Ch. 20 Periodontal Examination Flashcards by McCall S

Periodontal examination is a component of what?

Care plan. Necessary for the treatment plan of the pt

How well did you know this?

Not at all

Perfectly

Basic exam instruments

Mouth mirror
Periodontal probe
Furcation probe
Sub gingival explorer (ODU EXD 11/12)

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Do not use shank to retract!

How well did you know this?

Not at all

Perfectly

Is subgingival calculus darker than supragingival calculus?

Yes

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Explorer

Slender, wire like metal tip that is circular in cross section and tapers to a fine sharp point

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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”

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Marquis Probe

Color coded in 3mm increments

How well did you know this?

Not at all

Perfectly

UNC 12

Color coded in 5, 10, 12
Used in clinic

How well did you know this?

Not at all

Perfectly

Sulcus

Healthy (normal space between tooth and gingiva)

How well did you know this?

Not at all

Perfectly

Pocket

Diseased, unhealthy gingival sulcus

Measured from base to Gingival Margin

How well did you know this?

Not at all

Perfectly

Where do gingival and periodontal infections begin most frequently?

COL area

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

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