Diagnosis

The severity of a gum disorder is diagnosed mainly through two methods. However, there are many facets of periodontal disease that are confusing and take the skill of a trained specialist to fully understand and treat appropriately. Dr. Culley trained for 3 additional years after dental school covering every aspect of periodontal disease and dental implants at one of the top residencies in the country becoming a specialist in the field. So often, cases are misdiagnosed and sent to us for treatment. After the examination with Dr. Culley, you will get diagnosed correctly, and he and his staff will cover the diagnosis and any recommendations he makes.

Why do I need to see a specialist?

Dr. Culley is a Periodontist. A periodontist completes a minimum of 3 additional years of training in the field of periodontics and dental implants. People often ask why they need to see a specialist. Most everyone has heard the saying, “Jack of all trades, master of none.” Well that statement is very true. Would you go to your family doctor and let him perform open heart surgery on you? Would you go to your OBGYN and let them treat you for cancer? Dentistry is no different. The mouth is a very complex environment. There have been so many advances, there is no way a single person can stay on top of the latest information and scientific understanding needed to give you the best treatment possible. If you find one, you need to keep looking because they are more concerned with lost revenue rather than their patients receiving the best treatment. Although Dr. Culley is a specialist, he too knows his limitations. He works with restorative dentists who act like the team quarterback. He also has excellent working relationships with specialists in Endodontics, Oral Surgery, Orthodontics, Pediatric Dentistry, Prosthodontics and Oral Pathology. lThe basic purpose is to understand the amount of plaque and tartar buildup in the mouth.

Measuring Pocket Depth with an Instrument

The most accepted and accurate way to diagnosis periodontal disease is the clinical exam. Dr. Culley will take a look at your entire oral cavity to get an idea of your overall condition. He will ask if you have issues or any complaints that you need him to address. From that point, he will perform a periodontal pocket examinaiont. As plaque builds up on you teeth over days, weeks, months and years, it hardens and builds above and below the gum line. The plaque and calculus builds up and the resulting acid produced by the bacteria eats into the teeth and gums. Pockets of space appear between the edge of the gum tissue, known as the free gingival margin, and the crest of the bone. This space is referred to as “pockets.” The pocket depth is identified with the help of a slinder metal probe with markings that indicate depth in millimeter increments, which is inserted below the gum line. A pocket depth in the range of 1-3 mm is considered normal. However, people with pocket depths of more than 4 mm may have periodontal disease. Other factors such as the level of the gum line (has recession or hyperplasia occurred), mobility of the teeth, decay (graded on a scale of 0-3), bite forces, existing restorative work and home care are examined to see how all the factors are affecting you. Because of Dr. Culley being in the field for 25 plus years, much of this is second nature to Dr. Culley making your assessment easy and painless.

Dental X-Rays

Dental X-rays can spot trouble early on in your mouth, teeth, gums and jaw. Treating problems before they get serious can save money, pain and sometimes even your life. (put this in a highlight text box)

What are dental X-rays and why are they needed?

In the list of your favorite things, getting an X-ray at the dentist’s office may not rank high. People thing about wearing that heavy apron and holding a sometimes uncomfortable device between your teeth for even a few seconds isn’t much fun. But this is an absolute necessity to properly diagnose and treat you.

X-rays show dental providers a lot. X-rays help doctors see the condition of your teeth, roots, jaw placement and facial bone composition. They also help doctors find and treat dental problems early in their development.

An x-ray is a form of energy that can travel through or be absorbed by solid objects. This energy is absorbed by dense objects, such as teeth and bones, and show up in X-rays as light-colored areas. X-rays pass through less dense objects, such as gums and cheeks, and appear as dark areas on X-ray film.

X-rays can help find problems that cannot be seen with an oral exam using the naked eye. Finding and treating problems early in their development may save you money, avoid discomfort (if these problems are treated at a later time) and possibly even save your life.

What types of problems do X-rays help detect?

X-rays help your dentist diagnose problems in your teeth and jaws.

In adults, X-rays show:

  • Decay especially small areas of decay between teeth.
  • Decay beneath existing fillings.
  • Bone loss in the jaw.
  • Changes in the bone or root canal due to infection.
  • Condition and position of teeth to help prepare for dental implants, braces, dentures or other dental procedures.
  • Abscesses (an infection at the root of a tooth or between the gum and a tooth).
  • Cysts and some types of tumors.

In children, X-rays determine:

  • If decay is developing.
  • If there is enough space in the mouth to fit all incoming teeth.
  • If wisdom teeth are developing.
  • If teeth are impacted (unable to emerge through the gums).

What are the different types of dental X-rays?

There are two main types of dental X-rays: intraoral (the X-ray film is inside the mouth) and extraoral (the X-ray film is outside the mouth).

Intraoral X-rays are the most common type of X-ray. There are several types of intraoral X-rays. Each shows different aspects of teeth.

