Periodontal Monitoring and Indices

Question 1

what is monitoring

Answer 1

it is a follow up on a patients disease progression AFTER treatment and establishing the baseline investigation

Question 2

what is meant by periodontal indices

Answer 2

a way in which we can collect information/ quantification of PDs

Question 3

list 7 ways in which periodontal indices may be used

Answer 3

screening

establishing grade/ level of disease

help to reach diagnosis

to monitor response to treatment

to determine if we need further treatment post therapy 
research tool (clinical trials, epidemiology, public health)

clinical management of patients

Question 4

what are specifically PLAQUE indices

Answer 4

evaluate the extent of plaque formation

important because plaque is a key factor in —> aetiology of gingivitis, periodontitis, success/ failure of periodontal treatment

Question 5

list the ways in which plaque indices may be used for

Answer 5

to give quantify distribution of plaque in mouth

identify areas of difficulty for patients OH

clinician can show patient the areas of plaque

allows tailor made OH

motivational tool

Question 6

gives examples of the 4 plaque indices and highlight which is used in LDI

Answer 6

6 point plaque index

o’leary plaque index —> used in LDI

tooth cleanliness index

plaque index- silness and loe

Question 7

O leary plaque index can also be called the..

Answer 7

plaque FREE score

Question 8

describe how you would caryr out an O’leary plaque index/ plaque free score

Answer 8

1. disclose teeth (apply petroleum jelly on cotton bud on lips, ask patient to chew on disclosing tablet/ paint teeth with disclosing solution, swish on the tablet for 30 SECONDS, spit, rinse once
2. inspect the GINGIVAL MARGINS –> all 6 surfaces of one tooth (mesio buccal, mid buccal, disto buccal, mesio palatal/lingual, mid palatal/ lingual, disto palatal/ lingual)
3. record on PLAQUE CHART –> determine the % of surfaces plaque free

Question 9

what is the difference between a plaque score and a plaque FREE score

Answer 9

plaque score gives a low mark for clean teeth and a high mark when teeth covered in plaque

plaque free score gives a high mark for clean teeth and a low mark for plaque

Question 10

when would you carry out a plaque index

Answer 10

at the start of treatment= baseline

then will do the plaque free score PERIODICALLY DURING TREATMENT FOR ALL PATIENTS

Question 11

give examples of the 3 gingival indices and which is used in LDI

Answer 11

gingival index -silness and loe

papillary bleeding index

6 point marginal gingival bleeding index –> LDI

Question 12

describe how you would carry out a 6 point marginal gingival bleeding index

Answer 12

1. insert a PCP10 probe into the gingival sulcus mid-buccally
2. rub the probe towards the mesial papilla
3. insert the probe mid-buccally again
4. run the probe towards the distal papilla
5. rub the probe similarly on the palatal/ lingual surface

you are observing for bleeding at the 6 points (3 for each side of tooth ) —-> mid, mesio and disto buccal and mid, mesio, disto lingual/ palatal

Question 13

when would you carry out marginal bleeding index

Answer 13

done ONCE FOR PATIENTS WITH A BPE SCORE 1+ 2 at the START OF TREATMENT = baseline
then would do as required

it is useful also to assess compliance over long periods

Question 14

give examples of periodontal indices

Answer 14

1. suppuration
2. furcation indices
3. mobility index
4. attachment levels
5. probing pocket depths
6. bleeding on probing

NB. BOP and probing pocket depth are only useful when done together

Question 15

when would you carry out periodontal indices

Answer 15

at the START of treatment = baseline
then
6-8 weeks AFTER TREATMENT = monitoring
on sexants with BPE CODE 3/4/*

Question 16

describe how you would do BOP index for periodontitis

Answer 16

1. insert the PCP10 probe into the BASE OF POCKET
2. will be a positive BOP if bleeding occurs with probing OR shortly after probing
3. examine for all 6 sites of tooth (3 buccal/3 lingual or palatal)
4. record on BOP chart

Question 17

it is very difficult to distinguish between gingival marginal bleeding and BOP. where should bleeding come from if marginal/ BOP respectively

Answer 17

marginal bleeding= bleeding of gingival margins. gingivitis

BOP= bleeding from THE BASE OF POCKET. periodontitis.

Question 18

describe how you would do a probing pocket depth chart index for periodontitis

Answer 18

1. insert PCP10 to the FULL POCKET DEPTH
2. read off the pocket depth in mm, do for all 6 sites of tooth. you will measure from base of pocket–> gingival margin
3. record on pocket depth chart

Question 19

the BPE probe (such as PCP10) is not always accurate, why not

Answer 19

we dont know when we are truly at the BASE of the pocket for many reasons

• gingival inflammation
• true probe tip position
• calculus and PRFs
• angulation of probe
• probing pressure (25g)

Question 20

to measure attachment, we need a fixed reference point. this is usually the

Answer 20

CEJ

Question 21

we measure attachment loss from the reference point to the …

Answer 21

CEJ (reference point) to the BASE OF POCKET

the attachment level between these 2 points will be different in different stages of periodontitis.

Question 22

what is disadvantage of having CEJ as reference point

Answer 22

can be difficult to find because often sub-gingival

Question 23

describe what you are measuring when carrying out recession index for periodontitis

Answer 23

measure from the gingival margin to the CEJ

- where the gingival margin is apical to CEJ

Question 24

mobility index for periodontitis has 3 grades which are

Answer 24

grade 1= 1 mm, horizontal movement

grade 2= >1mm, horizontal movement

grade 3= vertical movement

Question 25

what is furcation

Answer 25

the BONE LOSS BETWEEN MULTIROOTED TEETH

in a furcation index a probe is used to determine the EXTENT of bone loss

Question 26

furcation index for periodontitis has 3 grades which are

Answer 26

grade 1= horizontal bone loss of LESS than 1/3 width of root

grade 2= horizontal bone loss of MORE than 1/3 width of root but NOT through and through

grade 3= horizontal THROUGH AND THROUGH involvement (also less commonly used vertical classification)

Question 27

suppuration index involves

Answer 27

recording the present of pus when probing to the BASE OF POCKET
record the +ve sites