Assessment of the Periodontal Patient Flashcards
Describe a new patient assessment
- Presenting Complaint
- History of Presenting Complaint
- Extra Oral Examination
- Intra Oral Examination
- Radiographic Assessment
- Diagnosis
- Treatment plan
What are 5 common presenting complaints with regards to periodontics?
- No issues
- Gingival bleeding on brushing
- Spacing or drifting of teeth
- Tooth mobility
- Gingival recession and sensitivity
Describe 3 components of a history-taking not related to the patient’s complaint
- Past Medical History - Medication or systemic diseases
- Social History - Smoking / Alcohol, Work Environment
- Past Dental History
How do you take a smoking history?
- Do you smoke?
- “Yes” > How many? / How long? > Current smoker
- “No” > Have you ever smoked?
- “Yes” > When did you stop / How many for how long > Ex-smoker
- “No” > Never smoker
Describe 5 components of a previous dental history
- Attendance with GDP
- Frequency of brushing
- Use of inter-dental cleaning aids or mouthwash
- Anxiety regarding dental treatment
- Denture wearer
What are 2 things to look out for during an extra-oral examination?
- Lymphadenopathy
2. TMJ disorders
Describe 4 components of an intra-oral clinical examination
- Soft tissue assessment
- Overall assessment of dentition
- Assess occlusion
- Inspection of periodontal tissues
Describe 6 components of a periodontal examination
- Plaque Index
- Periodontal Pocket Depths
- Bleeding on Probing
- Mobility
- Gingival Recession
- Presence of Furcation Defects
What plaque index is used during a periodontal examination?
O’Leary Plaque Index
Describe the O’Leary Plaque Index
- Method of recording plaque on individual tooth surfaces
- Mesial, distal, buccal and lingual surfaces assessed
- Plaque Score = (Number of Surfaces Exhibiting Plaques / Number of Surfaces Available x 100)
Name 2 periodontal probes which can be used to determine pocket depths
- Michigan-O probe with William’s markings
2. WHO-621 Periodontal Probe
What is probing pocket depth?
Distance from gingival margin to base of periodontal pocket
What is clinical attachment loss?
Distance from CEJ to base of the periodontal pocket
In terms of clinical attachment loss and probing pocket depth, how is gingival recession determined?
If CAL is greater than PPD then gingival recession is present
In terms of clinical attachment loss and probing pocket depth, how is gingival swelling determined?
If periodontal pocket depth is greater than clinical attachment loss, gingival swelling is present
Name 2 uses of bleeding on probing
- Sign of inflammation in tissues
2. Use as a marker of stability
What 2 reasons may a pocket bleed on probing?
- Ulcerated pocket epithelium
2. Increased vascularisation of connective tissues
What 2 reasons may a pocket bleed on probing?
- Ulcerated pocket epithelium
2. Increased vascularisation of connective tissues
What 2 reasons may a pocket bleed on probing?
- Ulcerated pocket epithelium
2. Increased vascularisation of connective tissues
How can bleeding on probing be used as a marker of stability of periodontal disease?
Presence of BOP is a marker of unstable periodontal diseases whereas absence of bleeding is a better indicator of stability
Describe Miller’s Index with regards to mobility of a tooth
0 - No movement of tooth
1 - Buccal-Lingual movement of <1mm
2 - Buccal-Lingual movement >1mm
3 - Buccal-Lingual movement >1mm and vertical movement
What causes mobility of teeth?
Alveolar bone loss
What is the function of carrying out radiographic assessment in periodontics?
Determine any alveolar bone loss and other pathology present in the oral cavity
What are 3 most common radiographic views in periodontics?
- OPT
- Bite-wings
- IOPAs
Describe an OPT with regards to periodontics
- Provides overview of all teeth, jaws and sinuses
- Poor quality anteriorly due to superimposition of cervical spine
- Good screening radiographs
- Increased radiations vs bitewings and IOPAs
Describe an OPT with regards to periodontics
- Provides overview of all teeth, jaws and sinuses
- Poor quality anteriorly due to superimposition of cervical spine
- Good screening radiographs
- Increased radiations vs bitewings and IOPAs
Describe a bitewing with regards to periodontics
- Excellent quality
- Posterior teeth only
- Does not show apices of roots so may not show full extent of bone loss
Describe an IOPA as a periodontal radiograph
- Excellent quality
- Gold standard
- Shows all tooth and root and periapical bone
What mnemonic is used to decide on choice of radiographs?
ALARP - As Low As Reasonably Practicable
What radiographs are likely to be taken for generalised moderate to advanced periodontal disease?
OPT plus anterior IOPAs
What radiographs are likely to be taken for generalised mild periodontal disease?
Bitewings and anterior IOPAs
What radiographs are likely to be taken for localised advanced periodontal disease?
Additional IOPAs of areas affected
Name 9 things to look for on a radiographic examination
- Bone Loss (severity and pattern)
- Presence of sub-gingival calculus
- Caries
- Restoration margins
- Peri-apical radiolucencies
- Presence of furcation lesions
- Widening of PDL
- Root form
- Any associated pathology
