On this page
- What does diagnosing gum disease involve?
- What happens at your first periodontal visit?
- What does each test and scan add?
- Do you need every test?
- How does technology help plan and perform your treatment?
- What are the limits of tests and imaging?
- What affects the cost of exams and imaging?
- Care at Perio One
- When to call us
- What to expect
- Common questions
At a glance
- Every plan starts with a periodontal exam, not a scan or a light.
- Dental X-rays fill in what the eye can't see, and a 3D cone beam CT scan adds depth before implants or grafts.
- VELscope® screening and OralDNA® saliva testing are optional add-ons that inform a plan; neither one is a diagnosis on its own.
- Piezoelectric instruments and other tools can add precision during treatment, once a plan is set.
Explore this topic
Exams and screening
Surgical technology
What does diagnosing gum disease involve?
Diagnosing gum disease starts with looking and measuring, not testing. A periodontist checks your gum tissue by eye, then measures the space between your gum and each tooth with a thin probe. X-rays and other tools are added only when they will change what happens next.
Those measurements, called pocket depths, show how much the gum has pulled away from the tooth. Bleeding, recession and how much a tooth can wiggle are recorded too. Together, this charting builds a picture of where disease is active.
From there, your periodontist decides what else the picture needs. Some visits need only X-rays already on file. Others call for new images, a 3D scan, or one of the screening tools covered below.
What happens at your first periodontal visit?
Your first visit usually opens with a review of your medical history and medicines, since some health conditions and medicines affect your gums. A periodontal exam then measures and charts every tooth. Most visits also include a look at recent X-rays, or new ones if yours are out of date.
The visit also includes a visual and touch check of your cheeks, tongue, lips and throat, the same screening included in every periodontal exam. Any area that looks different is noted and watched or referred.
By the end, you should know what was found, in plain words, and what happens next. That might mean starting treatment, scheduling more imaging, or simply returning at your usual interval.
Some visits are combined with a cleaning if your gums are healthy, while others are kept separate so measurements aren't rushed. Either way, you'll know beforehand what the visit covers.
What does each test and scan add?
Each tool answers one question, and no single one covers everything. Between the exam, X-rays and a few optional add-ons, different parts of the picture get covered. The table below lines up what each one shows and when it's used.
A cone beam CT scan builds a 3D picture of bone height, width and nearby nerves and sinuses, mainly before implants or grafts. It adds detail that flat X-rays can't show, so it's used only when that extra depth will change the plan.
VELscope® screening shines a blue light that makes healthy and irritated tissue glow differently, as an extra look alongside the visual exam. It flags areas worth a second look; it doesn't diagnose anything on its own.
An OralDNA® saliva test checks a rinse sample for specific bacteria or genetic risk markers. It may help explain why gum disease keeps returning, though it works best alongside the exam, not instead of it.
| Test or tool | What it shows or does | When it is used |
|---|---|---|
| Periodontal charting | Pocket depths, bleeding and recession around each tooth | At every exam |
| Dental X-rays | Bone level and decay between and around teeth | Routinely, or when new images are needed |
| Cone beam CT | A 3D view of bone, nerves and sinuses | Before implants, grafts or some surgeries |
| VELscope® | Fluorescence that highlights unusual tissue | As an extra look during screening |
| OralDNA® | Bacteria or genetic risk markers from a saliva rinse | When the cause of ongoing disease is unclear |
| Piezoelectric surgery | Ultrasonic micro-vibrations that cut bone gently | During some bone or grafting procedures |
Do you need every test?
No. Most visits need only a periodontal exam and the X-rays already on file or newly taken. Extra scans and screening tools are added when a specific question calls for them, not as a routine add-on.
A 3D scan is common before implants, grafts and some surgeries, because the extra depth changes how the surgery is planned. VELscope® screening and an OralDNA® saliva test are offered selectively, when they add real information for your case.
Your periodontist explains the reason for any extra test before it happens. If a tool won't change your plan, it's left out.
How does technology help plan and perform your treatment?
Once a diagnosis is set, some tools carry over into treatment itself. A 3D scan can guide precise implant placement, and some bone procedures use piezoelectric surgery, an ultrasonic instrument that cuts bone while sparing nearby soft tissue.
