Periodontal history and examination Flashcards
What are the stages involved in treating periodontal disease?
- Periodontal history and examination
- Diagnosisand prognosis
- Treatment plan
- Treatment
- Recall
What are some of the aetiologies of periodontal disease?
Primary aetiological factor: dental plaque
What does a classic case history entail?
Medical history
Social history eg use of drugs, alcohol smoking status
Oral hyphen regime
What is prognosis?
Predicting the out come of the treatment
What are the 3 stages of periodontal treatment?
- Initial therapy
- Corrective therapy
- Supportive therapy
What do we do before carrying out initial therapy?
Solve the original problem the patient came in for eg tooth pain
What do we need to note down before coming to a diagnosis?
- Not down the patients complaints / reason for attendance
- Take history of presenting complaint
- Take dental history
- Take a social history
- Take a medical history
What does a medical history identify ?
Identifies patients:
- With systemic illness or taking drugs/medication that may affect management in the surgery /Allergies
- At risk from periodontal examination
- Who may pose an infection control risk
- With systemic periodontal risk factors
Which website can we use to gain further information on medication?
The British National Formulary (BNF) website
What must we record when taking a medical history?
Must record what drugs and in what quantities a patient is taking
What are 4 considerations we must keep in mind when taking a medical history?
- Illness or drugs/medication that may affect management in the surgery eg angina, diabetes
- Does the patient’s medical history put them at risk from having periodontal examination/therapy? eg anticoagulant Warfarin
- Does patient have systemic risk factor(s) for periodontal diseases? eg poorly controlled diabetes, medication
4, Does patient pose an infection control risk to you? eg HIV
What is the current recommended alcohol consumption in units?
14 Units
What may patients with angina need?
may need glyceryl trinitrate tablet or spray to relieve angina symptoms;
What do patients with angina have a higher risk of getting?
increased risk of heart attack
What may patients with type 1 diabetes have a higher risk of getting?
risk of hypoglycaemia
What must we ask for from patients who are taking anticoagulants?
We need an INR (International Normalized Ratio) prior to sub-gingival scaling, root surface debridement, surgery or extractions due to increased bleeding risk
Before which treatment to we need to take an INR number from our patient?
prior to sub-gingival scaling, root surface debridement, surgery or extractions due to increased bleeding risk
When do we need an INR?
Need INR on day of visit in LDI
What is currently the INR threshold?
currently INR must be less than 4
Against NICE guideline what should patients who are having dental treatment who may have infective endocarditis not take?
Prophylaxis
What questions do we need to ask when taking a social history?
- note smoking habit (how many cigarettes/day, how long been smoking)
- alcohol consumption
- note occupation/ patient’s personal situation
- psychological stress levels
- check availability to attend
What are some of the most common complaints people come in with?
- Bleeding gums,
- loose teeth,
- drifting of teeth (specially anteriors) creating spaces between teeth,
- bad breath and taste,
- gum shrinking,
- sensitivity of teeth,
- occasional vague dull pain,
- Itching in the gums,
- swelling of the gums
10 Food impaction - Difficulty in chewing
When taking a history of presenting complain what should we note down?
note details of onset, duration, severity of the complaint
What should we record when taking a past dental history?
- past dental experience, attendance pattern
- past periodontal treatment, plaque control advice
- Frequency of brushing, type of brush and use of other interdental aids, mouthwashes
When taking an examination what is the first thing we usually notice?
Patient appearance and behaviour
What may we look for when a patient first comes in?
Their General posture obesity pallor skin rash heavy breathing, gait
What are the steps we take when taking an examination?
- External oral exam
- Internal oral exam
- Soft tissues
- Check is they have removable appliances
- Chart the patients mouth
- Assess their periodontal status
What do we record when doing a dental chart?
Record missing, unerupted or partially erupted teeth or tooth roots
Record restorations, crowns, bridges, caries, abrasion cavities, fractures
In what order do we take a BPE chart?
1. Upper right posterior (UR7-UR4) 2. Upper anterior UR3 –UL3) 3. Upper left posterior (UL4 –UL7) 4. Lower right posterior (LR7 –LR4) 5. Lower anterior (LR3-LL3) 6. Lower left posterior (LL4-LL7)
What test do we use to check periodontal health?
The basic periodontal examination (BPE)
What are the advantages of BPE
- BPE is a quick, simple means of screening patients
- Determines who has periodontal disease
- Identifies presence of bleeding, calculus or plaque retention factors, shallow or deep pockets, furcations in sextants
- Identifies which sextants are affected
What can a BPE be used to do?
BPE can help you decide which other periodontal indices to do later
What are BPEs measured in?
In codes from 1-4 (4 being the most severe)
And then code * means they have friction
What should you do if a patient has a/some code 3 sextants?
- Take radiographs for the code 3 sextants and periapicals are recommended
- should only take a 6 point pocket chart after initial therapy
What should you do if a patient has a/some code 4 sextants?
- Take radiographs for the code 3 sextants and periapicals are recommended
- Carry out a 6 point pocket chart
What do we record when taking a 6 point pocket chart?
When carrying out a 6 point pocket chart only record sites of 4mm and above
Always record bleeding on probing with a 6 point chart
How do you carry our a BPE?
Walk probe around 6 sites per tooth on every tooth in sextant except 3rd molars unless 1st and/or 2nd molars missing
Worst score recorded in each sextant (If code 4 found continue to examine all sites in sextant)
Must have minimum of 2 teeth per sextant
What does a code 0 mean in a BPE?
Healthy
What does a code 1 mean in a BPE?
Bleeding on probing
What does a code 2 mean in a BPE?
Supragingival or subgingival calculus or Plaque retention factor (PRF)
What does a code 3 mean in a BPE?
Shallow pocket 3.5mm or 5.5mm (black band partly visible)
What does a code 4 mean in a BPE?
Deep pocket 5.5 mm or more (black band disappears)
What does a code * mean in a BPE?
Patient has friction
If a patient has a code 0 from their BPE what should you do?
No periodontal treatment required just do a BPE at their next appointment
If a patient has a code 3 from their BPE what should you do?
Initial therapy, post treatment periodontal charting
Take radiographs
If a patient has a code 4 from their BPE what should you do?
Take radiographs
more detailed periodontal charting required
If a patient has a code 1 from their BPE what should you do?
Give them some oral hygiene instructions
Do a BPE at their next appointment
If a patient has a code 2 from their BPE what should you do?
Give them some oral hygiene instructions
Do a cake a polish to remove and plaque
Do a BPE at their next appointment
What factors affect probing?
- The size of the probe
- The angulation of the probe
- The contour of the tooth and root surface
- The probing force used
- The inflammatory state of the tissues
Other than BPE what else do you examine in the mouth?
- Occlusion
- Dentures
- Other findings
- Special Tests
- Vitality tests
- Radiographic 7. Assessment
- Diagnosis
- Treatment Plan
What are the 4 different types of radiographs?
- panoramic
- periapicals
- horizontal bitewings
- vertical bitewings
What must you so when you have made a diagnosis?
Write you diagnosis down and make a treatment plan
Who should have a BPE taken?
All new patients
What is furcation?
Bone loss due to severe periodontal disease
