comprehensive exam and TP Flashcards
patient eval and examination
1) medical and dental history
2) thorough clinical and radio exam
3) IOE and EOE
4) document findings
medical history
1) predisposing conditions
2) treatment, management, outcomes
3) any oral implications
4) any medications
examples
1) diabetes
2) hypertension
3) pregnancy
4) smoking
5) substance abuse
6) medication
dental history
1) chief complaint
2) past dental and periodontal therapy
exams
1) thorough EOE and IOE
what else
1) caries, mobility
2) missing teeth and why?
- impaction, orthodontic reasons, periodontal disease
3) signs of parafunctional habits
4) root irregularities
examination of periodontium
1) review initial exam before 2nd visit
2) present case to attending perio instructor
- take recorded data and use it to come up with a logical diagnosis and TP
gingiva
1) pink, blue, pigmented
2) size
3) contour
4) consistency
5) texture
tissue response
1) edematous
2) fibrotic
pockets
1) mm
2) CAL and BOP
3) usually painless
4) detected with periodontal probe, not radiographs alone
techique
1) walk that probe around
PD vs level of attachment
1) base of pocket and GM
2) base of pocket to CEJ
attachment loss
1) 1-2 mm mild
2) 2-4 moderate
3) >= 5mm severe
probing around implants
1) plastic probe
attached gingiva
1) keratinized gingiva - sulcus depth
MG problem
1) lack of keratinized tissue
2) gingival recession
3) abnormal frenum insertions
4) no attached gingiva
periodontl abscess
1) acute
- avoid, along alteral aspect of root surface
- gingiva is red and edematous
2) chronic
- usuall sinus tract
- opens into gingival mucosa along the length of the root
classification
1) class I
- incipient bone loss
2) class II??
radiographs
1) diagnostic, current
other diagnostic aids
1) microbial sampling
2) diagnostic casts
3) radiographic image
4) medical labs
categories of diagnosis
1) health, gingivitis, periodontitis
diagnosis
1) generalized or localized-
- if 30% or less is localized
2) severity
- mild, moderate, severe
- based on CAL
3) stage and grade
mild
1) >3 <5 mm PD
2) BOP yes
3) up to 15% radiographic bone loss
*just check the slides!!
stage and grade
1) staging is based on severity complexity, extent
2) grading is past progression and risk
everyone with a history of PD should be staged and graded
primary etiology
1) bacterial or microbial plaue
2) susceptible host
secondary etiology
1) caries, calculus, over contours margins, open contacts
2) modifying, alter the response
- occlusal trauma, diabetes
prognosis
1) educated guess and estimate of response to treatment
2) depends on damage that has occurred and dentist’s periodontists ability to remove etiologic factors
prognosis considerations
1) excellent, good, fair, guarded, poor, hopeless
2) look at CAL, PD, patient compliance, med history, etc.
systemic/environmental factors
1) smoking
2) systemic disease
3) genetic factors
local factors
1) subgingival calculus
2) location of teeth
3) prosthetic factors
baseline form
1) occlusal considerations!!
2) for new patients or >2 years
3) inflammatory diagnosis
- health, gingivitis, periodontitis
- generalized or localized
- mild, moderate, or severe
4) stage and grade only periodontitis hx patients
5) etiology
- plaque, followed by calculus, restoration, diabetes, smoking, etc.
6) re-evaluation 4-6 weeks later (even for prophy and SRP)
proposed TP
1) present it to patient
2) patient education
3) alternatives
4) potential complications
5 )expected results
inital therapy
1) pt education and OHI
2) periodontal therapy
3) adult prophy, sc/RP or debridement
4) re-evaluation
- all new pacific patients!!!!!
5) even if tx was a prophy are scheduled for re-evaluation
steps in reevaluation
1) update med and dental history
2) periodontal findings
3) tissue response
- inflammation, bleeding, plaque control, PD, mobility, caries control, mucogingival defects
repeat portions of initial therapy
1) OHI
2) sc/rp
3) reinstrument, surgery
periodontal surgery
1) make a more cleansible environment
when to refer
1) significant attachment and bone loss
2) mucogingival defects
3) aesthetic concerns
4) unstable periodontal condition
5 )rapid progression of periodontitis
6) anything beyond your scope
