Full assessment Flashcards
When do we carry out a Full periodontal assessment?
After BPE score of more than 3 or 4
After recieving a BPE if 4 how long often must full periodontal assessments be carried out?
Initially every 3 months until stabilised
For rest of lives at least yearly
When is a referal to a specialist made?
If not responded well to treatment
If worsening despite good plaque control
If patient has underlying systemic illness e.g. diabetes
What does the full periodontal assessment tell us (5)?
- Site specific nature of disease
- Extent and severity of disease (more localised takes less time to treat)
- Treatment planning
- Moniter disease and hygiene therapy
- Predict likely treatment outcome
What makes an individual more susceptible to periodontal disease?
Crowding
Durnications
Right hand = miss tip left buccal area when brushing
What are the clinical signs of periodontitis (7)?
- True pocketing >4mm where attachement loss has occured
- Recession
- Supparation (problem with pulp or apex = not only periodontal!)
- Mobility
- Migration (different directions fue to lips or opposing dentition)
- Furcation involvement
- Bone loss on radiographs
What 5 things do we record in a full periodontal assessment?
- Pockets
- Bleeding
- Supparation
- Mobility
- Furcations
Which probe do we use to do a full periodontal assessment?
Williams probe
What are the measurement intervals on the BPE/WHO probe?
- 5
- 5
- 5
- 5
- 5
What are the measurement intervals on a Williams probe?
1
2
3
5
7
8
9
10
How much pressure do you apply a williams probe with?
2.0 - 2.5 N (enough to start blanching your nail)
In which ways is the shape adapted for periodontitis?
It is fine = enters narrow pockets
Blunt end = avoids damage
How many sites on each tooth do we probe at?
6
What is bleeding a sign of?
Acute inflammation
(lack of bleeding = lack of disease activity but may occur if probing is too forceful & less bleeding in smokers)
Which two things may cause drainage of pus?
When released during probing
On pressure of the gingiva
(associated with bad taste)
How do we test mobility?
Put finger against one side of tooth
Push on other side with metal handle of instrument
Which index do we use to measure tooth mobility?
Miller mobility index
(write in roman numerals!!)
What is grade 0 mobility?
No mobility (<0.2mm) = physiological
What is grade I mobility?
Horizontal mobility of <1mm
What is grade II mobility?
Horizontal mobility >1mm
What is grade III mobility?
Includes vertical mobility of any degree
= must be extracted as will move whenever you masticate!
Which classification system do we use to measure furcation involvement?
Hamps
Which probe do we use to measure furcation involvement?
Williams probe
What is a grade 1 furcation involvement?
Up to 3mm
= difficult but maintainable
What is grade 2 furcation involvement?
Probe goes in 6mm but not all the way through
What is grade 3 furcation involvement?
Probe passes all the way through the roots
How do we measure gingival recession?
Use a williams probe to measure the distance from the CEJ to the gingival margin at 6 sites per tooth
Why can it sometimes be difficult to measure gingival recession?
It can be difficult to see the difference bwtween enamel and root due to wear from brushing
Which classification system do we use for recession?
Millers
= 4 categories, assesses both hard and soft tissues
= both diagnostic & prognostic (class 3 & 4 cannot be surgically corrected)
What is Class I gingival recession?
Does not extend to mucogingival junction
No alveolar bone loss
No soft tissue loss from interdental area
What is Class II gigival recession?
Extends beyound mucogingival margin (harder for patient to clean = looks less healthy)
Good interdental papillae
No alveolar bone loss or soft tissue loss in interdental area
What is Class III gingival recession?
extends beyound mucogingival margin, some bone & soft tissue loss
What is class IV gingival recession?
recession beyond mucogingival junction
What can cause gingival recession (9)?
- Root anatomy (enamel pearls/bulbous roots)
- Root angulation/tooth position/crowding
- Thin labial bone/dehiscence (sheathing around tooth incomplete)
- Thin gingival biotype
- Toothbrush trauma
- Periodontal disease
- Traumatic occlusion
- Habitual (nail biting, piercing, pen chewing = jiggling forces on teeth)
- Orthodontic arch expansion (teeth pushed out towards edge of arch)
What are the 3 different types of radiographs taken?
- DPT = all teeth & bone but not all detail needed
- Full mouth periapicals (goes to apex of every tooth)
- Periodontal diagnositic unit (PDU) = left & right vertical bitewings plus periapicals of anterior teeth
