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Periodontal Assessment

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Whitney Simonian

on 9 September 2013

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Transcript of Periodontal Assessment

Periodontal Assessment
Periodontal Probing & Charting
Evaluation of supporting structure
Treatment planning
Reference during treatment
Evaluation (compare pre-treatment & post-treatment findings)
Legal Documentation
Bleeding Index
After probing a sextant, look back on the area you probed and identify the bleeding areas
If bleeding is present, check the BOP on the perio charting form, or circle the probing depth.
Bleeding Index= # of bleeding sites/total # of surfaces probed X 100%
Documentation of the Periodontal Assessment
Record ALL probing depths on perio chart
Record any bleeding & exudate
Record a general statement of the probing depths that were charted on the Patient Worksheet
Recession is also charted on the perio chart under GM (gingival margin)
Record Gingival Description on the Patient Worksheet
Color, contour, consistency, texture
Gingival Description,
Periodontal Probing & Charting,
and Bleeding Index

Periodontium
Functional unit of tissues that surrounds and supports the tooth
Includes:
Gingiva
Periodontal ligament (PDL)
Cementum
Alveolar bone
Gingiva
Main components:
Free gingiva
Attached gingiva
Interdental papilla
Gingiva:
Other structures
Gingival margin: opening of gingival sulcus
Free gingival groove: depression between free gingiva & attached gingiva
Gingival sulcus: crevice bewteen the free gingiva and tooth
Junctional epithelium: attaches gingiva to tooth
Gingival crevicular fluid (very little in health)
Alveolar mucosa
Gingival Description
Color
Contour-consider free gingival margin & interdental papilla
Consistency
Texture
Position
Wilkins pg.217-218 has a great table
Descriptive Terminology
Severity: Slight, moderate, severe
Distribution
Localized: limited to few teeth or specific areas
Generalized: affecting the majority of teeth
Marginal: limited to the free gingival margin


Diffuse: affecting gingiva from its margin to the mucogingival junction-typically in a localized area
Papillary: Involves the papilla, but not the rest of the free gingiva around a tooth
Color
Signs of Health
Pale pink uniformly
Coral pink uniformly
Pigmentation
Changes in disease
Acute: erythemic, varying degrees possible
Chronic: Cyanotic-pallor to blue, Magenta
Countour
(margins & papilla)
Signs of Health
Margins: knife edged, or slightly rounded, closely adapted to the tooth
Papilla: Pointed or slightly flattened under the contact (flatter posteriorly), fills the interdental space, flat/saddle shaped where there is space
Changes in Disease
Margins: rounded, rolled festooned, clefted
Papilla: blunted, bulbous, cratered, flattened
Healthy: slightly rounded
Contour
Consistency
Sign of Health: Firm
You can use a blunt instrument to assess (the end of a probe)
Minimal depression with resiliency in health
Indicates that gingiva is firmly bound to underlying bone
Healthy: knife edged
Festooned
Rolled
Cleft
Pyramidal papilla
Blunted papilla
Changes in Disease
Soft & spongy
Decreased resiliency of tissue to "rebound"
Hard & fibrotic
Difficult to depress
Flaccid
Can be retracted from around the tooth easily
Can also be displaced with air
Consistency
Firm
Texture
Signs of Health
Free Gingiva: smooth
Attached Ginigva: stippled
Interdental gingiva is divided into free and attached
Changes in Disease
Free Gingiva
Shiny (acute)
Hyperkeratinized
Attached Gingiva
Shiny (acute)
Hyperkeratinized
Heavy stippling indicates fibrotic tissue
Texture
Position of the Gingival Margin
Signs of health:
Height should be at the level of or slightly below the enamel contour or the prominence of the cervical third of the tooth
Changes in Disease
Enlarged
Receeded
Position of the Gingival Margin
Bleeding & Exudate
Signs of health
No bleeding
No exudate
Changes in Disease
Bleeding upon probing or spontaneously
Exudate is related to the severity of acute inflammation, but not the depth of the pocket
Gingiva in Children with Primary or Mixed Dentition
Color
Pink or slightly red
Contour
Margins: thick, rounded, rolled
Interdentally: flat due to diastemas
Consistency
Less fibrous than adult's; not usually as tightly adapted
Texture
May lack stippling & appear shiny
Let's recap
Gingivits vs. Periodontitis
Which involves attachment loss?
Which is reversible?
What is the gingival description? (Color, contour, consistency, texture, position)
Periodontal Probe
Uses
It is a diagnostic instrument used to determine a patient's periodontal status, in conjunction with radiographs.
Helps determine health vs. disease (bleeding/exudate on probing)
Measure possible pathologic lesions
Measure recession (from CEJ to GM)
Probe is used in the initial assessment, during treatment, and after treatment.

