Periodontal probing: Stop when you see red

Periodontal probing: Stop when you see red

Gingival bleeding on probing indicates inflammation and requires treatment.
Jun 01, 2012

During oral assessment, treatment and prevention visits, a periodontal probe is used to evaluate gingival health while patients are anesthetized. Depending on an animal's size, the veterinarian or dental assistant checks each tooth, probing the subgingival pockets for abnormal depths. During probing, little attention is usually given to bleeding because it's accepted as a common occurrence.

Jan Bellows DVM, Dipl. AVDC, Dipl. ABVP
Consider your own oral hygiene. This morning when you brushed your teeth and looked at the brush, I hope you didn't see blood. But what would have happened if you had? An alarm would have gone off in your mind. A trip to the dentist certainly would have been in order.

Let's bring this same knee-jerk reaction to dogs' and cats' mouths. Gingival bleeding on probing indicates an inflammatory lesion both in the epithelium and in the connective tissue. Gingival inflammation leads to engorgement of the capillaries and thinning of the sulcular epithelium, predisposing capillaries to rupture from usually innocuous stimuli. Thus, bleeding during pocket-depth probing should elicit an immediate reaction to stop, diagnose and treat. Bleeding doesn't occur in healthy tissue unless abnormally traumatized by the probe.

In simple terms, gingival bleeding is an objective, easily assessed sign of inflammation associated with periodontal diseases. Rare causes of gingival bleeding include hemophilia, leukemia, thrombocytopenia and liver and kidney disease. More commonly, though, bleeding comes from gingival inflammation due to inadequate plaque and tartar removal beneath the gum line.

Gingival bleeding assessment

Indices commonly used in human dentistry to assess gingival bleeding include the sulcus bleeding index, bleeding on probing and the gingival index.

Sulcus bleeding index (SBI) scores indicate:
  • 0—Gingiva of normal texture and color, no bleeding on probing (Photo 1)
  • 1—Gingiva clinically normal, but bleeding on probing (Photo 2)
  • 2—Bleeding on probing, change in color, no edema (Photo 3)
  • 3—Bleeding on probing, change in color, slight edema (Photo 4)
  • 4—Bleeding on probing, obvious edema and/or obvious change in color (Photo 5)
  • 5—Bleeding on probing and spontaneous bleeding, change in color, marked edema (Photo 6).

Bleeding on probing (BOP) is evaluated by noting bleeding after insertion of a probe into the base of the sulcus or pocket. Bleeding on probing is associated with inflammatory changes at the pocket's base and is a predictor of periodontal breakdown when present.

Gingival index (GI) scores of 0 to 1 indicate nonbleeding sites, despite clinical assessment of marginal inflammation (GI score of 1). GI scores of 2 and 3 indicate that bleeding is found spontaneously or after stimulation of the gingival margin with a probe. Specifically, GI scores signify:

  • 0—Normal gingiva
  • 1—Mild inflammation, slight change in color, slight edema, no bleeding on probing
  • 2—Moderate inflammation, redness, edema, bleeding on probing
  • 3—Severe inflammation, marked redness and edema, ulceration, spontaneous bleeding.