Microscopic Exam

Oral Phase Microscope

In 1982, I purchased my first phase microscope. Initially, I used it to motivate my periodontal patients – seeing the bacteria running around the screen with the little “squigglies” here and there was very impressive! This was probably the best motivator that I had ever seen. After we first started using the microscope, I rapidly found out that it was also a superior diagnostic tool for discovering just how active and destructive a periodontal problem my patient had.

If you are not diagnosing with a microscope or doing some diagnostic test to see what bacteria are present, you have no idea what is going on with the periodontal problems that your patients are having. Doing periodontal treatment without a microscope is like trying to diagnose tooth decay without x-rays. I used to probe the mouth for pockets, diagnosing moderate to advanced periodontal cases with patients having 4 to 7 millimeter pockets (1MM to 3MM is considered normal). Since using the microscope, it has been very enlightening to see how active these pockets really are. Some patients may have deep pockets but their activity can be very low and their condition may not change over the years. The color and texture of their tissues look relatively healthy with no bleeding. With other patients, when I check their 3 or 4-millimeter pockets, they may have major bleeding with slight contact. Other patients may have pink, deceptively healthy looking tissues with advanced activity.

Utilizing the microscope greatly enhances periodontal diagnosis even before bone loss can occur. The bacteria that are associated with periodontal disease can be identified. The normal bacteria seen in the pockets are cocci. As the disease process advances, rods and vibrios develop. In the more advanced stages, spirochetes are identified. The most advanced cases have amebas, clustered spirochetes and trichomonas. This visual tool is a great motivator as well as a diagnostic tool. When a patient looks at the microscopic sample on the TV monitor and sees active bacteria, they understand how their treatment is progressing.

What is surprising to me is the number of teenagers that I see that have very active periodontal problems. We used to think that a teenager with bleeding gums was not brushing and flossing – we thought that was all they needed to do and it was just gingivitis. Today, we are finding that many teenagers have rampant spirochete colonization in their mouth. By finding these problems at this earlier age, we are able to treat them much more conservatively and without permanent damage.

The first time that you look at a microscope will be like the first time you started doing dentistry with a set of magnifiers. In my office, my two hygienists use the microscopes all day long and they have a better understanding of the periodontal disease process, can customize the treatments for our patients and can motivate their patients easier. They are also able to monitor the progress of our periodontal patients and re-evaluate our recall patients for anything that may be going on in suspect areas. I use the microscope during every new patient examination for the evaluation of a patient’s periodontal health.

For more information on microscopes or if you are a patient and want to see a dentist in your area that has a microscope, contact: OraTec at 12181 Balls Ford Road, Manassas, Virginia 20109-2449, (800) 368-3529. OraTec is the country’s largest manufacturer of microscopes specifically for dentistry.

If you have any questions that our office can answer, please feel free to give us a call at (540) 635-3610.