Clinical Assessment of Periodontal Disease Flashcards
Describe the dental hygiene process of care.
ADPIE
Assessment Dental Hygiene Diagnosis Planning Implementation Evaluation
Discuss the elements that make up the “assessment”
phase.
- Med hx
- Social hx
- Family hx
- Dental hx
- Chief Complaint (CC)
- EO/IO
- Dental Examination
- Periodontal Examination
- Must use open ended questions and have follow up questions that address “yes” Answers
Explain how different items on med hx, social hx,
dental hx, CC, and examinations can affect
periodontal disease
Med Hx: Uncontrolled diseases, diabeties
Social Hx: What their habits are? Drinking/Smoking/Vaping
Dental Hx: Frequeny of snacking, brushing/flossing, careis risks
CC: CC can give us an idea of what is going on.. such as sensitivity of pain
EO/IO
- Lymphadenopathy what does this tell us
- How might this relate to perio?
- Gingival Discription- what does this tell us?
- How might he medical hx or social hx affect what we might see
- Infection of the lymph nodes
- The Mandible or maxilla nodes may be swollen from infection from perio
- The gingival description tells us weather the gingiva is healthy or not
- Medical history.. certain diseases to show signs in the mouth and social history of smoking may show loss of color in gingiva
Dental Evaluation
What might we see that would affect perio?
- Teeth
- Attrition, abfraction, erosion -Malpositioning
- Restorations
- Decay
- Stain
- Appliances
- Hypersensitivity
These can contribute to perio due to overhangs, recurrent decay, appliances hard to clean.
Dental Evaluation
What might we see that would affect perio?
- Teeth
- Attrition, abfraction, erosion -Malpositioning
- Restorations
- Decay
- Stain
- Appliances
- Hypersensitivity
These can contribute to perio due to overhangs, recurrent decay, appliances hard to clean.
Gingival Description
- Anything from the med hx or social history that may come into play here… picture not shown but it was gingival hyperplasia from medicatios
- Color
- Consistency
- Contour
- Size
Periodontal assessment provides the ____ for __-term monitoring of periodontal disease activity
Outcomes evaluation to measure success after periodontal therapy
baseline long-term
Periodontal Examination is completed typically ___- ____ times a year
1-4
For periodontal maintenance patients: Complete periodontal charting at every appointment- This may vary form office to office
For healthy patients: complete periodontal charting at least __ yearly
At other visits ___ screening may be used to determine if complete charting is needed- if a __ or above is scored, then complete charting is indicated
Research has shown that usually screening and documentation is ___ **
1
3
PSR
** INADEQUATE
THE PSR is a periodontal assessment used to determine the periodontal health status of a patient and determine if a more ____ examination is indicated
complete
THE PSR exam take __-__ mins
Uses the __ probe ( has a __ tip and a colored band that marks __ - ___ mm
Mouth divided into __
All sites are probed on each tooth, but only the __ probing depth is scored and recorded
2-3minutes PSR ball tip 3.5-5.5mm sextants deepest
Colored band is completely visible; no bleeding; no calculus; no roughness
Code 0
Colored band is completely visible; bleeding; no calculus or roughness
Code 1
Colored band is completely visible; bleeding; calculus and/or roughness
Code 2
Colored band is partially visible (3.5-5.5 mm PD)
Code 3
Colored band is not visible (5.5mm or greater PD)
Code 4
PSR * next to score
Furcation, mobility, mucogingival involement or recession
When scoring a __ or __ then a comprehensive charting is indicated
3 or 4
current or ongoing loss
of soft tissue attachment, specifically destruction of
gingival fibers and apical migration of JE, with
subsequent bone loss
Periodontal Disease Activity
Disease activity is typically seen in periods of ____ followed by periods of quiescence (inactivity)
exacerbation (worsening)
most commonly used physical
screening method for measuring the depth of the
gingival sulcus and the clinical attachment level
Periodontal Probing
Distance from the gingival margin to the base of the sulcus
Probing Depth
***In healthy gingiva, the marginal gingiva is approx.__ - __mm coronal to the CEJ
.5-2
distance from CEJ
to the base of the sulcus (JE)
Clinical Attachment Level
Even in a healthy state, the probe tip can penetrate the ___ (coronal to middle portion)
In gingiva that is inflammed, it goes even deeper into the LP, and sometiems all the way to the alveolar crest
