Periodontal probing: Stop when you see red - DVM
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Periodontal probing: Stop when you see red
Gingival bleeding on probing indicates inflammation and requires treatment.


DVM360 MAGAZINE


What to do when bleeding is noted

Determine the probing depth or attachment level (in cases of gingival recession). In midsized dogs, a depth > 3 mm is considered abnormal. In cats, a depth > 1 mm is consider abnormal.

Next, determine the stage of tooth mobility:

  • 0 (M0)—Physiologic mobility is up to 0.2 mm.
  • 1 (M1)—Mobility is increased in any direction other than axial over a distance of more than 0.2 mm and up to 0.5 mm.
  • 2 (M2)—Mobility is increased in any direction other than axial over a distance of more than 0.5 mm and up to 1 mm.
  • 3 (M3)—Mobility is increased in any direction than axial over a distance exceeding 1 mm, or any form of axial movement is noted.




Finally, determine the stage of periodontal disease (PD) present and treat accordingly:
  • Stage 1 (PD 1) involves gingivitis only, without attachment loss. The height and architecture of the alveolar margin are normal. Probing depths will be normal. Treatment: Clean the teeth and apply a plaque prevention gel (Photos 7A and 7B).




  • Stage 2 (PD 2) is considered early periodontitis. Less than 25 percent of attachment loss is present, or, at most, there's a stage 1 furcation involvement in multirooted teeth. Early radiologic signs of periodontitis are present. The loss of periodontal attachment is less than 25 percent as measured either by probing the clinical attachment level or by radiographically determining the distance of the alveolar margin from the cemento-enamel junction relative to the length of the root. Treatment: After professional cleaning, apply a local antimicrobial agent.
  • Stage 3 (PD 3) involves moderate periodontitis, which is noted when 25 to 50 percent of attachment loss is measured either by probing the clinical attachment level or by radiographically determining the distance of the alveolar margin from the cemento-enamel junction relative to the length of the root. Alternatively, stage 2 furcation involvement may be noted in multirooted teeth. Treatment: If stage 2 or 3 tooth mobility is present and the owner cannot agree to an effective homecare regimen, consider extraction. Other options include gingival surgery to decrease pocket depth. Perform gingivectomy if sufficient attached gingiva remains (Photos 8A and 8B; 9A and 9B, p 8S). Open-flap root planning is indicated in cases in which clients are committed to home care and the teeth are not mobile (Photos 10A, 10B, 11A and 11B).


Photo 12: Stage 4 periodontal disease that necessitates extraction.
  • Stage 4 (PD 4) is advanced periodontitis, which is noted when more than 50 percent of attachment loss is measured either by probing the clinical attachment level or by radiographically determining the distance of the alveolar margin from the cemento-enamel junction relative to the length of the root. Alternatively, stage 3 furcation involvement may be noted in multirooted teeth. Treatment: Extraction is the treatment of choice in cases of advanced periodontal disease (Photo 12).


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Source: DVM360 MAGAZINE,
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