Exam and Dx Tests Flashcards
do you need to be accurate or precise in tx planning for perio
BOTH accurate and precise
purpose of history taking
the examination is to arrive at a DIAGNOSIS and preliminary assessment of PROGNOSIS upon which a TREATMENT PLAN may be based
diagnosis – prognosis – tx plan
what must be taken before clinical exam?
a current medical history must be taken before starting the clinical exam
minimum that must be known in a medical history?
- whether the pt. is under care of a physician or not
- is the patient taking medication or has any medical condition that may affect the diagnosis or tx.
- complete list of medications MUST be obtained
* also when in doubt consult
who responsible for getting the medical history exam?
the dentist
after medical history?
obtain the dental history
- including the chief complaint or reason for the visit
- past dental and perio care and records, including radiographs
importance of the chief complaint?
need to make note of this but often this is not symptomatic in earlier stages
symptoms occur when in chronic inflammatory perio disease
usually in the later stages of disease so cannot wait for patients to come forward about perio symptoms so dentist must detect the disease
usually the diagnosis of a patient who reported that bleeding occurred during tooth brushing and not associated with pain or swelling and stops after brushing
more likely a marginal gingivitis
what do we need to be aware of in atients who have had repeated extensive periodontal theray?
they may have refractory or recurrent periodontitis that cannot be effectively reated with conventional therapy
after dental history?
extra-oral exams
TMJ exam
then intra-oral
fremitus importance
movement upon occlusion
- teeth move when bite down
- examines the occlusion
occlusal trauma is indicated by?
fremitus (mobility in function) is recoreded
fremitus can be determined when/how
by having patient make excursice mandibular movements and close repeatedly in habitual centric occlusion while dentist feels for tooth movement with an index finger placed on the buccal surfaces of the teeth
steps 5 - 12 in exam
5 - teeth and their replacements should be examined and evaluated
- radiograhs
- presence and distribution of plaque and calculus
- perio soft tissues- including implant tissues
- probing depths
- mucogingival relationships
- furcations
- additional tests that may not always be done routinely
a thorough periodontal examination consists of the following clinical and radiographic data?
look at slide
PSR?
periodontal screening and recording examination
clinical sign of gingival inflammation
increased redness or erythoema is a clinical sign of gingival inflammation because of the increased gingival vascularity in response to local irritants (like plaque and calculus)
sign of gingival inflammation
any swelling or enlarged apearance of MARGINAL gingiva
bleeding from the gingival crevice when the inner asect of the gingival sulcus is gently swept with the side of a perio probe
clinical attachment loss definition
is the distance from the cementoenamel junction to the apical extent of the pocket and represents the best clinical measure of disease severity in terms of loss of support for the teeth
which depths need to be recorded on certain form
probing depth greater than 3mm and clinical attachment level greater than 1mm should be recorded
furcation involvement significance
b/c teeth with perio pockets in furcations have been shown to have increased loss of attachment and poorer prognosis - even after following perio therapy
lesions in multi-rooted teeth that have advanced into the furcation area between the roots have worse response to tx
probe with what in furcation teeth
Nabors probe to determine extension of pockets into areas between roots
Class I vs Class II gingival recession
class II recession DOES EXTEND beyond the MGJ into the mucosa
bleeding index importance?
number of sites bleeding over the total number of sites in the mouth X 100
- helpful in monitoring the progress of therapy
- at next appointments a new index can indicate the effectivness of therapy
second generation probe?
attempts to permit the use of CONSTANT PRESSURE DURING PROBING
third generation probes
have advantage of using computer software and controlled force
how is mobility recorded
by moving teeth in a buccolingual and occlusoapical direction
what is only thing radiogrpahs can determine
essential for determining the extent and severity of bone periodontal support and for detecting osseous lesions
when take bitewings?
when clinical examination indicates the presence
when take bitewings?
when clinical examination indicates the presence of periodontitis
so we need selected periapical or bitewing radiographs should be obtained
when take full mouth intraoral radiographs
appropriate when patients have clinical evidence of generalized dental disease or a history of extensive dental treatment
when take full mouth intraoral radiographs
appropriate when patients have clinical evidence of generalized dental disease or a history of extensive dental treatment
periodontitis?
now affecting attachment appratus
*considered irreversible
cardinal symptom of periodontitis?
ERIO POCKOT
definition of pocket
abnormal extension APICAL of the gingival sulcus caused by an EXTENSION OF THE JUNCTIONAL EITHELIUM along the root surface and the formation of pocket epithelium as the periodontal ligament is detached and destroyed by the disease process
only reliable instrument to assess pockets
periodontal probe
- designed to facilitate pocket or attachment level measurements at any tooth site
conceptually the probe depth is intended to reflect what distance?
from the bottom of the pocket to the gingival margin (histological sulcus)
in inflammed gingival patient you get what types of probing depth?
over estimate
in healthy patient - type of probing depths we get?
under estimate
in healthy patient - type of probing depths we get?
under estimate
healing time of the epithelial cleft following probing is achieved within what amount of time?
5-7 days about a week
- when probing a NON-INFLAMMED periodontium
healing time of the epithelial cleft following probing is achieved within what amount of time?
5-7 days about a week
- when probing a NON-INFLAMMED periodontium
better reflection of periodontal destruction can be obtained by measurement of
Clinical attachment level (CAL)
so probe tip to level of CEJ
manual probing cannot reliably measure changes of PPD in what?
changes in PPD or less than 2.5-3mm