JE
2 examples of Controlled Force Probes
Florida Probe
Interprobe
Controlled Force Probes provide a fixed __ - ___ g probing force in order to reduce examiner error
20-25g
Connected to a computer for recording and storing data
controlled force probes
Factors that Affect Probing
- Probe angulation
- Variation in placement
- Site of probing
- Probe size, type of probe
- Tooth anatomy
- Presence of calculus -Visibility
- Patient discomfort
Probe is ___. Spot probing is not sufficient. Most errors occur on ____ readings
walked
interproximal
Probing:
Posterior: probe is angled into the _
Anterior probe is parallel to the long axis of tooth
Facial and lingual surfaces probe is paraellel to the long axis
*** it will need to be angled just a hair to get into the sulcus
col
Clinical Attachment LEVELS
Need to know
- Probe depth
- Distance from CEJ to gingival margin
CAL= PD+Recession CAL= PD-Amount of gingival overgrowth
**A patient has clinical attachment loss when there is periodontitis with __ migration of the __
apical
junctional epithelium
Determination of attachment loss is part of __
Clinical attachement level
a shift in the position of the
gingival margin apical to the CEJ à root is now
exposed
Gingival recession
Causes of Gingival Recession
trauma, orthodontic
movement, dental procedures, crown margins, clasps
from RPDs, periodontal disease, periodontal
therapy, oral habits (nail biting, aggressive
brushing), anatomic variations (frenum pull)
a discrepancy in
the relationship between the mucogingival junction
and the free gingival margin Usually, there is no attached gingiva remaining
Mucogingival involvement (defect)
Determining the amount of attached gingiva:
- Measure the amount of keratinized gingiva (FGM
to MGJ)– now known as Keratinized Tissue Width
(KTW) - Subtract the probing depth from this measurement
- The result is the amount of attached gingiva
Determining the amount of attached gingiva:
/mucogingival involvement
- Measure the amount of keratinized gingiva (FGM
to MGJ)– now known as Keratinized Tissue Width
(KTW) - Subtract the probing depth from this measurement
- The result is the amount of attached gingiva
4 parts for consideration in treatment-oriented classification of gingival biotype and recession:
and which are collectively, gingival biotype or phenotype
- Recession Depth
- (Gingival Thickness)
- (Keratinized Tissue Width)
- Root Surface Condition
Gingival Phenotype Explained: Gingival thickness and keratinized tissue width
Thin KTW: roughly < mm
Thick KTW: roughly >mm
Thin gingiva <1mm thick is associated with an increased risk of
Thick gingiva >1mm is at less risk
5mm
5mm
gingival recession
What is the trick to figuring out gingival thickness
If the probe is visible through the tissue yes thin biotype
if no thick biotype
**What is the trick to figuring out gingival thickness
If the probe is visible through the tissue yes thin biotype
if no thick biotype
Recession Classification
***Attachment loss is measured from the CEJ to base of sulcus
Recession Type 1
Type 2
Type 3
gingival recession with no loss of
interproximal attachment; IP CEJ is not detectable at both mesial
and distal aspects
RT1
gingival recession associated with loss of IP
attachment; IP attachment loss is less than or equal to the buccal
attachment loss
RT2
Gingival recession associated with loss of IP
attachment; IP attachment loss is greater than buccal attachment
loss
RT3
Root Surface Classification:
- Root concavity (ex. abfraction) = “step” cervical step >equal to _mm +
CLASS A: CEJ is detecable
CLASS B: CEJ is undetecteble
REFER TO CHART
.5mm
Tooth can be moved up to 1mm in any
direction
CLASS 1 MOBILITY
Tooth can be moved more than 1mm in
any direction but is not depressible in the socket
Class II MOBILITY
Tooth can be moved in a buccolingual
direction and is depressible in the socket
CLASS III
**MOBILITY SHOULD BE ASSESSED WITH
2 INSTRUMENTS
FURCATION INVOLEMENT: THE ABILITY TO ASSESS FURCATION WITH AN EXPLORER OR \_\_ - MAXILLARY MOLARS: - MANDIBULAR MOLARS: - MAXILLARY FIRST PREMOALRS :
PROBE
TRIFURCATED
BIFURCATED
BIFURCATED
The concavity just above the furcation entrance can be felt with the probe tip and this area may pose a challenge for patient cleaning; the probe can enter the furcation up to 3mm
GRADE 1 FURACATION
The probe or explorer can enter the
furcation more than 3mm, but cannot pass all the way through
GRADE 2 FURACATION
Probe passes all the way through.
GRADE 3 FURCATION
Visible through and through.
GRADE 4 FURCATION
