1: Periodontal Examination & Diagnosis Flashcards
6 components of history taking?
reason for attendance (complaint) history of complaint past medical history past dental history family history social history
medical history: uses?
- partially help to explain the perio disease seen
- alert precautions needed to ensure patient safety
- alert precautions for clinician to safeguard themselves, staff and other patients
past dental history: uses?
previous perio disease/treatment attendance pattern OH habits presence and care of appliances problems with latex, LA/GA, bleeding other dental treatment
family history: uses?
genetic link in some forms of perio disease: aggressive periodontitis
positive family history: increase monitoring frequency, may prompt more aggressive treatment if required
screening of siblings/children of affected patients is recommended
social history: uses?
occupation, family: availability for treatment
reveal risk factors: smoking, alcohol habits, stress
what does stress to do periodontal health?
reduces immune function
reduces saliva flow
increases salivary viscosity, acidity, glycoprotein content
- favoring plaque accumulation
how to assess periodontal disease?
must be done thoroughly and carefully, disease varies from site to site within mouth
- each periodontal site/micro-environment is assessed
components of the 5 point periodontal examination?
- lack of BOP
- probing depth
- loss of attachment: ACJ-base of pocket
- tooth mobility
- furcation involvement
lack of BOP - indicates what?
lack of disease activity, at that site and at that time
30% of BOP sites -> LOA
no BOP - almost 100% no LOA
why are pockets >3mm significant?
what does periodontal treatment aim to do?
- they cannot be reliably cleaned by patients. probing depths will influence treatment plan.
- perio treatment aims to reduce pocket depths
what index is used to measure tooth mobility?
miller’s index
miller’s index - describe the different degrees?
0 - horizontal movement up to and including 0.2mm
1 - horizontal movement of >0.2mm but =1mm
2 - horizontal movement of >1mm
3 - movement in both horizontal and vertical planes
causes of mobility: 3 main dental causes?
- periodontal disease, leading to loss of support
- peri-radicular disease
- occlusal trauma
what is furcation involvement?
what is the prognosis for teeth with furcation involvement?
- area between roots of multi-rooted teeth can be probed in horizontal plane (probe goes between tooth)
- reduced prognosis
diagnosis: should be in place before ____?
diagnosis should be in place before treatment planning
diagnosis is based on which 2 things? where to find other clues?
- BOP
- LOA
+ in medical/family history
what does diagnosis have NOTHING to do with? why?
probing depths, as pockets could be true or false
systematic diagnosis of periodontium? for periodontitis and gingivitis
1) distribution, severity, type, periodontitis
2) distribution, type, gingivitis
3) alternatively, periodontal stability
patient with BOP - diagnosis
generalized disease vs localized disease?
> 30% sites bleeding - generalized disease
most cases of gingivitis are chronic or acute?
chronic gingivitis
examples of acute gingival conditions?
describe them
ANUG, abscesses
- they are more specific, less common, and usually associated with pain
diagnosis of gingivitis: what to write in notes for diagnosis of localized disease?
localized chronic gingivitis affecting e.g. lower anteriors
describe in DETAIL the four parts used to describe a case of periodontitis
i. distribution: localized/generalized
ii. severity: slight/moderate/severe
iii. type: chronic/aggressive
iv. periodontitis
periodontitis: how does LOA vary with the severity of the condition?
slight: 1-2mm LOA, bone loss up to 1/3rd of root length
moderate: 3-4mm LOA, bone loss >1/3rd, 1/2 root length and/or furcation involvement
what does loss of attachment represent?
the sum of all the episodes of disease which have taken place at the site since the tooth erupted
what is the best indicator of future periodontal disease?
past periodontal disease experience
once periodontitis is identified, what factors to study to determine the type of peridontitis present? what is the most common type?
- OH, LOA, age, family history, social history, medical history
- chronic periodontitis
what if a patient is young, has excellent OH and no risk factors eg. smoking BUT has a positive family history of periodontitis? what is the likely diagnosis?
check for aggressive periodontitis
generalized bleeding, no LOA at BOP sites - what disease does the pt have?
generalized chronic gingivitis
generalized bleeding, LOA of 3-4mm at those bleeding sites - what disease does the pt have?
generalized moderate chronic periodontitis
what constitutes a stable periodontium?
when there is no BOP, pockets are maintainable by the patient (
radiographic examination - must be preceded by?
clinical examination and examination of previous radiographs, to decide whether radiographs are required or which views are required
what are 3 things useful to aid periodontal diagnosis, in addition to clinical findings?
- bone loss/support
- pathology
- prognosis of teeth
what are the advantages of taking radiographs in periodontology?
- shows teeth present
- shows bone loss/levels
- suggestion of furcation involvement
- calculus “wings”
- caries
- overhangs
- periradicular pathology
- unerupted/impacted teeth
- retained roots
what are the disadvantages of taking radiographs in periodontology?
- superimposition of structures
- radiation exposure (ALARA principle)
- does not show disease activity
- no indication of timescale of periodontal disease
- does not show periodontal pockets/soft tissue
- underestimates bone loss
- interpretation of small changes difficult (digital subtraction radiography)
superimposition can occur in which 3 forms?
- bone on bone
- tooth on tooth
- tooth on bone
name 2 methods of intraoral radiography
bitewing (horizontal/vertical)
paralleling periapicals
full mouth periapicals
- how many intraoral films?
- radiation?
- 14 intraoral films
- high dose radiation
bitewings - used for what type of teeth?
posterior teeth only
horizontal bitewing - used when?
used where loss of attachment is slight
vertical bitewing - used when?
how many films needed?
where loss of attachment is moderate
may need 2 films of LHS and 2 of LHS
extraoral radiography - DPT: advantages? equivalent to?
- fast, simple, shows whole dentition and supporting structures on film
- equivalent to around 4-6 periapicals
what is the mechanism of digital subtraction radiography?
2 images of same object taken, image intensities substracted, producing a uniform difference image
advantages of digital subtraction radiography?
- more accurate
- far greater diagnostic yield than conventional films
disadvantages of digital subtraction radiography?
need to standardise image for serial radiographs
3 headings to describe bone loss?
distribution
pattern
severity
bone loss: difference between localized and generalized?
localized: 30% sites affected
what are the two patterns of bone loss? what is each associated with?
horizontal: associated with suprabony pockets
vertical: associated with infrabony pockets
bone loss: measuring severity
- measured as?
- radiograph: true representation of object or not? why?
- measured as ratio %
- not a true representation, due to distortion via magnification and foreshortening
how is severity of bone loss calculated?
( acj to bone crest / acj to root apex ) x 100%
bone loss severity percentage: how does it determine severity?
mild/slight: up to and including 1/3rd root length (33%)
moderate: >1/3rd, 1/2 root length (>50%), OR suggestion of furcation involvement
