periodontal diagnosis, prognosis and tx planning Flashcards
chief complaints with periodontal disease
bleeding gums, bleeding on brushing, dull generalized pain, mobility of teeth
t/f PSR is recorded in sextants
yes. the probe has a 0.5mm ball at the end so the first line up is 3.5mm. the highest score is recorded for each sextant
psr code 0
colored area of probe is visible in deepest cervice. no calculus or defective margins, tissues are healthy with no bop
psr code 1
same thing as 0 but there is bop (gingivitis).
DO A PROPHY
psr code 2
colored area of probe is visible in deepest probeing depth. supra/subgingival calculus and defective margins (overhangs)
CALCULUS AND PLAQUE REMOVAL, CORRECT OVERHANGS
psr code 3
colored area partly visible (between 3.5-5.5mm)
COMP EXAM and CHARTING (probe, mobility, recession, furcation, radiographs)
psr code 4
colored area of probe completely disappears
1 section of code 4 or 2 of code 3 = full mouth exam
COMP EXAM AND CHARTING
psr code *
whenever there is a problem with codes 0, 1, 2
psr code X
edentulous sextant
t/f you should drag the probe and point the probe away from the tooth when perio charting
false. walk the probe and keep the tip on the tooth
what does BOP tell you
objective indication of inflammation
recession
distance from the cej to the gingival margin when the margin is apical to the cej (+)
pseudopocket/overgrowth
distance from the cej to the gingival margin when the gingival margin is coronal to the cej with no attachment loss (-)
t/f al can be present without recession
true
how do you measure the fgm if you cant see the cej
feel for the cejj with your rpobe and measure how much further the probe goes beyond the cej
pocket depth is relative to what
the gingival margin. you can have attachment loss without a pocket (recession)
mobility index I
1st distinguishable sign of movement greater than normal
mobility index II
movement of the crown by up to 1 mm in any direction
mobility index III
movement of crown more than 1 mm in any direction and/or vertical depression or rotation
what do you use to detect furcation involvement
nabers probe
how many furcations are there on mandibular molars compared to maxillary molars
2 mand (B/L), 3 max (B/ML/DL)
glickmans furcation I
pocket formation into the flute but intact interradicular bone
glickmans furcation II
loss of interradicular bone and pocket formation of varying depths into the furcation.
probe sticks
glickmans furcation III
through and through lesion to the other side
glickmans furcation IV
same as III with recession and the furca is clearly visible clinically
max 1st: furcal aspect of the root is concave in what percent of MB roots
94
max 1st: furcal aspect of root is concave in what percent of DB roots
31
max 1st: furcal aspect of root is concave in what percent of P roots
17
max 1st: where is the deepest furcal concavity found
MB root (about 0.3 mm)
t/f the concavity in the mand 1st molar is bigger than the max 1st molar
true. about 0.7 mm
mand 1st: furcal aspect of root is found in what percent of M roots
100
mand 1st: furcal aspect of root is found in what percent of D roots
99
why is it so hard to clean furcations
furcation is narrower than the instrument we use (curret) in 58% of 1st molars
what do furcation triangle show us
there could be bone loss
width of attached gingiva is the distance from
the bottom of the pocket to the mgj
t/f lack of attached ging means there is loss of attachment
no
how do you tell if the tissue is attached gingiva or mucosa
using the rolling technique, if you roll the probe and the tissue moves, it is mucosa, if not it is attached gingiva
fremitus
movement of tooth when in function
where does healthy bone lie in a radiograph
2mm below cej
slight bone loss
loss up to 25% of root length
moderate bone loss
bone loss from 25-50% of root
severe bone loss
loss more than 50%
t/f. angular/vertical bone loss can be fixed
true. you can place a bone graft, whereas horizontal you cannot
what can radiographs tell you about a perio patient?
bone loss (amount and type), furcation involvement, overhangs, crown root ratio (should be less than 1) must also check clinically to further evaluate radiographic findings
how do you classify localized aggressive perio
M1 and incisors
how do you classify generalized aggressive perio
3+ teeth in addition to M1 and molars
how do you classify localized perio
less than 30% of sites
can be slight (1-2mm), moderate (3-4) or severe (5+)
prognosis
prediction of the probable course, duration, and outcome of a disease based on a general knowledge of the pathogenesis of the disease and the presence of risk factors for the disease
when do you establish the prognosis
after diagnosis, before tx plan
determination of prognosis is what kind of process?
dynamic
should the prognosis be reevaluated?
yes. after the completion of all phases of therapy and perio maintenance
good prognosis
control of etiologic factors and adequate periodontal support ensure the tooth will be easy to maintain by the patient and clinician
fair prognosis
25% of AL, Class I furcation involvement
poor prognosis
50% AL, Class II furcation
questionable prognnosis
more than 50% AL, poor crown:root ratio, poor root form, Class II/III furcation, more than 2+ mobility, root proximity
hopeless prognosis
inadequate attachment to maintain health, comfort, and function, class 3 mobility
Tx protocol for periodontitis
- ohi and Tx plan discussion
- intial therapy: SRP
- reeval (4-6 wks) with ohi
- probe deph resolved (pocket 3mm or less) = perio maintenence
- probe deph not resolved = surgery/referral with perio maintenance