None of this technology replaces a clinician's judgment. It gives your periodontist more information, or more control during a procedure, but the plan still rests on the exam and on experience.
During implant placement, a plan built from a 3D scan also guides depth and angle, so the surgery follows what was already mapped out. That kind of planning adds precision without changing what the exam decided about your gums.
What are the limits of tests and imaging?
No test replaces the exam, and no image replaces a biopsy when one is needed. A scan or a screening light can point toward an area worth watching, but only tissue examined under a microscope can confirm what it is.
Dental X-rays use a small amount of radiation, and only the images your care actually needs are taken. Screening tools like VELscope® can flag harmless, irritated tissue along with anything more serious, which is why a finding leads to a recheck or referral, not an automatic alarm.
None of this replaces steady home care between visits; tools add information, they don't clean your teeth for you.
If a tool won't change your plan, we say so rather than recommend it anyway. The goal is useful information, not a longer list of gadgets.
What affects the cost of exams and imaging?
Cost depends on which tools your visit actually needs, and only an exam can show that. A routine visit with existing X-rays costs less than a visit that adds a 3D scan or a saliva test.
Ask which tools your visit needs before any imaging happens, and why. A clear answer upfront makes it easier to plan for the appointment ahead.
- Whether new X-rays or a 3D scan are needed
- Whether VELscope® screening or an OralDNA® saliva test is recommended
- How many teeth or areas need charting
- Whether images from your general dentist can be reused
- How much of it your dental plan is willing to cover
Care at Perio One
At Perio One in Lafayette, every visit starts with an examination before any plan is made. Dr. Randal Comeaux, DDS, Diplomate of the American Board of Periodontology, decides which images or screening tools actually add information for your case.
Findings are explained in plain language, so you understand what was found and why a next step is or isn't recommended. When an implant or a graft is being planned, 3D cone beam CT imaging is often part of that planning.
We coordinate with your general dentist and welcome referrals. Ongoing gum health is followed through our periodontal maintenance program.
When to call us
- Gums that bleed or look swollen
- A sore, lump or patch in your mouth that lasts more than two weeks
- Teeth that feel loose
- You are planning an implant or a graft
Our periodontists, Dr. Randal Comeaux and Dr. Lauren Langlois, can talk through what you’re noticing.
Call to scheduleWhat to expect
- Call or get a referral
Reach out directly, or ask your dentist to send a referral along with any recent X-rays.
- Health history and exam
We review your medical history and medicines, then measure and chart your gums.
- Any extra imaging or tests
A 3D scan, VELscope® screening or an OralDNA® saliva test is added only if it will change your plan.
- Findings explained
Dr. Comeaux walks you through what was found, in plain language, before recommending next steps.
- Your plan and follow-up
Treatment, if needed, is scheduled next, and ongoing checks continue through periodontal maintenance.
Common questions
How is gum disease diagnosed?
Diagnosis starts with a periodontal exam that measures and charts every tooth. X-rays, and occasionally a 3D scan or a screening tool, are added only when they will change the plan.
What instruments do periodontists use?
The main tool is a thin measuring probe, used to chart the pocket depth around each tooth. Beyond that, periodontists use dental X-rays, and sometimes a 3D cone beam CT scanner, a light-based screening device, or an ultrasonic instrument for piezoelectric surgery, depending on the case.
Do periodontists do implants?
Yes. Periodontists are trained in placing dental implants as well as treating gum disease, and 3D imaging is often used to plan implant placement.
Do periodontists do bone grafts?
Yes, bone grafting is a routine part of periodontal and implant care, whether to rebuild bone lost to gum disease or to prepare a site for an implant.
Does every visit include a scan?
No. A 3D scan, VELscope® screening or an OralDNA® saliva test is added only when it will add real information for your care, not as a routine part of every visit.
Sources
- American Academy of Periodontology: Comprehensive periodontal evaluation
- Cleveland Clinic: Dental X-rays
- Cleveland Clinic: Oral cancer screening
- National Institute of Dental and Craniofacial Research: Periodontal (gum) disease
This page is general education, not a diagnosis. Your periodontist will recommend care after an examination.