Clinical Tips: Periodontal microscopy and endoscopy

Imagine practicing clinical dental hygiene without magnification loupes. While it's not necessary for patient care, many clinicians who utilize this technology say they wouldn't feel comfortable practicing without it. What if I told you there were other ways to enhance your vision while communicating the value of your disease prevention services to patients?

Phase contrast microscopy

Although this technology isn't new, many hygienists have not tapped into its transformative power in periodontal diagnostics and patient education. Much like the ones we used in microbiology class, phase contrast microscopes allow practitioners to analyze the diverse microbiota unique to each patient. A biofilm sample is collected from the oral cavity and is placed on a prepared slide and viewed at the beginning of the appointment. A sample from a healthy microbiome will exhibit very little motility, few white blood cells, and an absence of gram-negative spirochetes. The opposite of these findings would indicate the presence of disease, along with any additional organisms like yeast or protozoa. This can assist in the initial diagnosis of periodontal disease and confirm when microbial symbiosis is achieved after therapeutic care is rendered.

Mounted dental microscopy

Historically reserved for surgeons and endodontists, mounted systems have recently been introduced to the dental hygiene industry as an alternative to magnification loupes. A mounted dental microscope offers significantly greater magnification and illumination than traditional loupes, allowing hygienists to detect and remove deposits with exceptional precision. Unlike loupes, which move with the clinician's head, a mounted system remains stable and adjustable, promoting better posture and reducing strain. The enhanced visualization supports earlier diagnosis, more thorough care, and improved patient communication. Additionally, some systems include a large display screen that can be used instead of the oculars for easy viewing with video recording capabilities for high-tech patient education.

Periodontal endoscopy

When a "scope" procedure is mentioned, many automatically think of their gastroenterologist or orthopedist. What if I told you dental hygienists are currently utilizing endoscopy technology in their clinical periodontal care? A miniature camera with a fiber -optic light is strategically placed below the gingival margin to give clinicians instant visibility of the subgingival space, once considered a complete blind spot during instrumentation. Regenerative periodontal endoscopy (RPE) is especially useful in complex periodontal cases and hard -to -reach areas with deep pockets. This can support a practice's goal of providing minimally invasive care, as enhanced visibility can assist patients in avoiding painful, invasive flap or LANAP procedures.

Aside from the clinical benefits of microscopy and endoscopy in the dental hygiene operatory, using the best tools and technology further communicates the immense value of the dental hygienist's role in the health-care system. Clinicians find fulfillment in knowing that they are practicing at the top of their game and can use these resources to highlight their expert-level education and skills for their patients and team. Gone are the days of the "tooth scraper" stereotype-the RDH of today has elevated far beyond.

Editor's note: This article appeared in the August/September 2025 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.