PERIODONTAL EXAMINATION AND DIAGNOSIS Flashcards by Pauline Cabatuando

Periodontal Examination & Diagnosis:

Overall Appraisal of the Patient Health History
Dental History
Photographic Documentation Clinical Examination
Tactile Periodontal Examination Periodontal Charting
Examination of the Teeth (and Implants) Radiographic Examination
Laboratory Aids to Clinical Diagnosis
Periodontal Diagnosis
Assessment of Biofilm Control and Patient Education

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Consider the Patient’s:
• Mental and Emotional Status
• Temperament
• Attitude
• Physiologic Age

Overall Appraisal of the Patient

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Importance of Health history

1) the possible impact of certain systemic diseases, conditions, behavioral factors, and medications on periodontal disease, its treatment, and treatment outcomes;
(2) the presence of conditions that may require special precautions or modifications of the treatment procedure; and
(3) the possibility that oral infections may have a powerful influence on the occurrence and severity of a variety of systemic diseases and conditions
Hx

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Morphological alterations evident

visual exam

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check for disease with periodontal manifestations (plaque / non plaque induced)
-oral hygiene status (amount of plaque on the tooth surfaces, distribution and localization)

visual exam

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clinically healthy gingiva

Interdental Papilla
-pointed
Marginal Gingiva
-knife edge
Color
-coral pink
Consistency
-firm
Bleeding
-absent

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inflamed gingiva

Interdental Papilla
-blunted
Marginal Gingiva
-rolled
Color
-erythematous
Consistency
-spongy
Bleeding
-present

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color of clinically healthy gingiva

coral/salmon pink

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consistency of clinically healthy gingiva

firm, well adapted

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contour of clinically healthy gingiva

scalloped, sharp papillae, knife edge margin

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surface texture of clinically healthy gingiva

matte stippled

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marginal bleeding of clinically healthy gingiva

absent or slight

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probing depth of clinically healthy gingiva

2-3mm

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tissue resistance of clinically healthy gingiva

present to probe penetration

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bleeding on probing of clinically healthy gingiva

absent,slight

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pain on probing of clinically healthy gingiva

absent,slight

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color of inflamed gingiva

erythematous,cyanotic

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consistency of inflamed gingiva

edematous, spongy, loosely adapted

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contour of inflamed gingiva

bulbous, swollen papillae, rolled margins

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surface texture of inflamed gingiva

smooth, shiny

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marginal bleeding of inflamed gingiva

moderate to severe

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probing depth of inflamed gingiva

> 3mm

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tissue resistance of inflamed gingiva

minimal to probe penetration

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bleeding and pain to probing of inflamed gingiva

,moderate to severe

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When probing, the probe tip should be _______ as it slides down along the tooth surface to get to the bottom of the gingival crevice

in contact with the tooth surface

probing allows detection of

tooth surface irregularities, furcation invasion, and subgingival calculus

important indicator of presence of inflammation but does not reveal disease progression

bleeding on probing

indicator of absence of burst but does not indicate possible burst

bleeding on probing

active loss of connective tissue attachment thus the best time to intervene

burst

absence of ___ is a sign of stability and health (if there is no BOP, there is 0 chance of attachment loss)

bleeding

severity of bleeding

pinpoint • thin linear or multiple pinpoint • triangular • droplets or pooling

does not reveal the true picture of attachment

pocket depth probing

measure the distance from the gingival margin to the bottom of the pocket.

pocket depth probing

measured on all surfaces using a graduated probe on 6 sites (like walking or sweeping)

pocket depth probing

in pocket depth probing we record the

deepest reading per site

in pocket depth probing you insert the probe until

there is resistance

Factors which Affect Probing

dimensions of perio probe position of the probe reference point location pressure on the instrument gingival tissue conditions presence of surface accretions

dimension of perio probe

tip 0.4-0.5mm, uncomy of greater

position of the probe should be

parallel to the long axis of the tooth

reference point location

gingival margin

clinically healthy gingival margin

at the level,of CEJ

inflamed gingival margin

coronal to the CEJ

gingival margin in recession

apical to the CEJ

normal pressure on the instrument should be

force 20-25g

less than 20-25g of force means

inadequate force therefore no bleeding

more than 25g force means

there is bleeding to to force or trauma

if the collagen is firm, there would be

underestimation

gingival tissue conditions beyond CJ, there would be

overestimation

presence of calcular deposits, overhanging resto

presence of surface accretions

treatment for surface accretions

perform initial scaling and remove overhangs

Normal Gingival Sulcus

apical termination of JE is at the CEJ

periodontal pocket depth considered as pristine

0.5mm

normal PPD

2-3mm

types,of pockets

pseudopockets true pockets

created by gingival enlargement. There’s no apical migration. 1mm increase due to inflammation in the coronal area

