Exam and Dx Tests

Question 1

do you need to be accurate or precise in tx planning for perio

Answer 1

BOTH accurate and precise

Question 2

purpose of history taking

Answer 2

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

Question 3

what must be taken before clinical exam?

Answer 3

a current medical history must be taken before starting the clinical exam

Question 4

minimum that must be known in a medical history?

Answer 4

1. whether the pt. is under care of a physician or not
2. is the patient taking medication or has any medical condition that may affect the diagnosis or tx.
3. complete list of medications MUST be obtained
   * also when in doubt consult

Question 5

who responsible for getting the medical history exam?

Answer 5

the dentist

Question 6

after medical history?

Answer 6

obtain the dental history

• including the chief complaint or reason for the visit
• past dental and perio care and records, including radiographs

Question 7

importance of the chief complaint?

Answer 7

need to make note of this but often this is not symptomatic in earlier stages

Question 8

symptoms occur when in chronic inflammatory perio disease

Answer 8

usually in the later stages of disease so cannot wait for patients to come forward about perio symptoms so dentist must detect the disease

Question 9

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

Answer 9

more likely a marginal gingivitis

Question 10

what do we need to be aware of in atients who have had repeated extensive periodontal theray?

Answer 10

they may have refractory or recurrent periodontitis that cannot be effectively reated with conventional therapy

Question 11

after dental history?

Answer 11

extra-oral exams
TMJ exam

then intra-oral

Question 12

fremitus importance

Answer 12

movement upon occlusion
- teeth move when bite down

• examines the occlusion

Question 13

occlusal trauma is indicated by?

Answer 13

fremitus (mobility in function) is recoreded

Question 14

fremitus can be determined when/how

Answer 14

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

Question 15

steps 5 - 12 in exam

Answer 15

5 - teeth and their replacements should be examined and evaluated

6. radiograhs
7. presence and distribution of plaque and calculus
8. perio soft tissues- including implant tissues
9. probing depths
10. mucogingival relationships
11. furcations
12. additional tests that may not always be done routinely

Question 16

a thorough periodontal examination consists of the following clinical and radiographic data?

Answer 16

look at slide

Question 17

PSR?

Answer 17

periodontal screening and recording examination

Question 18

clinical sign of gingival inflammation

Answer 18

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)

Question 19

sign of gingival inflammation

Answer 19

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

Question 20

clinical attachment loss definition

Answer 20

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

Question 21

which depths need to be recorded on certain form

Answer 21

probing depth greater than 3mm and clinical attachment level greater than 1mm should be recorded

Question 22

furcation involvement significance

Answer 22

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

Question 23

probe with what in furcation teeth

Answer 23

Nabors probe to determine extension of pockets into areas between roots

Question 24

Class I vs Class II gingival recession

Answer 24

class II recession DOES EXTEND beyond the MGJ into the mucosa

Question 25

bleeding index importance?

Answer 25

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

Question 26

second generation probe?

Answer 26

attempts to permit the use of CONSTANT PRESSURE DURING PROBING

Question 27

third generation probes

Answer 27

have advantage of using computer software and controlled force

Question 28

how is mobility recorded

Answer 28

by moving teeth in a buccolingual and occlusoapical direction

Question 29

what is only thing radiogrpahs can determine

Answer 29

essential for determining the extent and severity of bone periodontal support and for detecting osseous lesions

Question 30

when take bitewings?

Answer 30

when clinical examination indicates the presence

Question 31

when take bitewings?

Answer 31

when clinical examination indicates the presence of periodontitis

so we need selected periapical or bitewing radiographs should be obtained

Question 32

when take full mouth intraoral radiographs

Answer 32

appropriate when patients have clinical evidence of generalized dental disease or a history of extensive dental treatment

Question 33

when take full mouth intraoral radiographs

Answer 33

appropriate when patients have clinical evidence of generalized dental disease or a history of extensive dental treatment

Question 34

periodontitis?

Answer 34

now affecting attachment appratus

*considered irreversible

Question 35

cardinal symptom of periodontitis?

Answer 35

ERIO POCKOT

Question 36

definition of pocket

Answer 36

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

Question 37

only reliable instrument to assess pockets

Answer 37

periodontal probe

- designed to facilitate pocket or attachment level measurements at any tooth site

Question 38

conceptually the probe depth is intended to reflect what distance?

Answer 38

from the bottom of the pocket to the gingival margin (histological sulcus)

Question 39

in inflammed gingival patient you get what types of probing depth?

Answer 39

over estimate

Question 40

in healthy patient - type of probing depths we get?

Answer 40

under estimate

Question 41

in healthy patient - type of probing depths we get?

Answer 41

under estimate

Question 42

healing time of the epithelial cleft following probing is achieved within what amount of time?

Answer 42

5-7 days about a week

• when probing a NON-INFLAMMED periodontium

Question 43

healing time of the epithelial cleft following probing is achieved within what amount of time?

Answer 43

5-7 days about a week

• when probing a NON-INFLAMMED periodontium

Question 44

better reflection of periodontal destruction can be obtained by measurement of

Answer 44

Clinical attachment level (CAL)

so probe tip to level of CEJ

Question 45

manual probing cannot reliably measure changes of PPD in what?

Answer 45

changes in PPD or less than 2.5-3mm