Monitoring and Periodontal Indices Flashcards
Timeline for Periodontal disease and how this come about?
- 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.
Index definition
Index is a measure of parameters that relate to periodontal diseases or health
indicators of things related to periodontitis
Periodontal indices what are their uses?
- 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
Periodontal indices what are their uses in research?
- Clinical trials
- Epidemiology- tell you amount of disease present in community
- Public health
Clinical management of
patients
Plaque is a key indice because it is is key in:
- the aetiology of gingivitis
- the aetiology of periodontitis
- the success or failure of periodontal treatment
Benefits of plaque indices:
- 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
4 types of plaque indices?
6 point Plaque Index
O’Leary Plaque Index
Tooth Cleanliness Index
Plaque Index (Silness and Loe)
6 point Plaque Index method:
End result = plaque free score
- Disclosing tablets and petroleum jelly
- Disclosed teeth
- Plaque chart sheet
- Plaque chart: teeth, right and left
6 Point Plaque Index inspections:
Inspect gingival margins Mesio buccal Mid buccal Disto buccal Mesio palatal/lingual Mid palatal/lingual Disto palatal/lingual
6 point Plaque final score:
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
3 Gingival indices:
6 point Marginal Gingival Bleeding Index Papillary Bleeding Index Gingival Index (Loe and Silness)
Marginal Bleeding Index method:
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
Examples of Periodontal Indices:
Bleeding on Probing Probing pocket depths Attachment levels Mobility index Furcation indices Suppuration
When do we use the indices
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 *
2 indices you always do together?
Bleeding on Probing and Probing Pocket Depths
Only meaningful if you have both sets of information
Bleeding on Probing = BOP
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
What does BOP assess?
Assessing bleeding at the base of the pocket tells you about deeper inflammation
Difference between Marginal bleeding and BOP?
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.
Issues with pocket probing depths
- 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
Attachment level:
CEJ to the base of the pocket
Adv= not affected by inflammation changing the height of the gingival margin.
Recession
Measurement involving the CEJ if it is coronal to the gingival margin i.e. measures the length between the 2 areas = exposed root.
Mobility measurement scale:
Grade 1: 1 mm horizontal movement
Grade 2: > 1mm horizontal movement
Grade 3: vertical movement
Furcation Involvement definition:
Involves bone loss in the area between roots in multi-rooted teeth
Use of probe determines extent of bone loss
Grades of furcation involvement:
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
Suppuration
Presence or absence of suppuration (pus) on probing to base of pocket
Record positive sites
