ICP L26: Assessment of periodontal disease Flashcards
Define periodontitis
An infection disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss - characterised by pocket formation and/or recession of the gingivae
What is plaque induced gingivitis
Inflammation of the gingivae due to bacterial plaque (common) and has a slow onset which is usually painless
Give examples of non-plaque induced periodontitis
- Genetic/developmental disorders
- Specific infections
- Inflammatory and immune conditions
- Reactive processes (epulides)
- Neoplasms
- Endocrine, nutritional and metabolic disorders
- Traumatic lesions
- Gingival pigmentation
What are the issues with full mouth comprehensive periodontal assessments
- Full assessment of plaque, calculus, bleeding and pocketing is time consuming and not always relevant
- An index gives a quick rough measure of these and is a systematic way of reporting the findings
- We can use screening methods to indicate who needs a more complete assessment (BPE)
- Full assessments are needed as screening cannot be used for risk assessment/diagnosis
What are periodontal pockets
Gingival sulcus is the space between the tooth and gingiva which is lined by sulcular epithelium - in periodontitis there is alveolar bone loss and the gums recede making them loose which causes pocket formation = deep and narrow spaces
Formation of pockets depends on probe dimensions, probing forces, inflammation of tissue and the periodontal probe penetrates at depth of the sulcus pocket
What are pseudopockets
This is where probing depth is increased due to gingival swelling, overgrowth or anatomical features (semi-impacted, angulates or not fully erupted teeth) - there is no attachment loss
What are true pockets
This is where probing depth is increased due to loss of periodontal attachment
What is gingival recession
- Distance between CEJ and free gingiva
- Can be negative/positive due to pseudo pockets
- Added to PPD to calculate CAL/PAL
- In patients with periodontitis it is a measure of past disease
- Needed to diagnose risk and assess periodontal disease
What is probing
The act of walking the tip of the probe along the JE within the sulcus or pocket to assess the health status of the periodontal tissue
The side of the probe should be kept in contact, and parallel with the root surface and then walked around the circumference
What is BPE and outline the method
Basic periodontal examination - should be used for all routine dental examinations aged 7+
The dentition is divided into sextants (molar/premolar and canine/incisors) and examination is done with WHO probe which is gently inserted into gingival crevice and walked around - for each sextant, only the highest score is recorded (scores are given 0-4)
Describe the WHO probe
- Ball end (0.5 mm)
- Dark black zone (3.5-5mm from tip of probe)
- Higher black lines at 8.5mm and 11.5mm
What does an X in a BPE sextant represent
A sextant that is edentulous or has only one functioning tooth
What does a * in BPE sextant represent
Signifies furcation involvement and is used as an adjunctive score
What are the scoring codes for BPE
0 = No pockets >3.5 mm, no calculus/overhangs, no bleeding after probing (black band completely visible)
1 = No pockets >3.5 mm, no calculus/overhangs, but bleeding after probing (black band completely visible)
2 = No pockets >3.5 mm, but supra- or subgingival calculus/overhangs (black band completely visible)
3 = Probing depth 3.5-5.5 mm (black band partially visible, indicating pocket of 4-5 mm)
4 = Probing depth >5.5 mm (black band entirely within the pocket, indicating pocket of 6 mm or more)
- = Furcation involvement
Outline treatment needs in relation to the scoring codes for BPE
0 = no treatment needed
1 = oral health intervention as bleeding on probing
2 = oral health intervention, scaling and elimination of plaque retentive restorative margins
3 = oral health intervention, scaling/root surface debridement, elimination of plaque retentive restorative margins
4 = OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated, and full mouth 6 point probing chart needed
- = OHI, RSD. Assess the need for more complex treatment; referral to a specialist may be indicated
How is BPE in paediatric different compared to in adults
Only 6 teeth are used: UR6, UR1, UL6, LR6, LL1, LL6 (teeth that erupt first into the mouth)
This is done age 7-12 using only codes 0, 1, 2 in cooperative children
What are the strengths and weaknesses of BPE
+
simple, rapid screening to identify those at risk
good indication of treatment appropriate to codes assigned
- not designed to monitor patients (need full charting)
no distinction between true and false pockets
lack detail within sextants
no detail about recession
no detail about furcation involvement
often misused
When is full periodontal probing (6 point pocket chart) done
When we need a full periodontal assessment (indicated by BPE as scores 3/4)
What is done in full periodontal probing (6PPC)
6 measurements are given for each tooth using the same walking technique using a Williams or UNC15 probe
Bleeding on probing is noted, recession, furcation defects, mobility and full mouth plaque scores
Describe the Williams probe
They have thin stainless steel tip (13mm) and a blunt tip end (1mm diameter) and there are gradations at 1, 2, 3, 5, 7, 8, 9, 10 mm (NOT 4 and 6)
Describe the UNC15 probe
Most commonly used - thin stainless steel tip (15mm) with gradations at 1, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15 and black zones between 4-5mm, 9-10mm, 14-15mm
Outline the technique for 6PPC
Probe along anatomy of the root surface and apply gentle pressure using a finger rest to give reproducibility and standardisation
What can cause probing errors
- Interference from the calculus on the tooth/root surface
- Presence of overhanging restoration
- Incorrect angulation of probe
- Amount of pressure applied
- Misread the probe
- Shape, size of probe
How does a radiographic examination of normal alveolar bone appear
The alveolar bone will have an external plate of cortical bone and an inner socket of thin compact cortical bone which is seen as the lamina dura on radiographs (bundle bone). There are cancellous trabecular between the external plates which act to support the alveolar bone
How is bone loss determined on x-rays
Bone crest is usually 1-2mm apical to the CEJ and clinical crown:root ratios are determined according to the amount of root remaining in bone compared with the amount of tooth above bone level
What is horizontal bone loss
When the level of bone is equal interdentally
What is vertical/angular bone loss
Angular = when one tooth has lost more bone than that next to it
Vertical = when bone crest is more apical to CEJ adjacent to one tooth than to the other neighbouring tooth
What radiographs are taken for periodontal examination
Horizontal bitewings (show crestal bone + indicated when pockets <5mm, show details of overhanging restorations)
Vertical bitewings (show bone levels in moderate-severe periodontitis around several teeth)
Periapicals (in severe periodontitis - show root morphology, furcation involvement, root share and periodontal-endodontic status)
Panoramic
