When a dentist or physician is preparing a treatment agenda to heal a disease, test results are analyzed. Treatment decisions regarding a potential cure depend on information gathered. The more accurate the diagnostic information, the better the diagnosis and treatment. In the realm of periodontal disease, diagnosis is based in part on the collection and analysis of many numbers, specifically, measurements of the depth of the sulcus (crevice) of gum tissue that surrounds each tooth.
A periodontal charting generally consists of taking at least six measurements around every tooth. Areas of bleeding are also recorded. The evidence of bleeding is significant. Healthy gum tissue does not bleed when gently probed. There are certain factors, such as found in smokers that restrict bleeding, so lack of bleeding alone does not signify a healthy site.
These measurements (in millimeters) are one of the diagnostic tools (along with tissue color, position, and shape) a dentist and dental hygienist use to determine the severity of periodontal (gum) disease. Measurements generally range from 0 to 12 mm. Probing of the sulcus around the tooth often shows normal depths of 1 to 2 mm with greater depths in between the teeth where they touch as opposed to the direct cheek side or tongue side. The numbers will vary from position to position and tooth to tooth. They are rarely uniform throughout the entire mouth. The higher numbers indicate more severe soft and hard tissue involvement, and the greater the number of higher readings, the more likely surgical intervention is needed.
0 to 3 mm with no bleeding: Great numbers. No periodontal disease present.
1 to 3 mm with bleeding: Gingivitis (the mildest form of gum disease) present. Probably no bone loss. Usually treated with a good professional prophylaxis (cleaning) and improved oral self-care.
3 to 5 mm with no bleeding: May or may not have gum disease present. Smoking may be a factor in lack of bleeding. Since a patient cannot reliably clean deeper than 3 mm on a routine basis, there is high potential for gum disease to begin. Recommend professional recare visits 3 to 4 times a year.
3 to 5 mm with bleeding: Early to moderately advanced periodontal disease. Treatment is professional prophylaxis consisting of scaling and root planing and possibly systemic and/or site-specific antibiotics and other medications. Supporting bone may be involved. More frequent and extensive recare appointments are required. Some surgical intervention is possible.
5 to 7 mm with bleeding: Soft and hard tissue damage. Bone loss likely. Treatment will involve a more aggressive prophylaxis-scaling and root planing. Multiple appointments will be needed. Localized surgical intervention probable. Systemic and site-specific medications commonly used. Teeth may have started to become loose.
7 mm and above with bleeding: Advanced periodontal disease. Aggressive treatment required if teeth are to be saved. Surgery almost always required. Referral to periodontist is common. Systemic and site-specific medications commonly used.
In short, low numbers are good and high numbers are bad. The presence of deep periodontal pockets corresponds to more extensive gum disease and the need for more periodontal treatment.