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Labor Day Road Trips, Periodontal Probing, and the Importance of Knowing the Way
Back to school sales are everywhere, football is gearing up, and nights are a little bit cooler – sure signs that summer is winding down. As we wrap up beach and barbeque season, nearly 40 million Americans are planning their Labor Day weekend getaways. They are planning their drives, reviewing routes online, and looking up traffic and weather. Road trippers do this because while the aim is the vacation destination, it would be silly – chaotic, even – to set off on their adventure without some planning and exploring what lies ahead. Likewise, treating your patients without periodontal probing is akin to setting off without a destination or a map.
There are no ifs, ands, or buts – periodontal probing is the standard of care. You wouldn’t set off on your long road trip without making sure you have gas or without checking your tires. Likewise, you shouldn’t start treatment without first knowing your patient’s periodontal condition. Both the American Academy of Periodontology (AAP) and the American Dental Hygienists' Association (ADHA) state that periodontal probing is an integral part of a comprehensive examination. Merely eyeballing the condition of the gingiva is not an accurate way of assessing gingival and periodontal health; appearances can be deceptive. Thorough probing can shed light on the health of the gingiva and the periodontium, the degree of recession, the sulcus depth, and the presence of any detachment. For implants, it serves as a vital early detector of peri-mucositis and peri-implantitis. “Starting restorative procedures without first performing periodontal probing is like building a house on quicksand without first testing the soil,” explains Dr. Goldstein, DDS, developer of the Goldstein Colorvue Probe and author of Esthetics in Dentistry (Wiley) and Change Your Smile (Quintessence). With so much at stake, it is imperative that clinicians probe to get the roadmap of their patient's oral condition before starting treatment.
Unlike a family road trip, there aren't multiple ways to get there. While there are multiple kinds of probes
It is important to measure the entire root surface, particularly in molars where the sulcus depth can vary in different areas of the same tooth. Clinicians can ensure thorough and efficient probing by hopping as they probe. Beginning at the distal line angle, gently take your measurement, and maintain a consistent and vertical angle as you take measurements every one to two millimeters. Measuring only at the midline can be misleading, as the midline measurement will typically be very shallow compared with other measurements of the same tooth. When measuring inter-proximally, the probe must be slightly angled to reach below the contact point. Be careful not to over tilt; your tip should align with the cusp tip of the tooth when you take interproximal measurements.
In the case of a furcation, you must use a specialized furcation probe. Place the furcation probe at the buccal groove and slowly roll into the furcation, keeping the handle parallel to the occlusal plane. Note that the markings on furcation probes are reference points. Furcations are categorized and recorded depending on how far into the furcation they can be inserted.
We've covered how to probe – or, the route we're taking to get to our destination. As good road trippers, we make note of points of interest passed en route – or, in this case, what we're looking for when we probe and record measurements.
One of the biggest points of interest is attachment loss. The degree of periodontal disease is determined by how much attachment loss is detected, which is measured in millimeters of pocket depth below the CEJ. In healthy scenarios, there is no pocket depth below the CEJ. However, this cannot be eyeballed; it must be accurately measured and recorded. In all cases, you should make note of any areas where there is bleeding on probing (BOP).
Now that we've covered how to probe and what to look for (points of interest), we need to cover the types of probes available and when to use them. In the same way that a getaway may call for a sports car or a minivan depending on who is traveling with you, different probes are used for different patients.
The two major categories of diagnostic probes are metal and resin. Metal probes are further divided into "classic" and "contemporary" subtypes. The difference between these classic and contemporary designs is the shape of the working end. The contemporary design features a right angle shank that some clinicians find easier to use and read in difficult-to-reach posterior areas. 
Alternatively, clinicians may use resin probes, such as the Hu-Friedy Colorvue™ probes. These thin, flexible resin probes are ideal for implant patients, as they will not scratch or damage the implant. Additionally, their flexibility renders them more comfortable for patients. “One reason more offices avoid periodontal probing on every patient is due to the patients refusing to be probed since they felt so much discomfort from their last probing. The Colorvue Probes are much more patient-friendly,” says Dr. Goldstein. As a bonus to clinicians, the bright yellow and black coloration of the original Colorvue probes provides contrast in the oral cavity and allows immediate and easy reading of the marks. The probe tips can be autoclaved approximately 30 times, and are easily replaced, making them economical as well as comfortable and easy to read. 
