Periodontal Examination Part 2: Periodontal Structures Flashcards
What are the components of the healthy periodontium from tooth to maxilla/mandible?
Interdental gingiva / Free gingiva
Attached gingiva
Mucogingival junction
Alveolar mucosa
What is the free gingiva?
The unattached portion of the gingiva that surrounds the tooth
Surrounds the neck of the tooth in a turtleneck manner
What is the gingival sulcus? What is the clinical significance of this sulcus?
The space between the free gingiva and the tooth surface
A periodontal probe is inserted here to assess its health.
What is the interdental gingiva? What are the components of the interdental gingiva?
Portion of the gingiva that fills the area between 2 adjacent teeth apical to the contact area
Facial papilla and lingual papilla
What structures are damaged in periodontitis?
The gingival connective tissue, periodontal ligament, and alveolar bone.
What are the features assessed clinically to diagnose periodontitis?
Gingival margin
Probing pocket depth
Bleeding on probing
Attachment level
Furcations
Mobility
Width of attached gingiva
What changes the level of the gingival margin?
It can change over time in response to trauma, medications or disease.
What are the possible marginal levels?
Margin at CEJ
Margin in health covers 1, 2, 3 mm
Margin significantly covering the CEJ
Margin significantly apical to the CEJ
Where is the natural position of the gingival margin?
slightly above the CEJ (1, 2, or 3 mm)
When does the gingival margin significantly cover the CEJ?
Commonly seen in gingivitis
When is the gingival margin found to be apical to the CEJ?
In recession caused by periodontitis
How is the gingival margin level determined?
Measure the distance from the gingival margin to the CEJ. If it is below, how far below. If it is above, how far above.
The measurement is recorded after.
What does it mean if the gingiva has receded?
Then the alveolar bone in that area has also been lost.
What is the technique to measuring the level of the gingival margin?
- Position the tip of the probe at a 45 degree angle to the tooth
- Slowly move the probe tip along the tooth until you detect the CEJ
- Record the distance between the gingival margin and the CEJ
How is the gingival margin level recorded?
In the patient chart or computerized record. Level of gingival margin should be accurately drawn on the periodontal chart.
0 = margin at the CEJ
Absolute health = negative probing depth
A negative number = margin significantly covers the CEJ
A positive number = gingival recession
What does the periodontium in disease form?
A periodontal pocket: Caused by deepening of gingival sulcus by disease.
How deep is a periodontal pocket that is caused by disease?
A healthy sulcus is 1 to 3 mm deep anything more than that is a periodontal pocket caused by disease.
The probe tip touches the tooth near the CEJ.
Can radiographs tell the extent of bone loss? Is it important to know this?
If there is bone loss, you need to know how much bone is lost.
Radiographs do not provide accurate information regarding extent of bone loss
Can perio probing tell us the extent of bone loss?
No, A probing depth reading ALONE is NOT enough information to tell you if a tooth has normal bone support or bone loss!
What is needed to calculate one support?
The gingival margin levels and probing depths.
What does bleeding on probing tell us about periodontal health?
Ulceration in JE is what bleeding tells us. The absence of BOP points to a very high probability for the maintenance of periodontal health. Patients with mean BOP of <=20% have significantly lower risk for further loss of probing attachment at single sites.
BOP >= 30% represents a risk for tooth loss.
What feature is important to know alongside bone support of a tooth?
The location of periodontal attachment system to the tooth.
What are the components of the periodontal attachment system?
Juntional Epithelium
Gingival fibers
Periodontal ligament fibers
Alveolar bone
What happens to periodontal attachment system in periodontitis?
Gingival fibers are destroyed
Periodontal ligament fibers are destroyed
Alveolar bone is lost
What is the clinical attachment level (CAL)?
The estimated position of the structures that support the tooth as measured with a peridontal probe.
How is the clinical attachment level calculated?
Information collected during the periodontal assessment is used to calculate the clinical attachment level on a tooth
What does it mean if the gingival margin and the CEJ are at the same level?
The probing depth and the CAL are the same.
How is the clinical attachment level calculated when the gingival margin has receded?
The gingival margin level and the probing depth level readings are added to each other and used to calculate the clinical attachment level of a tooth.
(Gingival margin is below the CEJ)
How is the clinical attachment level calculated when the gingival margin is well above the CEJ?
Subtract gingival margin reading from the probing depth reading.
Pocket goes all the way down to the approximate site of clinical attachment so this makes sense.
Why is CAL necessary?
Probing depths don’t tell the full story about attachment loss.
What structures attach the tooth to the skull?
Periodontal attachment system. This includes:
The junctional epithelium (attaches gingiva to the tooth)
Fibers of the gingiva (network of fibers that brace the free gingiva against the tooth)
Periodontal ligament fibers (surround the root; one end attaches to the alveolar bone and the other to the root)
Alveolar bone (Surrounds the roots of the teeth and forms the bony socket)
What is loss of attachment?
Damage to structures that support the tooth:
Relocation of the junctional epithelium
Destruction of gingival fibers
Destruction of periodontal ligament
Loss of alveolar bone support
Where is the gingival margin typically located in periodontitis??
In periodontitis the gingival margin may remain near the CEJ.
This creates a deep periodontal pocket.
In periodontitis, the gingival margin may recede.
Part of the tooth roots will be visible in the mouth.
Important to note:
The gingiva can mask bone loss. It can be above the CEJ and there can still be lots of bone loss.
What is a furcation?
A furcation is the place on a multirooted tooth where the root trunk divides into separate roots.
What is furcation involvement?
Furcation involvement is a loss of alveolar bone and periodontal ligament fibers in the space between roots of a multirooted tooth.
How is furcation involvement detected?
Most furcation involvement is hidden from view by gingival tissues and must be located with a probe
What is a furcation probe?
Type of periodontal probe used to evaluate the bone support in the furcation areas of multirooted teeth
How are furcations assessed?
The furcation probe is placed into the furcation.
Class I: Probe tip partially enters the furcation (extends about 1/3rd of the tooth but cannot pass through)
Class II: Mandibular molars - probe passes through more than 1/3rd of the furcation but cannot pass completely through
Class III: Probe passes completely through
What is tooth mobility and what causes it?
Loosening of a tooth in its socket and it is usually the result of bone support to the tooth.
What is horizontal mobility?
The ability to move the tooth in a facial-lingual direction in its socket
How is horizontal mobility assessed?
Using the ends of 2 handles, gently apply alternating pressure against the tooth, from from facial and then lingual aspect.
What is vertical mobility?
Ability to depress the tooth in its socket
How is vertical mobility assessed?
Use the end of an instrument to exert gentle pressure against occlusal surface of incisal edge of the tooth.
What is class I mobility?
Slight mobility, up to 1mm of horizontal displacement in a facial-lingual direction
What is class 2 mobility?
Greater than 1mm of horizontal displacement in a facial-lingual direction
What is class 3 mobility?
Greater than 1mm of displacement facio-lingually and some vertical mobility.
How is width of attached gingiva calculated?
The part of the gingiva that is tightly connected to the cementum on the cervical-third of the root and to the
connective tissue cover of the alveolar bone.
