Supragingival clinical examination Flashcards
What are the things tested for in periodontal clinical exams?
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.
What are the clinical features of good periodontal health?
Clinically: Absence of inflammatory signs such as bleeding
What are the microbiological signs of good periodontal health?
Supragingival plaque biofilm compatible with health
Mainly coccos and gram + bacteria
Harmonious relationship with host
No visible plaque
What are the histological features of healthy periodontium?
Unaltered sulcular epithelium
Coronally restricted inflammatory infiltrate
Mainly PMNNs (PolyMorphoMonoNuclear Neutrophils)
What triggers inflammation of the protection periodontium?
Caused by supragingival dental biofilm
What are the clinical signs of gingivitis?
Inflammatory signs; bleeding most importantly
What are the microbiological signs of gingivitis?
Non-health compatible supragingival plaque biofilm
Mainly coccos and gram + bacteria, facultative anaerobes m.o.
Deleterious relationship with host
Presence of visible plaque
What are the histological signs of gingivitis?
Ulcerated sulcular epithelium
Increased inflammatory infiltrate
Proliferation of junctional epithelium
How is gingivitis different to periodontitis?
Periodontitis has both inflammation (bleeding/suppuration) AND attachment loss.
What are the clinical signs of periodontitis?
Inflammatory signs (bleeding/suppuration)
Evidence of connective tissue attachment/bone loss
What are the microbiological signs of periodontitis?
Non-health compatible subgingival plaque biofilm
Mainly gram - bacteria proteolytic anaerobe m.os
Deleterious relationship with host
What are the histological features of periodontitis?
Ulcerated sulcular epithelium
Apical migration of the Junctional Epithelium
Increased inflammatory infiltrate, plasma-cell rich
Connective tissue and bone destruction
How is a supragingival periodontal exam conducted?
Periodontal probe is used: it is blunt, round-shaped working end with a circular cross section and is graduated for measurement of sulcus.
What is naber’s probe?
A probe used to measure the extent of furcation of a multi-rooted tooth.
How is partial isolation achieved in periodontics?
Cotton rolls
Gauze
Suction
What is the visible plaque index?
An index that identifies presence and distribution of supragingival plaque.
Positive sites are divided by total sites and multiplied by 100.
What does the visible plaque index tell us?
Patient capacity of self-performed plaque control
The momentaneous clinical situation of the patient
Allows for adequacy of unsatisfactory measures of plaque control
What is the marginal bleeding index?
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.
What does the marginal bleeding index tell us?
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.
How is the marginal bleeding index conducted?
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.
What does the combined VPI and GBI tell us?
Gives us an overall picture of real patient habits in performing plaque control measures.
What is the retentive factors index?
Determine the presence of factors that facilitate plaque accumulation/retention.
Why should retentive factors be removed?
Although they are not aetiological factors they foster supragingival plaque accumulation and retention and so they should be removed.
What are some examples of retentive factors?
Dental calculus
Cavities near the gigival margin
Overhangs/overcontoured restorations
Hopeless root remnants
Extensive hyperplasias
Crown/root anomalies
How are thin and thick gingival biotypes distinguished?
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