Building on the features of the Colorvue probe is the Goldstein Colorvue Probe, which features a white resin with alternating green, blue, red, and black ½ millimeter markings, which making readings faster and more accurate than ever. “A major reason I developed the Goldstein Colorvue Probe. into ½ mm increments is to enable the dentist to first accurately evaluate the sulcular depth before deciding on margin placement,” explains Dr. Goldstein. 
Diagnostic probes used for measuring sulcus depth are calibrated with uniform striations. However, there are multiple variants of calibrated probes, with different markings and measurement intervals, including the UNC probe, Williams probe, and Marquis Probe. It is important to know which probe you are using and how it is marked whenever you probe. 
Growing numbers of clinicians recognize the importance of knowing your patient's biotype and using it to inform your treatment, especially in the fields of periodontology, orthodontics, restorative dentistry, and cosmetic procedures. Hu-Friedy's Colorvue Biotype Probes are the first probes designed to assess the biotype reliably, quickly, and inexpensively – leading to better treatment and outcomes for patients. The Colorvue Biotype Probe line is comprised of three probes, and the patient’s biotype is quickly determined by which colored tips show through the gingival tissue. One word of advice for dental practices everywhere: “Regardless of the type of probe you use in practice, all members of the team need to use the same probe for consistent results. By using the same instrument within the team, probe depth agreement rates should improve," says Mary Jacks, MS, RDH. Choose a standard and stick with it. Anyone who has ever crossed the border into Canada and followed the speed limit only to discover that they are flying past everyone else as they go 80 miles per hour – instead of 80 kilometers per hour – knows that different measurement systems can really throw you off. Likewise, having multiple variants of probes in a practice, each with different millimeter markings, can – and will – lead to confusion among staff. With something as important as a periodontal disease at stake, you want to be sure that you are measuring consistently and accurately every time. The route is set, the car is packed, and the points of interest mapped out. Now you're just waiting for that last shift before the holiday weekend. Until then, you have your probes to guide the way. With the information they give you, you have the roadmap of your patient's periodontal health, which informs your treatment plans and overall discussions.
FEATURED KEY OPINION LEADER
Read about Ronald Goldstein, DDS - Key Opinion Leader. Ronald Goldstein is an esteemed member of the Doctor Mastery Program. The five-year program consists of clinical training conducted by world-renowned clinicians, from building on foundational skills and advancing to mastery of the most complex dental care. Upon completion of the five-year program, Dr. Goldstein, DDS will achieve a Fellowship with the Academy of General Dentistry (FAGD) held by only 7% of general dentists in the United States, as well as increase access to dental care. Dr. Goldstein has presented continuing education courses at more than 20 universities and lectured at over 600 dental meetings in North and South America, Australia, Asia, and throughout Europe. His dedication to Continuing Education has recently earned him distinction as one of the "Leaders in Continuing Education" by Dentistry Today Magazine. Currently, Dr. Goldstein is a Clinical Professor at the Georgia Health Sciences University, and an Adjunct Clinical Professor at both Boston University and the University of Texas. Dr. Goldstein is the author of Change Your Smile, while the 3rd edition of his book Esthetics in Dentistry was released in 2012. He is also co-author of other books, including Bleaching Teeth, Porcelain Laminate Veneers, Porcelain, and Composite Inlays and Onlays, Imaging in Esthetic Dentistry, Complete Dental Bleaching.
FEATURED CONTRIBUTOR
Read about Mary Jacks, RDH, MS - Featured Contributor. Mary Jacks is a respected Educational Development Specialist and a former Associate Professor in the Dental Hygiene Division of the University of Texas Health Science Center at San Antonio. Mary has over 25 years of clinical experience. Areas of teaching expertise include Periodontics, advanced hand and powered instrumentation, faculty calibration, humor in healthcare and distance education technologies. She has provided numerous national and international lectures on faculty calibration to create a fair testing environment, and micro-ultrasonic instrumentation focused on adapting techniques to efficiently manage periodontal clients. Mary is also a prolific writer, with multiple publications in dental journals, with an emphasis on her passion for dental education. Ms. Jacks was the recipient of the UTHSCSA Presidential Teaching Excellence award in 2007 and 2008 Read about ADHA/Crest-Oral B Dental Hygiene Educator of the year.
