What is a Comprehensive Periodontal Evaluation?

Comprehensive Periodontal Evaluation

The Comprehensive Periodontal Evaluation. You’re going to see it come up a lot. If you’re a new patient, I’ll be conducting one during your first appointment. So, what is it?

A few years back, the American Academy of Periodontology (AAP) established the evaluation and recommended that all adults undergo one on an annual basis. A Comprehensive Periodontal Evaluation, very simply, is a means to assess your periodontal health by examining several key areas:

  • Your teeth
  • Your plaque
  • Your gums
  • Your bite
  • Your bone structure
  • Your risk factors

The AAP’s recommendation seemed to stem from two emerging and diverging realities. The first: We’ve reached a point, as a result of advances in our knowledge and therapy, where the majority of patients can retain their teeth over their lifetime with the proper treatment, reasonable plaque control, and continuing care. The second: The majority of patients are not taking those basic measures, and the prevalence of periodontal disease, at a time when it should be barely visible in our culture, is instead growing into a crisis.

Shortly after the AAP came out with its recommendation, the Centers for Disease Control and Prevention (CDC) published a study titled Prevalence of Periodontitis in Adults in the United States: 2009 and 2010, which found that 64.7 million American adults age 30 and older, or 47.2 percent at the time, had mild, moderate, or severe periodontitis, the more advanced form of periodontal disease. And in adults 65 and older, prevalence rates increased to 70.1 percent.

From blip to public health concern

The findings were both disturbing and a shock to the AAP. Never before has periodontal disease been so easily preventable, yet it was flourishing. Not only that, the findings were a massive departure from previous estimates.

They were based on data collected as part of the CDC’s 2009-2010 National Health and Nutrition Examination Survey (NHANES), which, for the first time, included a full-mouth periodontal exam to assess for mild, moderate, and severe periodontitis, making it the most comprehensive survey of periodontal health ever conducted in the United States. (Researchers measured periodontitis because it’s the most destructive form of periodontal disease. Gingivitis, the earliest stage of periodontal disease, was not assessed.)

Previous NHANES relied on partial-mouth periodontal exams. And since periodontal disease is not evenly distributed in the mouth, the estimates that stemmed from those partial-mouth exams may have underestimated actual prevalence rates by as much as 50 percent.

In other words, with the publication of this one study, periodontal disease went from a blip on the radar to a full-blown public health concern.

“We now know that periodontal disease is one of the most prevalent non-communicable chronic diseases in our population, similar to cardiovascular disease and diabetes,” said Robert Genco, DDS, PhD, a co-author of the study.

Why you need a Comprehensive Periodontal Evaluation

Though the AAP released the Comprehensive Periodontal Evaluation guidelines several months prior to the study’s publication, it fast became a pillar of the new prevention recommendations to emerge in the wake of the CDC’s data.

The thinking being, by assessing your oral health on an annual basis, you and your dental professional—the evaluation can be performed during a regular check-up by a dental hygienist, your dentist, or a periodontist—will be able to more accurately gauge how healthy your mouth is and, in turn, be better positioned to notice any conditions, such as periodontal disease, that may require treatment.

There’s also a growing body of research that’s strengthening the link between periodontal disease and other chronic inflammatory diseases, such as diabetes, cardiovascular disease, and respiratory diseases, which heightens the urgency to treat the inflammation that causes periodontal disease to help shore up your overall health.

How to prepare for your Comprehensive Periodontal Evaluation

You’re probably already familiar with aspects of the Comprehensive Periodontal Evaluation before you really knew what it is. What you probably didn’t realize is that the evaluation is a two-way street.

The sixth part is a discussion of your risk factors. The AAP sets the foundation with a few points we need to address: your age, whether you’re a smoker, and if you have a history of diabetes and cardiovascular disease. That last part’s critical because of the link I mentioned a couple of paragraphs ago.

From there, I like to open up the conversation beyond the standard checklist to see what more the two of us can learn about your oral health. Your family history, for one, is important to me. Recent research has shown that genetics may be a risk factor for developing periodontal disease, though to what extent remains unclear. I’ll also want to know about any medications you’re taking because they may inform something I picked up on earlier in the evaluation or a treatment that will follow. So, it helps to give some thought to these areas before your appointment.

I’ll close by asking, very simply, “Do you have any thoughts?” I find that it’s a little less intimidating than asking, “Do you have any questions?” It’s meant as a catchall for anything that may not have already risen to the surface earlier, like some spotty bleeding while you were brushing the other day or a piece of your family’s medical history that may seem unrelated.

The more information we can gather at each installment, the more effective the Comprehensive Periodontal Evaluation is.