Monitoring and Periodontal Indices

Question 1

Timeline for Periodontal disease and how this come about?

Answer 1

• Initial screening using BPE= determines whether pt has disease and broadly what kind.
• Baseline investigation = determines extent of disease and locations in the mouth.
• Monitoring = looking at the effects of treatment, see if its successful.

Question 2

Index definition

Answer 2

Index is a measure of parameters that relate to periodontal diseases or health
indicators of things related to periodontitis

Question 3

Periodontal indices what are their uses?

Answer 3

• Screen for disease
• Establish / grade the level of disease
• Assist in reaching a diagnosis
• Monitor response to treatment
• Establish further need for treatment post therapy

Question 4

Periodontal indices what are their uses in research?

Answer 4

• Clinical trials
• Epidemiology- tell you amount of disease present in community
• Public health
  Clinical management of
  patients

Question 5

Plaque is a key indice because it is is key in:

Answer 5

1. the aetiology of gingivitis
2. the aetiology of periodontitis
3. the success or failure of periodontal treatment

Question 6

Benefits of plaque indices:

Answer 6

• Gives the distribution and/or amount of plaque in the mouth
• Identifies areas of difficulty for patient’s oral hygiene measures
• Enables clinician to show patient areas of plaque
• Allows tailor made OHI to be given
• Motivational tool= can see progression

Question 7

4 types of plaque indices?

Answer 7

6 point Plaque Index
O’Leary Plaque Index
Tooth Cleanliness Index
Plaque Index (Silness and Loe)

Question 8

6 point Plaque Index method:

Answer 8

End result = plaque free score

1. Disclosing tablets and petroleum jelly
2. Disclosed teeth
3. Plaque chart sheet
4. Plaque chart: teeth, right and left

Question 9

6 Point Plaque Index inspections:

Answer 9

Inspect gingival margins
Mesio buccal
Mid buccal
Disto buccal
Mesio palatal/lingual
Mid palatal/lingual
Disto palatal/lingual

Question 10

6 point Plaque final score:

Answer 10

A plaque score gives:
a low mark for clean teeth
a high mark for plaque covered teeth
This is what Salud will calculate for you

A plaque free score is the score we tend to give to patients to reverse the information and make it more understandable:
a high mark for clean teeth
a low mark for plaque covered teeth

Question 11

3 Gingival indices:

Answer 11

6 point Marginal Gingival Bleeding Index
Papillary Bleeding Index
Gingival Index (Loe and Silness)

Question 12

Marginal Bleeding Index method:

Answer 12

Insert PCP 10 probe into gingival sulcus mid-buccally
Run the probe towards the mesial papilla
Insert the probe mid-buccally again
Run the probe towards the distal papilla
Run the probe similarly on the palatal/ lingual surface

Question 13

Examples of Periodontal Indices:

Answer 13

Bleeding on Probing
Probing pocket depths
Attachment levels
Mobility index
Furcation indices
Suppuration

Question 14

When do we use the indices

Answer 14

At start of treatment: baseline investigations- use different indices for this
6-8 weeks after treatment: monitoring- undertake same investigations.
Mainly investigate those in sextants BPE Codes 3, 4 and with *

Question 15

2 indices you always do together?

Answer 15

Bleeding on Probing and Probing Pocket Depths

Only meaningful if you have both sets of information

Question 16

Bleeding on Probing = BOP

Answer 16

Insert PCP 10 probe to base of pocket
Site is positive if bleeding occurs with or shortly after probing- recorded on BOP chart
6 sites per tooth same as plaque index

Question 17

What does BOP assess?

Answer 17

Assessing bleeding at the base of the pocket tells you about deeper inflammation

Question 18

Difference between Marginal bleeding and BOP?

Answer 18

Marginal bleeding is not an indice for periodontitis as we would need to see bleeding from deep at base of pocket.
Marginal bleeding tells us a pt may have gingivitis= tells you about oral hygiene.

Question 19

Issues with pocket probing depths

Answer 19

• Gingival inflammation affects the gingival margin= will make pockets deeper.
• Difficult to know whether base is the true base = e.g. in healthy tissue may not be able to reach the base.
• Plaque or calculus- can prevent probe from reaching the true base.
• Angulation can cause the probe measurement to be higher than it should be.
• Probing pressure - can affect measurement

Question 20

Attachment level:

Answer 20

CEJ to the base of the pocket

Adv= not affected by inflammation changing the height of the gingival margin.

Question 21

Recession

Answer 21

Measurement involving the CEJ if it is coronal to the gingival margin i.e. measures the length between the 2 areas = exposed root.

Question 22

Mobility measurement scale:

Answer 22

Grade 1: 1 mm horizontal movement
Grade 2: > 1mm horizontal movement
Grade 3: vertical movement

Question 23

Furcation Involvement definition:

Answer 23

Involves bone loss in the area between roots in multi-rooted teeth
Use of probe determines extent of bone loss

Question 24

Grades of furcation involvement:

Answer 24

Grade 1
Horizontal bone loss of less 1/3rd width of tooth
Grade 2
Horizontal bone loss of greater than 1/3rd width of tooth but not through and through
Grade 3
Horizontal through and through involvement
Also a less commonly used vertical classification

Question 25

Suppuration

Answer 25

Presence or absence of suppuration (pus) on probing to base of pocket
Record positive sites