Periodontal Probing Protocol
QUESTION: I just started working for a new
dentist whose periodontal protocol is lacking.
I would like to implement a new system but I
need evidence to back up my position. I am trying
to find an article that specifically states the standard
of care for full-mouth periodontal probing is once a
year. I have found numerous articles that state this
but none from professional sources such as the
American Dental Association, American Dental
Hygienists' Association, or American Academy of
Periodontology (AAP). Where can I find this information?
ANSWER: I understand why you haven't
had any luck finding a "standard of care"
regarding the frequency for periodontal probing.
As part of a comprehensive periodontal
evaluation, full-mouth probing is a key aspect
of assessment. A newly published study also
showed that the prevalence of periodontitis
in the United States is underestimated by
50% when only partial-mouth probing is used
to assess periodontal status.1 This tells us that
so-called "spot-probing" is likely inadequate.
Like you, I searched numerous sites to find a
specific timeframe for full-mouth probing, but
could not find anything definitive. In fact, the
various Position Papers and Guidelines from the
AAP seem to be purposely vague on this topic.
I also sought the opinions of my husband, Mike
Rethman, DDS, MS, and Gary Greenstein, DDS,
a well-known periodontist who has written
many literature review papers. They both stated
that there is no standard and agreed there
should not be, because full-mouth periodontal
probing varies according to the
needs of the patient. I know this isn't
much help for you in trying to convince
the new dentist you work with, but maybe
a medical analogy would be helpful. Ask
him or her if there is a standard of care for
how often blood pressure should be monitored.
There isn't—it depends on the individual.
Some people should check their
blood pressure daily, while others
don't need such frequent monitoring.
Yet even though there is no
set standard, it behooves the
patient (and the clinician) to
be aware of blood pressure
readings and check
them regularly. The
same can be said for periodontal parameters,
such as probing depths, bleeding on probing,
furcation involvements, mobility, etc. In fact, a
comprehensive periodontal examination
involves those measurements as well as medical
and dental history updates, intraoral and
extraoral tissue examinations, necessary radiographs,
recording the presence of deposits
on the teeth, and an evaluation of the teeth
and their replacements (eg, the condition of
restorations, notation of carious lesions,
occlusal relationships, and more). As stated in
the AAP's Parameter on Comprehensive Evaluation:
"Based on the results of the examination,
a diagnosis and proposed treatment plan
should be presented to the patient. Patients
should be informed of the disease process,
therapeutic alternatives, potential complications,
the expected results, and their responsibilities
in treatment. Consequences of no treatment
should be explained to the patient."
Therefore, a comprehensive periodontal exam
once a year seems not only reasonable but an
important aspect of assessment.
The AAP's Parameter on Comprehensive
Evaluation is available at: www.perio.org/resources-products/pdf/847.pdf. Share this
article with your dentist so he or she can
unde rstand the various aspects of a complete
periodontal examination and the
importance of regular monitoring, including
periodontal probing, based on the
needs of the patient.
1. Eke PI, Thornton-Evans GO, Wei L, Borgnakke WS,Dye BA. Accuracy of NHANES periodontal examination protocols. J Dent Res. 2010;89:1208-1213.