INDICATIONS

• Every patient that is anesthetized for any dental procedure should have a complete dental examination performed, including periodontal probing of every tooth surface.

EQUIPMENT

Periodontal Probe

• Round, flat
  
• Marked in millimeters—various markings (Fig. 2-1)
  
  
  
  • Some marked with indentations at 1, 2, 3, 5, 7, 8, 9, and 10 mm
    
  • Some marked in alternating 3-mm bands of black and silver
  
  
• Pressure-sensitive—plastic probe with additional indicator that is depressed when too much pressure is applied

Figure 2-1 Two periodontal probes: the top one with marked indentations at 1, 2, 3, 5, 7, 8, 9, and 10 millimeters; the bottom one with alternating black and silver bands of 3 mm each.

Periodontal Explorer (Other End of Many Probes)

• “Shepherd’s hook”—sharp, slender tip used as tactile instrument to detect soft enamel (pre-carious), open canals, and enamel defects, especially feline resorptive lesions (Fig. 2-2)
  
• Can be gently used subgingivally to detect calculus deposits

Figure 2-2 Explorer tip (shepherd’s hook).

PROCEDURE

• Initial assessment with probe before dental therapy to identify specific areas of concern (“red flag check”)—for better treatment planning and to inform owner of unexpected problems
  
• Complete probing and charting must be done after plaque and calculus is removed because areas will be occluded with the debris
  
• After cleaning each “half-mouth,” examine and probe the buccal/facial surfaces of the “up” side, and the lingual/palatal surfaces of the “down” side
  
• Gently insert the probe into the gingival sulcus, advancing to the depth of the sulcus or pocket until touching the base (Fig. 2-3)
  
  
  
  • Note: with inflamed pockets, the probe can easily be pushed past the base attachment because the tissue is delicate—use great care!
  
  
• “6-points” refers to gently placing the probe at the six line angles of the tooth (in human dentistry with interproximal contact points, the probe cannot be advanced circumferentially around the tooth).
  
• Measure and record abnormalities encountered:
  
  
  
  • Periodontal pocket (PP): pathological depth greater than normal sulcus
    
    
    
    • Greater than 2–3 mm in the dog (take size into account)
      
    • Greater than 0.5 mm in the cat (Fig. 2-4)
    
    
    
    
    • Mark “PP” and millimeter depth on chart—there may be several measurements recorded around an individual tooth
    
    
  • Root exposure (RE): area of exposed root now visible due to gingival and alveolar bone loss (Fig. 2-5)
    
    
    
    • Mark “RE” and millimeter depth on chart
      
    • If additional pocket formation, mark that as well
    
    
  • Attachment loss (AL) (see Chapter 26)
    
    
    
    • Combination of RE and PP
      
    • Total AL is the measurement from the neck of the tooth (cementoenamel junction) to the depth of the pocket
    
    
  • Furcation exposure (FE): space between roots of multirooted teeth are exposed due to gingiva and bone loss
    
    
    
    • F1: stage 1 exists when a periodontal probe extends less than halfway under the crown in any direction of a multirooted tooth with AL.
      
    • F2: stage 2 exists when a periodontal probe extends greater than halfway under the crown of a multirooted tooth with AL but not through and through.
      
    • F3: stage 3 exists when a periodontal probe extends under the crown of a multirooted tooth, through and through from one side of the furcation out the other.
  
  
• Areas of note: while every tooth surface should be probed and examined, there are specific areas that demand special attention or can often be accompanied by minimal outward indications:
  
  
  
  • Palatal surface of maxillary canines (Fig. 2-6): an inapparent deep infrabony pocket may be present, and if advanced, the bone loss can form a communication into the nasal cavity, which would then necessitate extraction of the canine and special closure of the oronasal fistula (ONF; see Chapter 28). Early intervention is essential.
    
  • Rostral/mesial surface of mandibular canines (Fig. 2-7): a significant pocket beside the lower third incisor can significantly compromise the lower canine, and advanced procedures may be used to save the incisor or more thoroughly treat the lower canine once the incisor is extracted.
    
  • Lower first molar—mesial and distal surfaces (Fig. 2-8): deep pockets at either aspect of this tooth can lead to further compromise of the mandible itself, especially in small-breed dogs. Gingival margins may indicate no external problems, so careful probing is essential.
  
  
• Periodontal explorer
  
  
  
  • Sharp tip is very tactile
    
    
    
    • Evaluate areas of tooth wear or fracture to determine if canal is exposed (Fig. 2-9)
    
    
    
    
    • Evaluate areas of potential resorptive lesions in cats (Fig. 2-10)

Figure 2-3 The tip of a periodontal probe is gently inserted into the gingival sulcus or pocket, advanced carefully to the base (without penetrating tissue further).

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