Periodontal charting technique

Question 1

What is the order in which periodontal parameters are assessed and recorded?

Answer 1

1. Gingival recession/
2. Probing/pocket depth
3. Bleeding on probing/Suppuration (presence of pus)
4. Tooth mobility
5. Furcation involvement
6. Clinical attachment loss

Question 2

Describe gingival recession and how it is recorded

Answer 2

• Is recorded as the distance between the cementum/enamel junction (CEJ) and the gingival margin (GM)

• CAL: Probing depth + GR
IF there is gingival recession

• Negative recession aka gingival overgrowth
CAL: Probing depth - GR

Question 3

Describe probing depth

Answer 3

The distance from the gingival margin to the bottom of the periodontal pocket

Question 4

Describe bleeding on probing/Suppuration (presence of pus)

Answer 4

• Bleeding is recorded as a “coloured in dot” on the chart face
• Suppuration (Pus) is recorded as an “S”
• Is recorded after probing depth for an entire arch

Question 5

Describe tooth mobility; how it is recorded and how to assess it

Answer 5

• Grade I: Slight mobility: up to 1mm of horizontal displacement in a facial-lingual direction
• Grade II: Moderate mobility: greater than 1mm but less than 2mm of horizontal displacement in a facial-lingual direction
• Grade III: Severe mobility: greater then 2 mm of displacement in a facial-lingual direction or vertical displacement (tooth depressible in the socket)

How to assess:
• Place the handles of two dental instruments on either side of the tooth being assessed
• Apply alternating light to moderate pressure in a facial-lingual direction against the tooth, first with one and then the other instrument handle
• Vertical mobility: use the handle of the instrument to push the tooth down into the socket

Question 6

Describe furcation involvement

Answer 6

• Nabers Probe records loss of Periodontal structures between the roots of multi-rooted teeth (molars)
• The Probe is marked in 3mm increments
• Technique is dictated by how far you can place the probe into the furcation and where it is noted on these increments

Question 7

How is the LOA/CAL measured to be localised or generalised?

Answer 7

• Localised: ≤ 30% of the (sites or) teeth are affected

* Generalized: > 30% of the sites or teeth are affected further characterized by extent and severity

Question 8

How is LOA measured?

Answer 8

• No recession: probing depth (PD) – 3mm
• CEJ is just visible: PD + 0mm » PD=LOA
• CEJ is totally visible: PD + GR (+3)
• Overgrown gingiva: PD - GR (-3)

Question 9

Describe stage 1 of periodontal disease

Answer 9

Stage 1:
• CAL: 1-2mm
• Bone loss: <15%
• PPD: < 4mm
• Tooth loss: 0
• Bone loss pattern: horizontal
• Furcation: No

Question 10

Describe stage 2 of periodontal disease

Answer 10

Stage 2:
• CAL: 3-4mm
• Bone loss: 15- 33%
• PPD: < 5mm
• Tooth loss: 0
• Bone loss pattern: horizontal
• Furcation: No

Question 11

Describe stage 3 of periodontal disease

Answer 11

Stage 3:
• CAL: > 5mm
• Bone loss: > 33%
• PPD: < 6mm
• Tooth loss: < 4
• Bone loss pattern: vertical
• Furcation: II or III

Question 12

Describe stage 4 of periodontal disease

Answer 12

Stage 4:
• CAL: 1-2mm
• Bone loss: > 33%
• PPD: < 6mm
• Tooth loss: > 5
• Bone loss pattern: horizontal
• Furcation: II or III

Question 13

List and describe the grades of periodontitis

Answer 13

Grade A:
• No loss of bone/ CAL over 5 years
• % bone loss/ age: < 0.25
• Heavy biofilm with low level of destruction

Grade B:
• <2 mm of bone loss/ CAL in 5 years
• % bone loss/ age: 0.25 - 1
• Biofilm level = destruction level

Grade C:
• > 2mm bone loss/ CAL in 5 years
• % bone loss/ age: > 1
• Biofilm levels not equal to level of destruction