week four - perio exam, gingival biotype, indices Flashcards
describe CAL and how to find it
CAL = clinical attachment level
- distance from CEJ –> base of sulcus [measured in mm]
- CAL values determine periodontal dx
- measured depending on loc of gingival margin
- gingival margin at CEJ
- then CAL = pocket depth - gingival margin apical to CEJ
- then CAL = recession recording + probing depth recording - gingival margin coronal to CEJ
- then CAL = probing depth - gingival margin covering CEJ
describe radiographic assessment of bone loss
- must be used as an adjunct to clinical exam to dx perio
- once bone loss is evident in xray = bone is ~30% worse than it appears
interpretation
- when bone loss = parallel to CEJ of adjacent tooth = horizontal bone loss
- when bone loss = diagonally oriented to CEJ of adj tooth = vertical bone loss
define gingival biotype, compare the TWO main types of gingival anatomy and describe clinical assessment
- “the thickness of the gingiva in the faciopalatal/faciolingual dimension”
- reduced gingiva = risk factor for periodontal attachment loss and marginal tx recession = major concern for perio dx progression
1. thick/flat gingiva
2. thin/highly scalloped gingiva
thick/flat gingiva
- assoc w square anatomical crown
- thick, flat, osseous gingival contour - thick hv periodontium
- gingival margin usually coronal to CEJ
- bulbous convexities in cervical 1/3 of facial surface
- wide zones of keratinised gingiva
- broad apical contacts
thin/highly scalloped gingiva
- assoc w tapered, triangular anatomic crown
- delicate, thin periodontium
- minimal zones of keratinised gingiva
- small incisal contacts
- subtle convexities in cervical 1/3 of facial surface
clinical assessment
- cannot assess thickness from visual eval
- probe transparency - eval probe visibility through gingival tx
- transgingival probing = measure thickness [thick > 1.5mm] [thin < 1.5mm]
define biologic width, its significance and variations
biologic width = combined height of JE and CT attachment to tooth [from bottom of sulcus –> alveolar crest]
- sugg func = protects alveolar bone from infection/disease [buffer zone before PDL/bone]
- average = 2mm in most pts
- healthy mean dimensions = 1.5 - 2.7mm
- perio mean dimensions = 1.25 - 3.95mm
clinical significance
- if resto margin placed WITHIN biologic width = negative effect on periodontal health + plaque retentive factor
signs/symptoms of biologic width violation
- chronic progressive gingival inflammation around resto [most common response - significantly on ant. restos]
- BOP
- gingival recession
- discomfort
- CAL, pocket formation, bone loss
outline the catergories in Dean’s Fluorosis Indices
normal - no dental fluorosis
questionable - slight aberrations from normal enamel translucency - few white flecks to occasional white spots
very mild
- small opaque white areas scattered irregularly over tooth but NOT involving more than 25% of surface
- no more than 1-2mm white opacity at tip of cusps of bicuspids or second molars
mild
- white opaque areas in enamel not involving more than 50% of tooth
moderate
- all surfaces affected and surfaces subject to attrition show wear or brown stains
severe
- all surfaces affect
- hypoplasia is so marked that general tooth form may be affected
- pitting surface w brown stain
Describe the O’Leary Plaque Index
- most common
- disclosing solution used to stain plaque
calculation
- no. of tooth sarces [/4] w plaque present / no. of surfaces examined x 100
Describe how the gingival bleeding index is calculated
bleeding score =
no. of sites w bleeding present / no. of sites examined x 100
describe the furcation index
- measured w Naber’s probe
class I
- beginning of involvement
- concavity of furcation can be DETECTED w explorer/probe but not ENTERED
- cannot be detected radiographically
class II
- furcation can be entered w probe/explorer but cannot PENETRATE to opposite side
class III
- furcation still covered by soft tx
- probe/explorer passes completely through furc
- in max molars probe passes between MB + DB roots and hits palatal root
- definite radiolucency in furcation area
class IV
- same as class III except not covered by soft tx = clinically visible due to tissue recession
describe the mobility index
class I
- tooth can be moved up to 1mm any direction
class II
- tooth can be moved > 1mm any direction but not depressible in socket
class III
- tooth can be moved > 1mm or more buccolingual/mesiodistally + depressible in socket
describe the standard perio exam and its TWO components
two components
1. PSR
2. tx needs
PSR
0 = no pockets > 3.5mm, no calc/overhangs or BOP
1= no pockets > 3.5mm, no calc/overhangs but BOP present
2 = no pockets > 3.5mm but sup/subging calc/overhangs
3 = probing depth = 3.5 - 5.5 mm
4 = probing depth > 5.5mm
* = furcation involvement
- codes 3 or 4 = requires comprehensive perio assessment
tx needs
0 = no need for perio tx
1 = OHI
2 = OHI, removal of plaque retentive factors, incl calc
3 = OHI, RSD
4 = OHI, RSD + assess need for more complex tx + specialist referral
* = OHI, RSD + assess need for more complex tx + specialist referral
describe the basic periodontal examination index [BPE]
BPE score
0 = no probing depths > 3.5mm, no calc/overhangs or BOP
1 = no probing depths > 3.5mm, no calc/overhangs - BOP present
2 = no probing depths > 3.5mm, sub/supra ging calc/overhangs present
3 = probing depth 3.5 - 5.5 mm
4 = probing depth of 6mm or more
* = furc involvement
describe the community periodontal index of treatment needs [CPITN]
0 = normal healthy periodontium = no tx needed
1 = BOP = OHI
2 = plaque + calculus = OHI + scale/polishing
3 = pocket depth 4-5mm = deep scaling w OHI
4 = pocket depth > 6mm = scaling, root planning, surg intervention
describe the DMFT Index
decayed missing failed tooth index
- index of past caries experience
- each tooth that is decayed, missing or failed resto given a score of 1
describe the ICDAS II Index
internation caries detection and assessment
0 = sound tooth surface - no caries evidence after 5 sec air dry
1 = first visual change in enamel - opacity or white/brown discolouration visible at pit/fissure system entrace after prolonged air drying
2= distinct visual change in enamel visible when wet - lesion visible when dry
3 = localised enamel breakbown =w/o clinical signs of dentin involvment - seen wet + after prolonged dry
4 = underlying dark shadow from dentin
5 = distinct cavity w visible dentin
6 = extensive [> half of surface] distinct cavity w/ dentin
