Enhancing accurate assessment of periodontal disease by improving radiographic interpretation

One of the most difficult areas of radiographic interpretation is periodontal assessment--an area critical to the success of the role of today's dental hygienists charged with the responsibility of evaluation and treatment of periodontal disease. The accurate evaluation and interpretation of radiographs, used by dental hygienists in conjunction with a clinical periodontal examination, is essential for effective planning and provision of nonsurgical periodontal therapy and appropriate referral as necessary. Definitive assessments require high quality radiographs with the minimum of distortion. Currently, bitewing radiographs are the technique of choice for evaluation of periodontal structures, with the use of vertical bitewings (which allow the clinician to view osseous tissue in both arches simultaneously) recommended as disease progresses. Clinicians have complete control over the various technical factors which may affect the processed radiograph and consequently the periodontal interpretation. The procedures highlighted in this article will result in good diagnostic quality with the minimum of exposure to the patient. Accurate radiographic assessment also depends upon the ability of the hygienist to recognize the appearance of normal periodontal tissues as well as the periodontium in a diseased state. Because in the early stages of disease radiographic changes are difficult to observe, a keen, well-trained eye is required to see the slight alterations occurring in the periodontium. This article reviews the radiographic appearance of normal tissues and the generally accepted sequence of radiographic changes associated with periodontitis according to the American Academy of Periodontology (AAP).