A Bad Taste in His Mouth: Salivary Testing for Periodontal Disease

Kimberly R. Miller, RDH; William M. Tudor, RDH, EMT


March 26, 2012

Halitosis and Bleeding Gums

A 31-year-old man reports a bad taste in his mouth, as well as bleeding gums a couple of times a week, especially when he brushes his teeth. His wife has told him that he has halitosis. He has no dental pain. He occasionally uses floss. He sees his dentist once a year; the last visit was about a year ago. The patient's third molars were extracted about 10 years ago, and it was a negative experience. He reports a family history of diabetes, myocardial infarction, and periodontal disease, which (along with bleeding gums) are risk factors for gingival disease. His own medical history is unremarkable except that his blood pressure is 135/90 mm Hg.

Patient Evaluation: A Collaborative Approach

The comprehensive oral evaluation includes a series of examinations and data collection and is a joint effort between dentist and dental hygienist. Following a dental examination by the dentist, data are collected and a treatment plan that is in the best interest of the patient is developed collaboratively by dentist and dental hygienist.

Dental Examination

Data collection for this patient included:

  • Full-mouth radiographs of all teeth, surrounding bone, and root tips;

  • Panorex/CT scan showing temporal mandibular joints, third molar region, sinus, and sphenoid bone;

  • Hard tooth examination to assess the presence of tooth decay, tooth fractures, abfractions, wear facets, bite relationship and interferences, missing teeth, and any tooth replacements (eg, bridges, implants, and partials or dentures); and

  • Periodontal evaluation, including charting of pocket depths (space between tooth and gum), gum recession, bleeding, pus, furcations (access to the space between the roots of molar teeth), and tooth mobility (Figure 1).

Figure 1. Periodontal chart showing degree of periodontal disease (> 5-mm pockets).

The comprehensive oral evaluation revealed the following:

  • Two areas of active decay that could easily be treated with composite and porcelain restorations; and

  • Active periodontal infection with pocket depths up to 6 mm with bleeding, indicating the need for periodontal therapy, especially when considering his risk factors.


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