Monitoring and periodontal indices Flashcards
Define screening
To find cases with disease within a population
Define monitoring
To follow up a patients disease progression after treatment
When we have identified which patient has the disease how do we find out about the extent of that disease and its location around the mouth?
We carry out a baseline investigation
When we have treated the disease, how do we know how successful the treatment has been?
We MONITOR the patient health
What does index mean?
It is a form of measurement
How are indices used?
They are used as a research tool
Are used for the clinical management of patients
How are indices used as a research tool?
They can be used in:
- Clinical trials
- Epidemiology
- Public health
How are indices used for the clinical management of patients?
- 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
What are the 3 thing we look at around each individual tooth when conducting a periodontal exam?
- stability
- loss of attachment
- bleeding on probing
Name some examples of indices we use in dentistry?
- Plaque indicies
- Periodontal indices
3 Gingival indicies
What is plaque the key factor in?
- the aetiology of gingivitis
- the aetiology of periodontitis
- the success or failure of periodontal treatment
What information does a plaque indices give us?
- Gives the distribution and/or amount of plaque in the mouth
- Identifies areas of difficulty for patient’s oral hygiene measures
Why are plaque indices good?
- They enable clinicians to show patient areas of plaque
- Allows tailor made OHI to be given
- Can be used as a Motivational tool
What are the 4 different types of plaque indices?
- 6 point Plaque Index
- O’Leary Plaque Index (this is the one we use more commonly known as the plaque free score)
3, Tooth Cleanliness Index - Plaque Index (Silness and Loe)
How do we get a patents plaque free score?
- Apply petroleum jelly on a cotton wool roll to patient’s lips
- Ask patient to chew on disclosing tablet or paint on disclosing solution
- To swish tablet around mouth for 30 seconds OR paint the solution on each individual surface of the tooth
- Spit out
- Rinse gently once
In the 6 point plaque index what so we inspect?
The gingival margins of each tooth: Mesio buccal Mid buccal Disto buccal Mesio palatal/lingual Mid palatal/lingual Disto palatal/lingual
What do we. calculate once we have taken a plaque index?
Calculate a plaque free score (%) or plaque
What does a plaque free score give you?
a high mark for clean teeth
a low mark for plaque covered teeth
When do you carry out a plaque index?
Carry out at start of treatment
Carry out periodically during treatment
Carry out for all patients
What are the 3 different types of gingival indices?
- 6 point Marginal Gingival Bleeding Index
- Papillary Bleeding Index
- Gingival Index (Loe and Silness)
How do we carry out a marginal bleeding index?
- 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
What fo we look for when taking a marginal bleeding indices?
We Observe for gingival bleeding from the buccal aspect of the tooth and palatal aspect of the tooth
When do we carry out a marginal bleeding index?
- Carry this out for patients with BPE scores of 1 and 2
- At start of treatment
- As required
Give some examples of periodontal indices
- Bleeding on Probing
- Probing pocket depths
- Attachment levels
- Mobility index
- Furcation indices
- Suppuration
When do we carry out a periodontal indices?
- At start of treatment: baseline investigations
- 6-8 weeks after treatment: monitoring
- On sextants BPE Codes 3, 4 and with *
If we take a bleeding on probing indices what else MUST we take?
Probing Pocket Depths
How do we carry out a bleeding on probing exam?
- Insert PCP 10 probe to base of pocket
- Site is positive if bleeding occurs with or shortly after probing
- Record positive sites on Bleeding on Probing chart
Name the 6 sites of the tooth we look at when carrying out a bleeding on probing exam
- distobuccal
- mid-buccal,
- mesiobuccal
- distopalatal (lingual),
- mid- palatal,
- mesiopalatal
What is hard about taking a bleeding on probing and marginal bleeding exam?
Distinction between marginal bleeding and bleeding on probing is not always easy to make.
If the bleed is coming from the gingival margins what is this an indication of?
Gingivitis
If the bleed is coming from the base of pocket what is this an indication of?
Periodontitis
What is the primary parameter to set threshold for gingivitis?
Bleeding on probing
How do we carry out a Probing Pocket Depth Chart
- Insert PCP 10 probe to full pocket depth
- Read off pocket depth in mms
- Record on pocket depth chart
When we measure a probing pocket depth that are we actually measuring from?
Want to measure from the base of the pocket to the gingival margin
When is taking the pocket probing depth inaccurate?
- If the gingiva is inflamed
- We don’t know where the True probe tip position is
- Calculus and PRFs may make it harder to reach the true depth
- Angulation of probe
- Probing pressure
Where do we measure from when we are checking attachment levels?
We measure from a fixed reference point either the:
- cement-enamel junction (CEJ)
- restoration margin
Where do we measure from when checking attachment levels?
We Measure from a fixed reference point to base of pocket
Where do we measure recession?
Measure from gingival margin to cement-enamel junction, where gingival margin is apical to the CEJ
Why is measuring recession important?
As they are an aetiological factor
It helps us treat sensitive dentine
What do the 3 grades we give when checking tooth mobility mean?
Grade 1: 1 mm horizontal movement
Grade 2: > 1mm horizontal movement
Grade 3: vertical movement
What are we checking when we take a Furcation Involvement exam?
Bone loss between multi rooted teeth
How do we measure Furcation Involvement?
A Probe is used to determine extent of bone loss
Why do we measure furcation involvement?
It is harder to clean Furcated teeth and also makes treatment difficult
What does grade 1 furcation involvement mean?
Grade 1
horizontal bone loss of less 1/3rd width of tooth
What does grade 2 furcation involvement mean?
Grade 2
horizontal bone loss of greater than 1/3rd width of tooth but not through and through
What does grade 3 furcation involvement mean?
Grade 3
Probe goes horizontally through and through involvement
What do we do when we are checking fro Suppuration
We record the Presence or absence of suppuration on probing to base of pocket
What is Suppuration?
Pus
How do we measure bone loss
We measure as a Percentage or in mms
We can describe the pattern of bone loss Pattern
Can be Horizontal or Vertical bone loss
We use x rays o determine bone loss
