Helping patients retain their natural teeth and maintain overall health is vital. It's important to closely monitor their periodontal health and recommend care based on our observations and diagnosis.

The two things critical to every periodontal diagnosis you make are having the appropriate radiographs and complete and accurate periodontal charting. Complete periodontal charting goes beyond probing depths; in fact there are five essential measurements.

These measurements include gingival margin location, mobility and any furcation involvement. Once these parameters are recorded the next step is to extrapolate the fifth and final parameter, which is clinical attachment loss (CAL). The process includes adding your probing depths and gingival margin location (GM) together.

The reason the clinical attachment level is so critical is if we think about someone with a 5mm probing, our level of concern and our recommended treatment will be quite different if there is recession or gingival hypertrophy. In cases of recession your CAL will be greater than your probing depth. Conversely in the case of gingival hypertrophy your CAL will be less than your probing depth due to your GM being above the CEJ and therefore a negative number.

When it comes to accuracy of our periodontal charting there are two factors that are critical: frequency and accurate repeatable measurements. Frequency is important because no matter how accurate our measurements are when we initially take them, we can expect there to be some change over time. It's this change or lack thereof that's important to monitor. When it comes to frequency, at minimum you should record complete periodontal charting once a year.

It's important to note that you should be taking the measurements and noticing any changes at every hygiene visit. When it comes to attaining accurate repeatable measurements remember that they must be accurate and repeatable across different clinicians. Whether it's a GP, specialist or hygienist taking the measurements, they should all be within 1mm of each other when it comes to probing depths and gingival margin location.

When it comes to confirming the accuracy and repeatability of the measurements you are taking the simplest place to start is to have each clinician in your office record periodontal charting on a team member without sharing it with the other clinician(s). Once each clinician has completed their charting, then the sharing starts. Simply compare the measurements you each got, then if you are off more than 1mm anywhere go back and review the areas of difference to determine why the measurements don't match. The next step in confirming the accuracy of the periodontal measurements in your office is to compare your periodontal charting to the charting taken at another office. It's important that these two different chartings be done with little time in between them and that no treatment that would greatly impact your charting has been done.

John R. Carson, DDS, PC, Spear Visiting Faculty. [ ]