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Importance of Case History

The very first step in diagnosing periodontitis is taking a detailed case history of the patient.
Why case history matters: The doctor can find out how long the disease has been going on by asking when the patient first noticed problems like:
  • Swollen gums / bleeding from gums
  • Bad breath (halitosis)
  • Dull gnawing pain deep in the jaw bones
  • Mobility of teeth (teeth becoming loose)
  • Tooth migration (teeth shifting from their position)

Stages and Grades - What They Tell Us

  • Stage III and Stage IV periodontitis mean the periodontal tissues (the gums and bone supporting the teeth) have been widely destroyed. This usually happens in younger patients and progresses fast - within just a couple of years. This fast progression is called Grade C.
  • Grade A/B periodontitis is the slow type. It takes many years to progress and is usually seen in older patients.

Common Complaints in Stage III/IV, Grade C Periodontitis

When a patient has generalized Stage III/IV, Grade C periodontitis, they most often report:
  1. Flaring - the front teeth (anterior teeth) suddenly started spreading apart
  2. Progressive spacing of anterior teeth - gaps between front teeth are getting bigger over time
  3. Bleeding from the gums
Other complaints can include:
  • Halitosis (bad breath)
  • Pus discharge from the gums
Mobility (loosening) of the affected teeth usually shows up in the later stages of the infection.
The patient is generally systemically healthy (no other body diseases involved).
The patient may also feel a dull nagging type of pain in the gums.
Severe pain is rare - it only happens when:
  • A periodontal abscess develops (a pocket of pus in the gums), OR
  • A periodontal-endodontic infection occurs through accessory canals or the root apex (the tip of the tooth root)
In short: Taking a good case history helps the dentist understand how long and how fast periodontitis has been progressing, which directly tells them the Stage and Grade of the disease.
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