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Active disease or not

Correct me if I’m wrong, but when we are looking for signs of active disease in a pt, we are just looking for bleeding on probing, right? Isn’t it “normal” for almost everyone to bleed just a little bit when scaling, at lest locally? Bleeding when scaling could be caused by improper adaptation of the cutting edge or just from stiring up the colonies of bacteria under the gums, right?

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1 Answer

Generally speaking, bleeding of tissue, upon instrumentation, probing, or spontaneously, is the first sign of disease. A patient’s tissue should not bleed if it’s healthy. Other clinical parameters include probing depth, clinical attachment level (CAL), the degree of furcation involvement, the extent of gingival recession, tooth mobility, and plaque score.
Bleeding may occur upon tissue trauma (improper angulation, etc.) however I wouldn’t consider it “normal” for everyone to bleed if they have healthy tissue. “Stirring up bacteria” I wouldn’t say causes bleeding, its the inflammation the bacteria has caused and the body’s response that causes bleeding.
Here’s an excellent breakdown of the periodontal treatment protocol and goes more into detail:

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