Message Boards
Today's Active Topics Today's Active Cases Browse Forum Categories My Recent Activity My Messages Private Groups My Marked Threads My Subscriptions
Today's Active Images Today's Active Polls Most Active Topics Global Townie Map Advanced Message Board Search Message Board Terms of Use

From Trisha's Desk Trisha E. O’Hehir, RDH, MS Editorial Director, Hygienetown

Start Discussion More by this author (282)

 
Underestimation of Periodontal Disease
– by Trisha E. O’Hehir, RDH, BS, Hygienetown Editorial Director

Has this ever happened to you? A regular patient is scheduled and it's been a year since his last visit. Mr. Hal E. Tosis presents for his "cleaning" and you begin with a review of medical history, extraoral and intraoral oral cancer screening exam and then you take a look at his teeth and gums
Not much supragingival calculus and the probing looks within normal limits, with only slight bleeding. You tell him he's doing fine and he's happy to hear that, reporting that he only brushes and never flosses. You begin instrumentation and suddenly, you drop into 4-6mm interproximal pockets and find subgingival calculus. What happened?

How could the probing measurements have been so wrong? Now, after just telling the patient that everything looks fine, you find he actually has early to moderate periodontal disease in all posterior interproximal areas.

The reason is simple and we can blame it on researchers and educators who listen to the researchers. Remember back in school when you were taught to probe with the tip of the probe in constant contact with the root surface, holding the probe parallel to the long axis of the tooth and making sure to probe the line angles of all the teeth? Researchers wanted their probing to be reproducible, so rather than angling the probe to reach the mid-interproximal surface and find any crater development, they kept the probe parallel to the long axis of the tooth and guided the probe around the tooth, from line angle to line angle. This method, while being easily reproducible, will not detect any mid-interproximal pockets. This significantly underestimates the prevalence of periodontal disease. According to the American Academy of Periodontology, periodontal disease might be underestimated by as much as 50 percent.

Good educators followed the direction of researchers and instructed years of students to hold the probe parallel to the long axis of the tooth and measure around the tooth from line angle to line angle. This explains why interproximal defects can be missed so easily.

Next time you see a patient who hasn't been in for a while and who doesn't practice daily interproximal oral hygiene, try probing according to Dr. Howard Farran. Wish I could take credit for this idea, but it was Howard who came up with it and it's a great idea! No more probing around the teeth as instructed in school and as so many computer programs require. Instead, separate facial and lingual surfaces from interproxiaml surfaces, making two passes with the probe. First, probe all the brushing surfaces. Tell the patient you are doing a new test for gum disease and you will say the measurements out loud so he can hear them. The numbers should be 1 to 3, anything 4 or higher is disease and any bleeding points are a sign of infection. After probing the brushing surfaces, tell the patient you are now going to check for infection on his flossing surfaces. Same rules about numbers – 1 to 3 are healthy, anything 4 or higher is disease. After you finish this probing system on patients, they will know their periodontal status before you say another word.

Make these two simple changes and you will never overlook interproximal disease again. First, be sure to angle your probe into the mid-interproximal, despite what you were taught in school. Second, probe brushing surfaces first, and then probe flossing surfaces. You might be surprised to find that you too have underestimated the prevalence of periodontal disease in your practice.

Inside This Section
116 Perio Reports
120 Profile in Oral Health: Your Fresh Breath Program
124 Drug-free Oral Wound Dressing Makes for Happier Patients (and a More Pleasant Office)
Look for additional content in the Hygienetown Magazine digital edition.
Dentaltown Magazine
September 2025
Dentaltown Magazine September 2025 Read Current Issue Read Archived Issues
Sponsors
Townie Perks
Townie® Poll
Who or what do you turn to for most financial advice regarding your practice?
  
Site Menu
Message Boards Magazine Continuing Education Podcasts Blogs Classifieds Dental News Events Townie® Poll Ebooks Townie Choice Awards
Company Info
Contact Us Advertise With Us Howard Farran DDS, MBA Policies and Agreements
Site Help
Sally Gross, Member Services Specialist
Phone: +1-480-445-9710
Email: sally@farranmedia.com
©2025 Dentaltown, a division of Farran Media • All Rights Reserved
9633 S. 48th Street Suite 200 • Phoenix, AZ 85044 • Phone:+1-480-598-0001 • Fax:+1-480-598-3450