of gingival recession is made in the dentist’s office. This is the only way to have the health of the gums properly assessed. In addition to the clinical assessment with a periodontal probe, X-rays are also consulted for the assessment.
The clinical examination in the dental office is the first opportunity to have early signs of gingival recession properly assessed.
While the central incisors in the lower jaw are often affected in adolescents, adults reveal gingival recession more frequently on their posterior teeth in the upper jaw.
One’s own assessment of the gums, for example at home in front of the mirror, is insufficient for a correct evaluation. Without a clinical examination in the dental practice, it is not possible to identify the reason for the gingival recession.
Only the correct clinical examination in the dental practice with a so-called gum probe (periodontal probe) can provide information as to whether the gums are healthy, an inflammation of the gums (gingivitis) or already a disease of the tooth anchorage (periodontitis) is present.
Severity of gingival recession
Gingivalrecessions are classified into different degrees of severity. Depending on the severity, only a small selection of treatment options are available.
Four degrees of severity are distinguished for gingival recessions, because the treatment options can also be derived from this.
Simple recession is when the recession of the gum line has not yet reached the mobile oral mucosa. In the second degree of severity, the recession has already penetrated the mobile mucosa. In both cases, correction of the gingival margin is possible with a surgical intervention.
Since in the case of severity levels 3 and 4, jawbone between the teeth has also already been removed, gingival recession present there cannot be completely corrected with surgical measures either.
Periodontal basic examination
During an initial check-up, the dentist or dental hygienist can carry out a so-called periodontal brief examination, which will only take a few minutes.
The basic periodontal examination is intended to determine in a short time whether gum problems are present. Gingivitis can be easily determined or periodontitis can be detected.
Using a gum probe (periodontal probe), the depth of penetration at the gum line is measured gently and with millimetre precision at selected points.
After this short examination, further clarifications are only carried out if signs of the degradation of the tooth anchorage are found. These examinations include the so-called periodontal status and additional X-rays.
Millimetre-precise clinical probing with the gingival probe to measure the gingival margins and to locate the jawbone are essential for the diagnosis of gingival recession.
During the clinical examination with the gum probe (periodontal probe), the penetration depth of the probe into the gingival pocket is measured with millimetre precision at up to six points per tooth. Strictly speaking, the length between the gum line and the bottom of the gingival pocket is measured. This is called the probing depth. In healthy areas, the probing depth will be no more than 3 mm. In places where the gingival recession has already degraded the tooth anchorage, the probing depth will only be a few millimetres.
In addition, the height of the jaw bone (attachment level) is recorded to the millimetre in a so-called periodontal status. A periodontal status is indispensable for the diagnosis and treatment planning of a gingival recession. The periodontal status can be recorded and used free of charge online in any dental practice: www.parodontalchart-online.com.
Measurements with the gingival probe can reveal areas in the dentition with existing bone loss that need to be additionally assessed with X-ray findings.
The diagnosis of gingival recession may only be confirmed with the necessary X-rays. The choice of x-rays necessary for the diagnosis of gingival recession is only made after the clinical examination has been completed. In this way, excessive exposure to X-rays can be prevented.
In the simplest case, an X-ray diagnosis consists of two images (bite wing images) and in the most comprehensive case of a so-called X-ray status with up to 14 additional X-ray images or an orthopantomogram. The X-rays taken must show the jawbone surrounding the tooth and thus make it possible to assess the severity of the bone loss.
In each X-ray from the dental practice, the dentition must be checked for both caries and periodontitis.
Classification of periodontal diseases
The diagnosis of gingivitis and periodontitis is based on the internationally recognised so-called classification of periodontal diseases.
In 1999, the first international workshop for the classification of periodontal diseases took place in the USA. The most important change compared to the European classification of 1993 was that the disease forms were generally no longer defined primarily on the basis of the age of the patient at the first diagnosis (e.g. juvenile and adult periodontitis). Chronic and aggressive periodontitis were introduced, as well as periodontitis that can be associated with systemic diseases.
However, the new classification since 2018 no longer distinguishes between chronic and aggressive. Periodontitis is now described with so-called stagings and gradings, following the classification of diabetes.
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