Supragingival clinical examination

Question 1

What are the things tested for in periodontal clinical exams?

Answer 1

Supragingival (protection) factors:

Plaque index, gingival index, retentive factors, and gingival biotype.

Subgingival (insertion) factors:

Bleeding on probing, probing depth, attachment levels, recession, furcation involvement.

Question 2

What are the clinical features of good periodontal health?

Answer 2

Clinically: Absence of inflammatory signs such as bleeding

Question 3

What are the microbiological signs of good periodontal health?

Answer 3

Supragingival plaque biofilm compatible with health

Mainly coccos and gram + bacteria

Harmonious relationship with host

No visible plaque

Question 4

What are the histological features of healthy periodontium?

Answer 4

Unaltered sulcular epithelium

Coronally restricted inflammatory infiltrate

Mainly PMNNs (PolyMorphoMonoNuclear Neutrophils)

Question 5

What triggers inflammation of the protection periodontium?

Answer 5

Caused by supragingival dental biofilm

Question 6

What are the clinical signs of gingivitis?

Answer 6

Inflammatory signs; bleeding most importantly

Question 7

What are the microbiological signs of gingivitis?

Answer 7

Non-health compatible supragingival plaque biofilm

Mainly coccos and gram + bacteria, facultative anaerobes m.o.

Deleterious relationship with host

Presence of visible plaque

Question 8

What are the histological signs of gingivitis?

Answer 8

Ulcerated sulcular epithelium

Increased inflammatory infiltrate

Proliferation of junctional epithelium

Question 9

How is gingivitis different to periodontitis?

Answer 9

Periodontitis has both inflammation (bleeding/suppuration) AND attachment loss.

Question 10

What are the clinical signs of periodontitis?

Answer 10

Inflammatory signs (bleeding/suppuration)

Evidence of connective tissue attachment/bone loss

Question 11

What are the microbiological signs of periodontitis?

Answer 11

Non-health compatible subgingival plaque biofilm

Mainly gram - bacteria proteolytic anaerobe m.os

Deleterious relationship with host

Question 12

What are the histological features of periodontitis?

Answer 12

Ulcerated sulcular epithelium

Apical migration of the Junctional Epithelium

Increased inflammatory infiltrate, plasma-cell rich

Connective tissue and bone destruction

Question 13

How is a supragingival periodontal exam conducted?

Answer 13

Periodontal probe is used: it is blunt, round-shaped working end with a circular cross section and is graduated for measurement of sulcus.

Question 14

What is naber’s probe?

Answer 14

A probe used to measure the extent of furcation of a multi-rooted tooth.

Question 15

How is partial isolation achieved in periodontics?

Answer 15

Cotton rolls

Gauze

Suction

Question 16

What is the visible plaque index?

Answer 16

An index that identifies presence and distribution of supragingival plaque.

Positive sites are divided by total sites and multiplied by 100.

Question 17

What does the visible plaque index tell us?

Answer 17

Patient capacity of self-performed plaque control

The momentaneous clinical situation of the patient

Allows for adequacy of unsatisfactory measures of plaque control

Question 18

What is the marginal bleeding index?

Answer 18

An index used to measure the inflammatory condition of the marginal gingiva.

Gingival status is examined and scored on a scale of 0 to 3 where 3 is severe inflammation.

Question 19

What does the marginal bleeding index tell us?

Answer 19

Determines the healthy or diseases status of the gingiva.

Measures the result of the interaction among bacterial challenge and defensive factors of the marginal gingival complex.

Also identifies where patient do not control plaque routinely.

Question 20

How is the marginal bleeding index conducted?

Answer 20

Periodontal probe is inserted approximately 0.5mm in the sulcus and gently ran through its extension then the bleeding is observed for the next 10 seconds.

Question 21

What does the combined VPI and GBI tell us?

Answer 21

Gives us an overall picture of real patient habits in performing plaque control measures.

Question 22

What is the retentive factors index?

Answer 22

Determine the presence of factors that facilitate plaque accumulation/retention.

Question 23

Why should retentive factors be removed?

Answer 23

Although they are not aetiological factors they foster supragingival plaque accumulation and retention and so they should be removed.

Question 24

What are some examples of retentive factors?

Answer 24

Dental calculus

Cavities near the gigival margin

Overhangs/overcontoured restorations

Hopeless root remnants

Extensive hyperplasias

Crown/root anomalies

Question 25

How are thin and thick gingival biotypes distinguished?

Answer 25

Thin gingival biotype:

Tissue thickness <1.5mm

Highly scalloped gingival architecture

Thin, narrow inter-dental papilla

Associated with narrow triangular teeth

Underlying bone is thin

More prone to recession

Less resistant to trauma

Thick gingical biotype:

Tissue thickness > 2mm

Less scalloped, flat gingival architecture

Thick, wide inter-dental papilla

Associated with wider square teeth

Underlying bone is thick

More prone to pocket formation

More robust and resistant to trauma