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DMD2 > Periodontal Examination Part 2: Periodontal Structures > Flashcards

Periodontal Examination Part 2: Periodontal Structures Flashcards

1
Q

What are the components of the healthy periodontium from tooth to maxilla/mandible?

A

Interdental gingiva / Free gingiva

Attached gingiva

Mucogingival junction

Alveolar mucosa

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2
Q

What is the free gingiva?

A

The unattached portion of the gingiva that surrounds the tooth

Surrounds the neck of the tooth in a turtleneck manner

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3
Q

What is the gingival sulcus? What is the clinical significance of this sulcus?

A

The space between the free gingiva and the tooth surface

A periodontal probe is inserted here to assess its health.

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4
Q

What is the interdental gingiva? What are the components of the interdental gingiva?

A

Portion of the gingiva that fills the area between 2 adjacent teeth apical to the contact area

Facial papilla and lingual papilla

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5
Q

What structures are damaged in periodontitis?

A

The gingival connective tissue, periodontal ligament, and alveolar bone.

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6
Q

What are the features assessed clinically to diagnose periodontitis?

A

Gingival margin

Probing pocket depth

Bleeding on probing

Attachment level

Furcations

Mobility

Width of attached gingiva

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7
Q

What changes the level of the gingival margin?

A

It can change over time in response to trauma, medications or disease.

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8
Q

What are the possible marginal levels?

A

Margin at CEJ

Margin in health covers 1, 2, 3 mm

Margin significantly covering the CEJ

Margin significantly apical to the CEJ

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9
Q

Where is the natural position of the gingival margin?

A

slightly above the CEJ (1, 2, or 3 mm)

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10
Q

When does the gingival margin significantly cover the CEJ?

A

Commonly seen in gingivitis

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11
Q

When is the gingival margin found to be apical to the CEJ?

A

In recession caused by periodontitis

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12
Q

How is the gingival margin level determined?

A

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.

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13
Q

What does it mean if the gingiva has receded?

A

Then the alveolar bone in that area has also been lost.

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14
Q

What is the technique to measuring the level of the gingival margin?

A
  1. Position the tip of the probe at a 45 degree angle to the tooth
  2. Slowly move the probe tip along the tooth until you detect the CEJ
  3. Record the distance between the gingival margin and the CEJ
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15
Q

How is the gingival margin level recorded?

A

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

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16
Q

What does the periodontium in disease form?

A

A periodontal pocket: Caused by deepening of gingival sulcus by disease.

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17
Q

How deep is a periodontal pocket that is caused by disease?

A

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.

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18
Q

Can radiographs tell the extent of bone loss? Is it important to know this?

A

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

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19
Q

Can perio probing tell us the extent of bone loss?

A

No, A probing depth reading ALONE is NOT enough information to tell you if a tooth has normal bone support or bone loss!

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20
Q

What is needed to calculate one support?

A

The gingival margin levels and probing depths.

21
Q

What does bleeding on probing tell us about periodontal health?

A

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.

22
Q

What feature is important to know alongside bone support of a tooth?

A

The location of periodontal attachment system to the tooth.

23
Q

What are the components of the periodontal attachment system?

A

Juntional Epithelium

Gingival fibers

Periodontal ligament fibers

Alveolar bone

24
Q

What happens to periodontal attachment system in periodontitis?

A

Gingival fibers are destroyed

Periodontal ligament fibers are destroyed

Alveolar bone is lost

25
Q

What is the clinical attachment level (CAL)?

A

The estimated position of the structures that support the tooth as measured with a peridontal probe.

26
Q

How is the clinical attachment level calculated?

A

Information collected during the periodontal assessment is used to calculate the clinical attachment level on a tooth

27
Q

What does it mean if the gingival margin and the CEJ are at the same level?

A

The probing depth and the CAL are the same.

28
Q

How is the clinical attachment level calculated when the gingival margin has receded?

A

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)

29
Q

How is the clinical attachment level calculated when the gingival margin is well above the CEJ?

A

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.

30
Q

Why is CAL necessary?

A

Probing depths don’t tell the full story about attachment loss.

31
Q

What structures attach the tooth to the skull?

A

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)

32
Q

What is loss of attachment?

A

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

33
Q

Where is the gingival margin typically located in periodontitis??

A

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.

34
Q

Important to note:

A

The gingiva can mask bone loss. It can be above the CEJ and there can still be lots of bone loss.

35
Q

What is a furcation?

A

A furcation is the place on a multirooted tooth where the root trunk divides into separate roots.

36
Q

What is furcation involvement?

A

Furcation involvement is a loss of alveolar bone and periodontal ligament fibers in the space between roots of a multirooted tooth.

37
Q

How is furcation involvement detected?

A

Most furcation involvement is hidden from view by gingival tissues and must be located with a probe

38
Q

What is a furcation probe?

A

Type of periodontal probe used to evaluate the bone support in the furcation areas of multirooted teeth

39
Q

How are furcations assessed?

A

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

40
Q

What is tooth mobility and what causes it?

A

Loosening of a tooth in its socket and it is usually the result of bone support to the tooth.

41
Q

What is horizontal mobility?

A

The ability to move the tooth in a facial-lingual direction in its socket

42
Q

How is horizontal mobility assessed?

A

Using the ends of 2 handles, gently apply alternating pressure against the tooth, from from facial and then lingual aspect.

43
Q

What is vertical mobility?

A

Ability to depress the tooth in its socket

44
Q

How is vertical mobility assessed?

A

Use the end of an instrument to exert gentle pressure against occlusal surface of incisal edge of the tooth.

45
Q

What is class I mobility?

A

Slight mobility, up to 1mm of horizontal displacement in a facial-lingual direction

46
Q

What is class 2 mobility?

A

Greater than 1mm of horizontal displacement in a facial-lingual direction

47
Q

What is class 3 mobility?

A

Greater than 1mm of displacement facio-lingually and some vertical mobility.

48
Q

How is width of attached gingiva calculated?

A

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.

DMD2 (89 decks)

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