The American Academy of Periodontology (AAP) recently issued a statement establishing the minimum standard of care for periodontal therapy. As part of that baseline standard, the AAP recommends that all patients receive a comprehensive periodontal evaluation (CPE) at least once a year. Research on periodontal therapy and medical advances demonstrate the importance of this annual appointment for many reasons. Some of those reasons include allowing us to (1) uncover crucial information about your oral and systemic health; (2) conduct an in-depth, comprehensive examination of your teeth, gums, mouth, tongue, plaque and calculus levels, any diseases, periodontal-systemic interrelationships, and your unique risk factors; (3) and create and implement a customized treatment plan.
First, the annual CPE allows you and your periodontist to stay apprised of your changing oral health and to plan your treatment accordingly. It is crucial to remain “in the know” regarding your oral health, particularly since your oral health does not remain static but changes over time.
The annual CPE is especially important in light of the goals of periodontal therapy: to prevent, diagnose, and treat oral structures supporting the gum tissue, teeth, and bones. Advances in treatment increasingly demonstrate that patients may, with vigilant care, maintain the health of their dentition for the long-term. Annual CPEs help facilitate this increasingly longer-lasting oral health. This is because CPEs help ensure that we diagnose and mitigate diseases, infections, and other problems that harm oral health early on before seemingly small problems worsen.
Second, your regularly scheduled dental or periodontal cleaning does not suffice to replace this appointment. While your periodontal maintenance appointment is designed to maintain your periodontal health, the CPE goes much more in-depth in evaluating, diagnosing, and planning a course of treatment to help you achieve the healthiest periodontal condition possible.
The CPE allows us to discuss your main complaint(s) with you, thoroughly review your medical and periodontal history, and conduct diagnostic, genetic, biochemical, and microbiologic tests as needed. The AAP states that the CPE should include but is not limited to the following (you can read the full list here):
- Extra and intraoral examination to detect non-periodontal oral diseases or conditions
- Examination of teeth and implants to evaluate gingival topography and related structures; to measure probing depths, the width of keratinized tissue, gingival recession, and attachment level; to evaluate the health of the subgingival area with measures such as bleeding on probing and suppuration; to assess clinical furcation status; to detect endodontic–periodontal lesions
- Assessment of the presence, degree, and distribution of plaque, calculus, and gingival inflammation
- Occlusal examination to determine the mobility of teeth and dental implants, bite patterns and discrepancy, and determination of fremitus (palpable vibration produced during breathing caused by partial airway obstruction)
- Interpretation of radiographs to examine the entire tooth or implant, assess the quality and quantity of bone and establish bone loss patterns
- Evaluation and risk assessment of periodontal-systemic interrelationships, (depending on the relationship between periodontal disease and heart disease, this could include dementia, stroke, or even pregnancy complications)
- Assessment of the need for and suitability of dental implants
- Analysis of patient risk factors such as age, diabetes, smoking, cardiovascular disease, and other systemic conditions associated with the development or progression of periodontal disease
Third, the yearly CPE is paramount because it gives us the opportunity to create a treatment plan specially tailored to account for a variety of factors that differ from person to person. The treatment plan we design for you considers the efficacy of adjunctive restorative, prosthetic, orthodontic, and/or endodontic treatment if necessary. We also account for risk factors including, but not limited to, diabetes, smoking, and other health or lifestyle factors.
To conclude, the CPE is imperative to preventing, treating, and diagnosing any oral health issues before those issues become unmanageable. The AAP has determined that to uphold at least the minimum standard of patient care, periodontists should conduct CPE’s annually for all periodontal patients. Doing so allows us to help you maintain your current health and/or manage, mitigate, or eliminate potentially more serious issues that may arise from year to year.