Everything You Need to Know About Periodontal Health: Insights from a Periodontist

In this video, periodontist Dr. Lena Palomo discusses what to expect at a dental appointment. She emphasizes the importance of assessing the patient’s medical history, evaluating the gums, teeth stability, and bite, and using advanced imaging techniques to identify any oral abnormalities. Dr. Palomo also explains the progression from gingivitis to periodontitis, highlighting the significance of early intervention in preventing bone loss and abscesses. She encourages individuals to seek professional help for bleeding gums, reassuring viewers that dentists are there to provide non-judgmental support. The video concludes with a lighthearted conversation about dental implants.

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Key Insights:

  • In the first appointment, a periodontist looks at the patient’s overall medical history, including medications and chronic conditions.
  • An evaluation of the mouth includes checking for abnormalities, measuring the health of the gums and bony socket, and assessing tooth stability.
  • Numbers like twos and threes during gum measurements indicate good oral health, while larger numbers may indicate defects or potholes in the bony socket.
  • Gingivitis is the inflammation of the gums caused by bacteria, and it can be reversed through professional cleaning or proper oral hygiene at home.
  • If gingivitis is not treated, it can progress to periodontitis, causing damage to the underlying bony socket and potentially leading to abscesses.
  • An abscess can cause swelling, toothache, fever, and if left untreated, can spread to other facial spaces or impinge on the airway.
  • Bleeding gums during brushing or flossing is a sign of gingivitis and indicates the need for a dental visit.
  • It is important not to ignore or feel ashamed when experiencing symptoms, as dental professionals are there to help without judgment.


All right everybody, we are talking everything you need to know when it comes to the mouth. This is periodontist Dr. Lena Palomo. Hello, Dr. Palomo.

Dr. Palomo: Hello, girl.

Dr. Palomo is a periodontist based in New York City. Where did you go to school, Dr. Palomo?

Dr. Palomo: I went to college and dental school and advanced training in periodontology at Case Western Reserve. But now I’m a professor and chair of the Ashman Department of Periodontology and Implant Dentistry at NYU. That is a mouthful. It sounds all important, and I am proud of you.

Interviewer: So, Dr. Palomo, I’m curious, when you see a new patient, what are some of the things you’re looking for in the very first appointment?

Dr. Palomo: We look at so many things, starting with the overall medical history – what medications you take, chronic conditions, health problems. It all affects each other. Second thing we look at is an evaluation of the mouth, which starts with looking for any abnormalities – lumps, bumps. Then we look at the periodontia, the gums, the bony socket which holds the tooth in place, and the ligament that connects the tooth to that bony socket. We measure how healthy it is by taking a little tiny ruler and inserting it between the tooth and the gums – you might remember this, you know when your dentist goes through and you hear numbers like two, three.

Interviewer: I was just about to say it, I was like, I remember a time I heard one of my dentists… What numbers? I used to go to „2-2-2“. Yeah, I pay attention.

Dr. Palomo: What we’re looking for there, and it’s really great that you paid attention, because numbers like twos and threes are healthy and good. But what we’re looking for is bigger numbers because a bigger number is a sign that there might be a pothole in that bony socket that’s holding your tooth in place. And if there’s a defect or a pothole, that means there’s not enough bone height around the neck of the tooth holding it in your jaw. There’s a problem after you eat, you can imagine all kinds of debris in those areas, and our body reacts to that – we develop a little infection, and that’s gum disease. Then, in addition, we look for recession, we look for any tooth that’s not stable – any tooth that’s mobile. We look for any tooth that may have moved into the spaces where another tooth might have been missing or where there’s no opposing tooth. Changes in the bite, we look for any other abnormalities related to the jaw – snapping, cracking, tight muscles from grinding your teeth at a stoplight or on the subway or at night when we’re sleeping. We look for so many things, and then we confirm it all with our advanced imaging, sometimes an x-ray, sometimes a cone beam CT.

Interviewer: Okay, Internet, give us your best shot. Let’s talk about one of those most common things I’m sure you see all the time, gingivitis.

Dr. Palomo: Well, there’s a lot of words floating around out there – gingivitis, periodontitis, gum disease. We have bacteria in our mouth, it should be no surprise to anybody that bacteria – our body recognizes it, our immune system says „This doesn’t belong here.“ And whether you call that bacteria plaque or tartar, stuff you hear about in toothpaste commercials, in the gingivitis phase, you see inflammation. Let’s get inflamed, something doesn’t belong here. Cleaning, whether professional cleaning or by the patient at home, can reverse that because there’s no damage yet to the underlying bony socket. If you don’t catch it at that point, or if you think, „Oh, this doesn’t really matter, it’s going to be fine,“ that’s not the time for denial. That inflammation spreads – it spreads to the ligament and finally to the bone, and then we develop those little potholes in the bony socket. If you catch some bacteria, cooks up a little nasty soup and turns into a little abscess. So we like to get that before periodontitis develops – the loss of that bony area.

Interviewer: What is the danger of an abscess?

Dr. Palomo: Well, first of all, you know, back in the day, we used to think of a toothache as something that looked like a golf ball, right? So an abscess is that infection – you see the swelling, sometimes you see swollen lymph nodes, sometimes you see a fever. Now, if that swelling impinges on our airway, that can be a problem. If that spreads to some of the other facial spaces, it can be a spreading infection. And that’s why we measure those pockets, that’s why we do the twos and threes, and that’s why we look at the advanced imaging because we want to see if there’s any of those periodontal pockets so we can address that before it turns into an abscess. A lot of times, people see pink in the sink, but they kind of ignore it or they’re ashamed to go to the dentist because it’s pink in a sink. The key sign of gingivitis is bleeding gums, so if you detect when you’re brushing or flossing a little bit of blood in the sink, that’s a sign that we’re starting to have gingivitis, and that usually means you should go to the dentist. The dentist and the entire dental staff is there to help. I have no shame in anything, that’s what the doctor is there for. We are there to have no judgment, say it, we’re here for you.

Interviewer: All right, comment below with your pressing health questions, and of course hit subscribe here to the health channel to get more answers from medical experts on the questions you want to know. Dr. Palomo, thank you so much for joining us and answering all of our periodontal dental questions. Remember to see your periodontist for any medical advice, right, Dr. Palomo?

Dr. Palomo: Right, Dr. Palomo.

Interviewer: Awesome. Now, listen, about that implant…

Dr. Palomo: Okay, now what if I never put…

Interviewer: No, don’t get me. Don’t get me. Do not. You’re looking at me like you don’t believe me. Okay, look, come on. Let’s talk about this off camera. Okay, let’s go.