pseudopocket

example of pseudopocket

gingivitis

types of true pocket

suprabony infrabony

supracrestal or supraalveolar

suprabony

-proliferating pocket epithelium -remnant of base of pocket is coronal to the alveolar crest -junctional epithelium persistent

suprabony

location of base pocketnof suprabony

coronal,to the alveolar crest

intrabony, subcrestal, intraalveolar

infrabony

can be simple, compound or complex

infrabony

can be 3 walled, 2 walled, 1 walled defect

infra

the bone loss in this pocket is vertical in nature

infra

location of the base/ bottom pocket of infrabony

apical to the adjacent alveolar crest

the clinical attachment level is measured from

CEJ to the base of the pocket.

evaluates amount of periodontal ligament lost in the disease and identifies apical extension of the lesion

CAL

measures severity of the tissue attachment loss/connective tissue destruction.

CAL

displacement of the soft tissue margin apical from the CEJ and exposure of the root surface, form of loss of attachment and is measured from CEJ to the margin of gingiva

gingival recession

formula for CAL

CAL=PPD+GR

if there is furcation involvement, there is

loss of periodontal support in furcation areas of multi rooted teeth

to look for furcation involvement we use

• findings from probing (Nabers probe) and radiographic analysis ( radiolucencies at furcation areas)

Diagnosis of furcation involvement

F1,F2,F3,F4

loss of periodontal support tissue not exceeding 1/3 of the width of the tooth

loss of periodontal support tissue (horizontal) greater than1/3 but not encompassing the total width.

through and through destruction at furcation areas (total width of the furcation area)

same as F3 except that the entrance to the furca is clinically visible because of the presence of recession of the gingival margin

Glickman Classification of Furcation Invasion

GRADE, I,II,III,IV

Glickman Classification of Furcation Invasion -pocket formation into the flute but intact interradicular bone

GRADE 1

loss of interradicular bone and pocket formation of varying depths into the furcation but not completely through to the opposite side of the tooth

GRADE II

Through and through lesion

GRADE III

same as grade III with gingival recession, rendering the furcation clinically visible

GRADE IV

provides evidence that the site is undergoing a period of exacerbation.

suppuration

presence of pus

suppuration

when in combination with other parameters, it increases the positive predictive value for progression of disease (increased chance of attachment loss)

suppuration

the degree of movement within the socket is measured in mm.

mobility

apply alternate forces on buccal and lingual

mobility

physiologic tooth mobility

0.2mm

0.5-1mm facial lingual tooth movement

grade 1

1-2mm facial lingual tooth movement

grade 2

over 2mm facial lingual tooth movement with vertical mobility

grade 3

causes of mobility

occlusal trauma loss of attachment periapical abscess

treatment for mobility

depends on the cause

Normal bone level • Normal attachment level • Excessive Occlusal Force

occlusal trauma

provides information which is not clinically detectable and confirms clinical findings

radiographic assessment

Limitation of Parameters

only reveals history of the disease does not show presence of active disease nor predict its occurrence reveals only the consequence of past disease inherent inaccuracies

Goals of Diagnostic Techniques

identify disease initiation and progression monitor response to treatment identify persons that are susceptible differentiate between periodontal diseases

New Diagnostic Techniques

controlled face, standardized probes (pressure sensitive probes) • Computer Assisted Digital Radiography • Bacteriologic DNA analysis • Immunologic Based Test

assessment of the susceptible host using markers in peripheral blood (PMN-leukocyte function, circulating antibody levels, monocyte responsiveness to lipopolysaccharide)

Immunofluorescent microscopy

Enzyme-Linked Immunosorbent Assay Test

ELISA

Used primarily to detect serum antibodies to periodontal pathogens, can also be used to quantify specific pathogens in subgingival samples using specific monoclonal antibodies.

ELISA Test

Test pressure of production of proteases by P. Ging and B. Forsythus

BAA (Benzoyl-Arginine-Naphthylamide) hydrolysis test/perio scan