Periodontal Probes
There are different probes with different calibrations: (millimeters: mm)
UNC 15: 1, 2, 3, 4.....15
Marquis: 3, 6, 9, 12
Williams: 1, 2, 3, 5, 7, 8, 9, 10
Michigan: 3, 6, 8, 11
PSR Probe: 0.5, 3.5, 5.5, 8.5, 11.5
Designed for the WHO
Entire dentition is probed, but each sextant is coded according to a coding system
See pg. 323 in your Wilkin's book
UNC 15
Cratered papilla
Bulbous papilla
Spongy
Fibrotic
Stippled
Smooth
Heavy stippling
Recession
Enlarged
Medication induced gingival overgrowth
Periodontal Probe: Probing Depths
Six measurements for tooth
DF, F, & MF
DL, L, & ML
Record ALL probing depths!
1-3mm are ideal readings: Always round up!
=>4mm readings are signs of inflammation or attachment loss
Mark bleeding points with a check mark
Bleeding points are used to calculate a bleeding index (BI)
Probing Technique: General
Modified pen grasp
Use the mirror to retract cheek and/or to use indirect vision
Stable intraoral fulcrum near the area of instrumentation
Insert into the free gingiva and extend to the junctional epithelium: Light force!!
Probe is to be held parallel to the long axis of the tooth
It is angled into the proximal area for an accurate reading (col)
Side of the probe is maintained against the tooth
"Walk" the probe along the JE
Periodontal Probes: Dental Implants
NEVER USE ANY METAL INSTRUMENTS ON DENTAL IMPLANTS
Furcation Probes
Naber's Probe
Designed to measure the severity of furcations
Furcations are classified according to accessibility
You will learn about furcation classifications later.

Col
Probing Technique

Insertion will occur at the distal line angle
Walk the probe distally and obtain distal reading
Facial or lingual: both will be assessed, but separately!
Walk from the distal line angle across the facial or lingual surface and the deepest reading will be what you record
Continue to walk the probe mesially and obtain the mesial reading
There are 6 readings to record for each tooth
Stay parallel to the long axis of the tooth!
Underneath the contact, between the lingual & facial papilla
Probing Technique Continued
Remember to angle the probe to access the col for an accurate proximal reading
Develop a sequence
Begin with the most posterior tooth on the distal, and move mesially
Work posterior to anterior
IMPORTANT: NO DEATH GRIPS!!!

REMEMBER: LIGHT GRASP, LIGHT PRESSURE!
Probing depths alone may not be reliable when determining the extent of attachment loss. The clinical attachment level (CAL) is a better indication of disease progression (Pocket depth + Gingival recession=CAL)
*Enlarged gingiva from overgrowth or inflammation can create pseudopockets.
Calculating BI
The patient had 28 bleeding sites
The patient had 28 teeth total
Remember: 6 measurements per tooth
28x6=168 total sites
28 bleeding sites divided by 168 total sites=0.167 x 100 = 17%

Let's Practice
Your patient has 22 teeth and 43 bleeding sites. What is your patient's bleeding index?


Considerations
Bleeding
Healthy gingiva does not bleed
Consider the etiology of the bleeding
Gingivitis associated with dental biofilm (plaque)
Gingivitis associated with medications or systemic disease
Educate your patient!
If exudate is present after probing, it should be noted as well.
Use radiographs during periodontal assessment--specifically to assess bone loss
You will present your findings to your faculty during evaluation of your patient assessment
Corrections may need to be made to your recorded findings, & faculty may include additional findings beyond those you have noted
Accurately record the findings in the patient's EPR chart in the appropriate modules: Progress Note & Periodontal Chart
Time for a video on probing!
Whitney Simonian, RDH, BS
Fall 2013

Objectives
At the completion of this lecture, the student will be able to:
Recognize the differences between gingivitis & periodontitis
Describe a patient's gingiva using the appropriate terminology.
Practice accurate probing technique.
Calculate a patient's bleeding index.
Document the periodontal assessment correctly.

Gingivitis VS. Periodontitis
Gingivitis
Reversible!
Confined to the gingiva
NO BONE LOSS
NO ATTACHMENT LOSS
Local factors
Acute=sudden onest
Chronic (most common-usually painless)
Periodontitis
Periodontal pocketing
Gingival Changes
Alveolar bone loss
PDL destruction
Tooth mobility
Histologic host response
Adult periodontitis
Early onset (also known as Juvenile or Aggressive)
Today's Key Points
Gingivitis is reversible and does not involve attachment loss
Be familiar with terminology to give a thorough gingival description
When probing, be sure to stay parallel to the long axis of the tooth, and angle into the col to obtain a proximal reading
Accurate documentation is important.
Full transcript