Lecture 5 Flashcards
Periodontal Assessment
DH process of care
Assessment
Diagnosis
Planning
Implementation
Evaluation
clinical periodontal assessment
a fact gathering process designed to provide a comprehensive picture of the patient’s periodontal health status
why is a comprehensive periodontal assessment important
there is a legal obligation to perform and document findings of a periodontal assessment for every patient
forms the basis for periodontal diagnosis and individualized treatment plan
objectives of the periodontal assessment
detect: clinical signs of inflammation in the periodontium
identify: damage to the periodontium already caused by disease
provide: the dental team with the information used to assign a periodontal diagnosis
document: features of the periodontium to serve as a baseline data for long-term patient monitoring
documentation
assessment is not complete until all of the information gathered has been accurately recorded in the patient’s record
accuracy is important
baseline data is used to evaluate the success or failure of perio therapy and for long term monitoring
standard of care
for dentists and DH to complete an accurate and thorough periodontal assessment on every patient
two types of periodontal assessment
periodontal screening examination
comprehensive periodontal assessment
periodontal screening examination
may be used as one of the first steps in a patient’s periodontal assessment
a quick information gathering process to determine signs of health, gingivitis, periodontitis
PSR technique
special probe: world health organization (WHO) probe
mouth is divided into sextants, each receiving a code (0, 1, 2, 3, 4)
documenting the PSR
codes 0, 1, 2 colored band is completely visible
code 0
no bleeding/calculus/defective margins
appropriate preventative care
code 1
bleeding on probing
no calculus/defective margins
appropriate preventative care
appropriate biofilm removal
code 2
calculus and/or defective margins present
appropriate therapy/PT education
biofilm removal
calculus removal
defective margins corrected
code 3
probing depths 4mm-5.5mm
calculus/defective margin/BOP may or may not be present
a comprehensive periodontal assessment is required for affected sextant
if 2 or more sextants score code 3: a comprehensive full mouth periodontal assessment is required
code 4
PD >5.5mm
a comprehensive full mouth periodontal assessment is necessary to determine an appropriate treatment plan
code *
a * is added to a sextant when a clinical abnormality is found
furcation
mobility
mucogingival problem
recession 3.5mm or greater
comprehensive periodontal assessment includes
probing depth measurements
BOP
presence of exudate
location of free gingival margin
gingival width/attached gingiva
mobility
furcation involvement
presence of calculus/biofilms
gingival inflammation
radiographic evidence of bone loss
presence of local contributing factors
gingival margin coronal to CEJ is recorded as a _____ number in axium
negative
gingival margin apical to CEJ is recorded as a _____ number in axium
positive
gingival pocket
due to gingival enlargement
no attachment loss
no apical migration of JE
periodontal pocket
sulcus over 3 mm in depth
apical migration of JE
loss of periodontal tissues/bone
clinical attachment level
a clinical measurement of the true periodontal support around the tooth
CAL accurately monitors change over time because it
is calculated from a fixed point on the tooth’s surface; the CEJ
gingival margin at normal level
the probing depth and the CAL are the same
gingival margin receded
the gingival margin level reading is added to the probing depth reading
gingival margin significantly above CEJ
subtract gingival margin level reading from the probing depth reading
gingival width
measure the total width of the gingiva from the gingival margin to the mucogingival junction
attached gingiva
the part of the gingiva that is tightly connected to the cementum on the cervical third of the root and to the connective tissue cover of the alveolar bone
width of attached gingiva on facial max and mand
widest on incisors and molars
narrowest on canine and biscuspids
width of attached gingiva on lingual on mand
widest on molars
narrowest on incisors
exudate
referred to as suppuration
may be revealed using light finger pressure
axium recordings: B (bleeding), N (no bleeding), S (suppuration)
pus
composed of mainly dead WBC which can occur in response to infection such as periodontal disease
mobility
horizontal: movement in facial/lingual direction
vertical: depressible
class 1 mobility
up to 1 mm horizontal
class 2 mobility
1-2 mm horizontal
class 3 mobility
> 2 mm
horizontal/depressible
furcations and classes
maxillary molars are tri-furcated
mandibular molars are bi-furcated
class I: probe penetrates <1mm
class II: probe penetrates >1mm
class III: probe passes through
class IV: probe passes through and clinically visible
presence of biofilm and calculus
can be identified using such instruments as the periodontal probe or an explorer
disclosing solution
calculate a plaque score
never disclose before having what checked by your instructor
gingival description
detecting calculus
use direct visual examination with mouth mirror
use compressed air to assist in identification of supragingival depositis
tactile examination using explorer
radiographs
occlusion: signs and symptoms or trauma
tooth mobility
fremitus
tooth migration
wear facets
pain (TMJ and/or musculature)
radiographic signs of trauma from occlusion
widening of PDL
increased thickness of lamina dura
vertical bone loss
root resorption
