The Salivary Crystal Ball – Part 1

Bleeding on probing (BOP) is encountered every day in virtually every dental practice. It is so common that there may be a tendency to undervalue its importance in diagnosing gingivitis and periodontitis. BOP is like periodontitis or pregnancy in the following regards: There is no such thing as “just a little bleeding.” You have it or you don’t. There is no such thing as a little periodontitis; you have it or you don’t. There is no such thing as a little pregnant; you are or you are not. You could have BOP or periodontitis of limited distribution, in only a few sites, but you still have it.

Why do the gums bleed upon probing? Because the gingival epithelium lining the sulcus is ulcerated. Why is it ulcerated? Because perio pathogens have toxins that break down the gingival epithelium, resulting in the ulceration, exposing the capillary beds in the underlying connective tissue. The probe nicks the capillaries when it contacts the ulcerated epithelium. An intact gingival epithelium acts as a bacterial and toxin barrier to the systemic circulation. The ulceration in the gingival epithelium is a tissue defect, which has penetrated the epithelial-connective tissue junction. When a periodontal probe is placed in the sulcus it breaks the capillary wall, the blood flows by the path of least resistance into the sulcus, giving clinicians insight into the patient’s oral health status.

Is BOP more important perhaps than we realize as it relates to periodontal disease and systemic health? You bet! It constitutes a diagnosis of gingivitis, which is the right time to intervene before full-blown periodontal disease develops.

Are you ready to move past only providing prophys, SRPs and perio maintenance, all of which has been around for longer than most of us have been practicing? These services are vital and cannot be discarded, but they do not predict what the future holds for at-risk patients, such as those with BOP.

The cascade of events is as follows: Perio pathogens cause gum disease. Ulceration of the gingival epithelium is an early manifestation of perio disease. The ulcerations are an open door to the subjacent connective tissue and capillary beds, which are nicked by the perio probe resulting in BOP. Shouldn’t we go back to the origin; the perio pathogens?

It is time to salivary test patients with BOP who do not yet have periodontitis to predict where they will be sometime in the future. More in the next blog post.

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The Salivary Crystal Ball – Part 2

READ MORE | BOP and gingivitis: Its time to draw a line in the sand



Richard H. Nagelberg, DDS
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