PERIODONTAL EXAMINATION AND DIAGNOSIS Flashcards
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
Consider the Patient’s:
• Mental and Emotional Status
• Temperament
• Attitude
• Physiologic Age
Overall Appraisal of the Patient
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
Morphological alterations evident
visual exam
- 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
clinically healthy gingiva
Interdental Papilla
-pointed
Marginal Gingiva
-knife edge
Color
-coral pink
Consistency
-firm
Bleeding
-absent
inflamed gingiva
Interdental Papilla
-blunted
Marginal Gingiva
-rolled
Color
-erythematous
Consistency
-spongy
Bleeding
-present
color of clinically healthy gingiva
coral/salmon pink
consistency of clinically healthy gingiva
firm, well adapted
contour of clinically healthy gingiva
scalloped, sharp papillae, knife edge margin
surface texture of clinically healthy gingiva
matte stippled
marginal bleeding of clinically healthy gingiva
absent or slight
probing depth of clinically healthy gingiva
2-3mm
tissue resistance of clinically healthy gingiva
present to probe penetration
bleeding on probing of clinically healthy gingiva
absent,slight
pain on probing of clinically healthy gingiva
absent,slight
color of inflamed gingiva
erythematous,cyanotic
consistency of inflamed gingiva
edematous, spongy, loosely adapted
contour of inflamed gingiva
bulbous, swollen papillae, rolled margins
surface texture of inflamed gingiva
smooth, shiny
marginal bleeding of inflamed gingiva
moderate to severe
probing depth of inflamed gingiva
> 3mm
tissue resistance of inflamed gingiva
minimal to probe penetration
bleeding and pain to probing of inflamed gingiva
,moderate to severe
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
F1
loss of periodontal support tissue (horizontal) greater than1/3 but not encompassing the total width.
F2
through and through destruction at furcation areas (total width of the furcation area)
F3
same as F3 except that the entrance to the furca is clinically visible because of the presence of recession of the gingival margin
F4
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
