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Dental professionals in the UK have a duty of care to diagnose the disease in its early stages.

In the early stages of the disease, the dental professional will notice:

 A variable degree of gingivitis. Some patients still have gingivitis, others not.

 Bleeding on deep probing.

 The presence of subgingival calculus.

 Gingival recession.

 Bone loss – may be horizontal or vertical (and only apparent on X‐rays).

In the advanced stage of the disease, the dental professional will notice:

 Periodontal abscess (see Chapter 8).

 Drifting and/or mobility of teeth due to loss of attachment (Figure 4.2). Fifty per cent of UK dentate adults over 16 years old have more than 4‐mm attachment loss [1]. It is characterised by true pocketing (Figures 4.3 and 4.4), which may be either:Suprabony (horizontal) – when the base of the pocket is above the crest of the alveolar bone.Infrabony (vertical) – when the base of the pocket is below the crest of alveolar bone.

Figure 4.2 Drifting.

Source: Professor Nicola West, Bristol University. Reproduced with permission of Professor Nicola West.

Figure 4.3 True pocketing, with probe inserted.

Source: Alison Chapman.

Figure 4.4 True pocketing.

Source: Alison Chapman.