  • Bitewing X-rays show details of the upper and lower teeth in one area of the mouth. Each bitewing shows a tooth from its crown (the exposed surface) to the level of the supporting bone. Bitewing X-rays detect decay between teeth and changes in the thickness of bone caused by gum disease. Bitewing X-rays can also help determine the proper fit of a crown (a cap that completely encircles a tooth) or other restorations (such as bridges). It can also see any wear or breakdown of dental fillings.
  • Periapical X-rays show the whole tooth — from the crown, to beyond the root where the tooth attaches into the jaw. Each periapical X-ray shows all teeth in one portion of either the upper or lower jaw. Periapical X-rays detect any unusual changes in the root and surrounding bone structures.
  • Occlusal X-rays track the development and placement of an entire arch of teeth in either the upper or lower jaw.
  • Intraoral x-rays can be done with old fashioned film or digitally which has many advantages, including decreased radiation. We only use digital intraoral x-rays.
  • Extraoral X-rays are used to detect dental problems in the jaw and skull. There are several types of extraoral X-rays.

    • Panoramic X-rays show the entire mouth area — all the teeth in both the upper and lower jaws — on a single X-ray. This X-ray detects the position of fully emerged as well as emerging teeth, can see impacted teeth and helps diagnosis tumors.
    • Tomograms show a particular layer or “slice” of the mouth and blur out other layers. This X-ray examines structures that are difficult to clearly see because other nearby structures are blocking the view.
    • Cephalometric projections show an entire side of the head. This X-ray looks at the teeth in relation to the jaw and profile of the individual. Orthodontists use this X-ray to develop each patient’s specific teeth realignment approach.
    • Sialogram uses a dye, which is injected into the salivary glands so they can be seen on X-ray film. (Salivary glands are soft tissue that would not be seen with an X-ray.) Dentists might order this test to look for salivary gland problems, such as blockages, or Sjogren’s syndrome (a disorder with symptoms including dry mouth and dry eyes; this disorder can play a role in tooth decay).
    • Dental computed tomography (CT) is a type of imaging that looks at interior structures in 3-D (three dimensions). This type of imaging is used to find problems in the bones of the face such as cysts, tumors and fractures.
    • Cone beam CT is a type of X-ray that creates 3-D images of dental structures, soft tissue, nerves and bone. It helps guide tooth implant placement and evaluates cysts and tumors in the mouth and face. It also can see problems in the gums, roots of teeth and the jaws. Cone beam CT is similar to regular dental CT in some ways. They both produce accurate and high-quality images. However, the way images are taken is different. The cone beam CT machine rotates around the patient’s head, capturing all data in one single rotation. The traditional CT scan collects “flat slices” as the machine makes several revolutions around the patient’s head. This method also exposes patients to a higher level of radiation. A unique advantage of cone beam CT is that it can be used in a dentist’s office. Dental computed CT equipment is only available in hospitals or imaging centers.
    • Digital imaging is a 2-D type of dental imaging that allows images to be sent directly to a computer. The images can be viewed on-screen, stored or printed out in a matter of seconds. Digital imaging has several other advantages compared with traditional X-rays. The image taken of a tooth, for example, can be enhanced and enlarged. This makes it easier for your dentist to see the tiniest changes that can’t be seen in an oral exam. Also, if necessary, images can be sent electronically to another dentist or specialist for a second opinion or to a new dentist. Digital imaging also uses less radiation than X-rays.
    • MRI imaging is an imaging method that takes a 3-D view of the oral cavity including jaw and teeth. (This is ideal for soft tissue evaluation.)
    • Our Cone beam CT is the most advanced on the market for use in a private practice made. Not only does it do extraoral scans, it also makes most of the other types of x-ray listed in addition to making external 3-D images of your face that can be superimposed on your radiographic images to help in multiple facets of treatment planning with dental implants and cosmetic periodontal plastic surgery.

    How often should teeth be X-rayed?

    How often X-rays need to be taken depends on your medical and dental history and current condition. Some people may need X-rays as often as every six months. Others who don’t have recent dental or gum disease and who have ongoing scheduled visits with their dentist may only need X-rays every couple of years. New patients may have X-rays taken at their first exam. First-visit X-rays are also used to compare with X-rays taken over time to look for problems and unexpected changes.X-rays may need to be taken more often in people at high risk for dental problems. These people include:

    • Children: Children generally need more X-rays than adults because their teeth and jaws are still developing and because their teeth are more likely to be affected by tooth decay than adults.
    • Adults with a lot of restorative work, such as fillings: To look for decay beneath existing fillings or in new locations.
    • People who drink a lot of sugary beverages: To look for tooth decay.
    • People with periodontal (gum) disease: To monitor bone loss.
    • People who have dry mouth: Whether due to medications (such as antidepressants, antianxiety drugs, antihistamines and others) or health conditions (such as Sjogren’s syndrome, damaged salivary glands, radiation treatment to head and neck). Dry mouth conditions cause decay.
    • Smokers: To monitor bone loss that results from gum disease (smokers are at increased risk of gum disease).

    Are dental X-rays safe?

    The amount of radiation emitted from X-rays is extremely small. Advances in dentistry — such as X-ray machines that limit the radiation beam to a small area; high-speed X-rays; use of lead-lined, full-body aprons; and federal laws that require accuracy and safety checks for X-ray machines — are a few of the improvements that limit the amount of radiation patients receive. Despite the safety of X-rays, some questions to ask your dentist include:

    • Was there something you found in your clinical exam that you feel needs to be further examined with an X-ray?
    • How will these X-rays help guide the treatment plan you have in mind for me?

    Plan

    After all of this diagnostic information is collected and all factors are considered that were discovered clinically, radiographically and from your health and dental history, an individualized treatment plan will be presented to you based on your needs by Dr. Culley and his staff.