Periodontal Disease: The Hidden Driver of Tooth Loss in Adults

Probing depths above 4 mm with bleeding on probing at three or more sites is the reading that turns a hygiene visit into a treatment plan. Here is what I do next.

Probing depths above 4 mm with bleeding on probing at three or more sites — that is the reading that turns a hygiene visit into a treatment plan. Patients usually do not feel it. Their teeth do not move. They have never seen blood on the brush. And yet the bone is going. This is what makes periodontitis the leading cause of adult tooth loss in the UAE and globally. It is silent for years, and by the time a tooth becomes mobile, we are talking about extraction and replacement, not preservation. What I actually measure at the first visit A real periodontal exam is not a glance. For every tooth I record six probing depths in millimetres, bleeding on probing as a binary yes or no, recession from the cementoenamel junction, mobility on a 0 to 3 scale, and furcation involvement in molars. Twenty-eight teeth, six sites each — that is 168 readings before I even open the imaging. Then a full-mouth set of bitewings and periapicals, and when furcations or vertical defects look suspicious on the 2D film, a Newtom CBCT. I want to see the bone before I write a stage and grade. The 2018 classification, in plain language The current global staging system — the one published from the World Workshop on the Classification of Periodontal Diseases in 2018 in the Journal of Clinical Periodontology — sorts patients into Stage I to IV by severity and Grade A to C by rate of progression. A 35-year-old with 5 mm of attachment loss and bleeding everywhere is Grade C until proven otherwise. That patient is losing bone faster than their immune system can defend. The Lancet 2019 periodontal disease series put the prevalence of severe periodontitis worldwide at around 11%. In a Sharjah population with high rates of type 2 diabetes and smoking, my clinical impression is that the number is higher, not lower. What treatment looks like, week by week For most Stage II and III patients I sequence the care like this: Week 1: full disclosure, plaque score, oral hygiene calibration with modified Bass technique and interdental brushes sized per site Weeks 2 to 4: non-surgical root surface debridement quadrant by quadrant under local anaesthetic — articaine 4% with epinephrine 1:100,000, ultrasonic with PEEK tips on implants and standard tips on teeth, hand instruments to finish Week 12: re-evaluation. New six-point probing. The sites that still bleed at 5 mm or more are the sites I consider for pe…

Read more from the aiHealth Medical Center clinical team on the dental health blog, or book an appointment.