Ch. 20 Periodontal Examination Flashcards
Periodontal examination is a component of what?
Care plan. Necessary for the treatment plan of the pt
Basic exam instruments
Mouth mirror
Periodontal probe
Furcation probe
Sub gingival explorer (ODU EXD 11/12)
Mouth mirror Purposes and uses
- Indirect vision
Distal surfaces of posterior teeth, lingual surfaces of anterior - Indirect illumination
Relict light to any area in oral cavity - Trans illumination
Direct light through teeth - Retraction
Protect or prevent interference by cheeks tongue lips
Do not use shank to retract!
Is subgingival calculus darker than supragingival calculus?
Yes
Precautions for air water syringe
Give pt a warning with the air
Avoid sharp blast of air on cervical areas of teeth or open carious lesions
Sensitive to pts
Dry by blotting with gauze or cotton roll
Explorer
Slender, wire like metal tip that is circular in cross section and tapers to a fine sharp point
Explorer-general purposes and uses
Detect irregularities by tactile sense
-calculus, defects in restorations, etc
Define extent of instrumentation needed
-How much calculus, what instrument to use
Evaluate completeness of treatment
Sublingual explorers
Specifics explorer #
What it can be used for
ODU 11/12
facilitated by angled shank with a short tip
Adapted to all surfaces of tooth but useful for proximal surface exam
Supragingival Explorer
Examines pits and fissures bc it’s not as sharp
Shepherd hook explorer
Surfaces and margins of restorations and sealants
Pigtail or cow horn
Proximal surfaces for calculus, margins of restorations, dental caries
Types of stimuli
Tactile
-Vibrations from instrument
Auditory
-sound may be created when in contact with irregular tooth structure
-cementum and calculus have distinctive click
Metallic restorations “Squeak” or “ring”
Purposes and Uses of a Probe
- Measure probing depth
- Location of gingival margin in relation to CEJ (CAL)
- Location of mucogingival junction
- Other gingival determinations (bleeding)
- Guide treatment- Assessment data (basis of tx plan)
- Evaluate Treatment outcomes
- Evaluation at continuing care and perio maintenance appointments
Marquis Probe
Color coded in 3mm increments
UNC 12
Color coded in 5, 10, 12
Used in clinic
Sulcus
Healthy (normal space between tooth and gingiva)
Diseased, unhealthy gingival sulcus
Measured from base to Gingival Margin
Where do gingival and periodontal infections begin most frequently?
COL area
Factors Affecting probe accuracy
- Stage and extent of perio disease
-severe inflammation, may overestimate attachment loss - Perio probe
- Placement problems
-anatomic: tooth contours, furcation, crowding
-Inferences: calculus, restorations
-access and visible: blood, biofilm, opening by pt
COL
Depression under contact area between facial and lingual papilla
Conforms to proximal contact area
where infection begins-usually deepest area on probe
Stages of extent of perio disease?
Normal
Gingivitis
Advanced
Normal-
Base of pocket goes to base of junctional epithelium
Gingivitis-
Probe goes into junctional epithelium
Advanced-
Probe passes fully through junctional epithelium
Preliminary assessment prior to perio exam
- Medical history
- Dental and psychosocial history
- Vital signs
- Eo/Io exam
- Risk assessment
- X-rays
- Dental exam (missing teeth, Carie’s, restorations, occlusion)
- Hard and Soft deposits noted
-Supra and subgingival calculus
Mouth deposits
Hard- calculus (can’t remove with toothbrush only metal instruments)
Supra, subgingival
Soft-biofilm, plaque
Where is supragingival calculus usually located?
Maxillary molars, buccal
Mandibular anterior incisors, lingual
Perio probe procedure
1-2mm
Up and down motion
Slow and controlled
Probe parallel with long axis of tooth
6 readings per tooth (3facial, 3lingual)
“Walking stroke”
CAL
Refers to attached tissue at base of
Measure from
Clinical attachment level (how many mm to get gums back to good health)
Refers to position of perio attached tissues at base of sulcus or pocket
Measured from fixed point (CEJ)
CAL recession
CEJ visible, add
PD+GM=cal
CAL inflammation
CEJ covered, subtract
PD-GM=cal
MGI
Muccogingival involvement
Not everyone has
Measure to detect adequacy of width of attached gingiva
-measure External surface measure From MGJ to GM
-Measure PD
Subtract PD from total width
Determination of mobility
2 single ended metal instruments with wide blunt ends, held in modified pen grasp
Apply specific firm finger rests
Also test vertical mobility (into socket) w/ one of mirror handles on occlusal/Incisal edge
Tooth to tooth systematically
Record degree of movement (1-3)
N. Normal, physiologic
Class 1. Slight mobility, greater than normal
Class 2. Mod mobility greater than 1mm displaced
Class 3. Severe mobility, moves vertically and is depressible in the tooth socket
Fremitus
Determined on which teeth?
Palpable vibration or movement
Vibratory patterns of teeth
Only determined on maxillary teeth
Fremitus measurement
1,2,3?
Finger on cervical third as pt bites down continually
N normal
+: one degree, only slight vibration
++: two degree, tooth is clearly palpable but movement is barley visible
+++: movement is clearly observed visually
When measuring MGJ, horizontally hold probe and _____ mucosa toward gingival margin.
Maxillary ____&_____
Mandibular______&_____
Wrinkle
Facial and buccal
Buccal and lingual
Blanching or wrinkling at gingival margin indicates __ attached gingiva
No
Bifurcation
Which teeth?
What surfaces can be tested for furcation involvement?
Mandibular molars
-facial and lingual
Maxillary first premolars
- medial and distal aspects under contact area
Trifurcation
Teeth with 3 roots
Maxillary molars-palatal and 2 buccal roots
Access at Straight lingual, mesiobuccal and distobuccal roots
Furcation involvement classes 1-4
Classified by amount of ___ destroyed in the area
Bone destroyed
1-early, feel furcation, bone in tact
2-Enter in furcation but can’t go all the way through to other side
-bone destroyed
-gum still covering
-probe barely enters
3-enter in furcation and goes through to other side
*gum still covering
4-enters all the way through and you can see
Normal bone level on radiograph
Crest of inderdental bone appears 1-1.5 mm from CEJ
Horizontal from CEJ of one tooth to another
Horizontal bone loss
What is the factor?
When the crest of the bone is parallel with a line between the CEJs of 2 adjacent teeth
Usually when inflammation is sole factor
Generalized vs localized bone loss
> 30% = generalized
<30% = localized
Vertical (angular) bone loss
Commonly ____?
What contributes to destruction? (2)
Reduction in height of Crestal bone that is irregular
Bone level is not parallel with a line joining adjacent cejs
*Angular is more commonly localized
-inflammation and trauma combined in destruction and irregular shape of bone
Crestal lamina dura
Normal radiograph
Evidence of disease
Compact bone that lies parallel to periodontal ligament
Normal-white, radiopaque
Disease-radiolucent, black, fuzzy
Furcation involvement on X-ray
Normal and diseased-color, size?
Normal-white opaque, bone fills the area between the roots
Disease-Appear as small radiolucent area or as a slight thickening of the periodontal ligament space
Periodontal ligament
Connective tissue
Appears as fine black radiolucent line next to the root surface
Widens with disease- around entire side of root to apex or around root
*Outer side is lamina dura=bone that lines tooth socket and appears radiopaque
Subgingival explorer facilitated by
Angulated shank w/short tip
Shepherd hook used for
Supragingival smooth surfaces
&
Examines pits and fissures
Pigtail or cow horn
Supragingival
Proximal surfaces for calculus, dental caries and margins of restorations
