Assessment of the Periodontal Patient

Question 1

Describe a new patient assessment

Answer 1

• Presenting Complaint
• History of Presenting Complaint
• Extra Oral Examination
• Intra Oral Examination
• Radiographic Assessment
• Diagnosis
• Treatment plan

Question 2

What are 5 common presenting complaints with regards to periodontics?

Answer 2

1. No issues
2. Gingival bleeding on brushing
3. Spacing or drifting of teeth
4. Tooth mobility
5. Gingival recession and sensitivity

Question 3

Describe 3 components of a history-taking not related to the patient’s complaint

Answer 3

1. Past Medical History - Medication or systemic diseases
2. Social History - Smoking / Alcohol, Work Environment
3. Past Dental History

Question 4

How do you take a smoking history?

Answer 4

• Do you smoke?
  
  • “Yes” > How many? / How long? > Current smoker
  • “No” > Have you ever smoked?
    • “Yes” > When did you stop / How many for how long > Ex-smoker
    • “No” > Never smoker

Question 5

Describe 5 components of a previous dental history

Answer 5

1. Attendance with GDP
2. Frequency of brushing
3. Use of inter-dental cleaning aids or mouthwash
4. Anxiety regarding dental treatment
5. Denture wearer

Question 6

What are 2 things to look out for during an extra-oral examination?

Answer 6

1. Lymphadenopathy

2. TMJ disorders

Question 7

Describe 4 components of an intra-oral clinical examination

Answer 7

1. Soft tissue assessment
2. Overall assessment of dentition
3. Assess occlusion
4. Inspection of periodontal tissues

Question 8

Describe 6 components of a periodontal examination

Answer 8

1. Plaque Index
2. Periodontal Pocket Depths
3. Bleeding on Probing
4. Mobility
5. Gingival Recession
6. Presence of Furcation Defects

Question 9

What plaque index is used during a periodontal examination?

Answer 9

O’Leary Plaque Index

Question 10

Describe the O’Leary Plaque Index

Answer 10

• Method of recording plaque on individual tooth surfaces
• Mesial, distal, buccal and lingual surfaces assessed
• Plaque Score = (Number of Surfaces Exhibiting Plaques / Number of Surfaces Available x 100)

Question 11

Name 2 periodontal probes which can be used to determine pocket depths

Answer 11

1. Michigan-O probe with William’s markings

2. WHO-621 Periodontal Probe

Question 12

What is probing pocket depth?

Answer 12

Distance from gingival margin to base of periodontal pocket

Question 13

What is clinical attachment loss?

Answer 13

Distance from CEJ to base of the periodontal pocket

Question 14

In terms of clinical attachment loss and probing pocket depth, how is gingival recession determined?

Answer 14

If CAL is greater than PPD then gingival recession is present

Question 15

In terms of clinical attachment loss and probing pocket depth, how is gingival swelling determined?

Answer 15

If periodontal pocket depth is greater than clinical attachment loss, gingival swelling is present

Question 16

Name 2 uses of bleeding on probing

Answer 16

1. Sign of inflammation in tissues

2. Use as a marker of stability

Question 17

What 2 reasons may a pocket bleed on probing?

Answer 17

1. Ulcerated pocket epithelium

2. Increased vascularisation of connective tissues

Question 17

What 2 reasons may a pocket bleed on probing?

Answer 17

1. Ulcerated pocket epithelium

2. Increased vascularisation of connective tissues

Question 18

What 2 reasons may a pocket bleed on probing?

Answer 18

1. Ulcerated pocket epithelium

2. Increased vascularisation of connective tissues

Question 19

How can bleeding on probing be used as a marker of stability of periodontal disease?

Answer 19

Presence of BOP is a marker of unstable periodontal diseases whereas absence of bleeding is a better indicator of stability

Question 20

Describe Miller’s Index with regards to mobility of a tooth

Answer 20

0 - No movement of tooth
1 - Buccal-Lingual movement of <1mm
2 - Buccal-Lingual movement >1mm
3 - Buccal-Lingual movement >1mm and vertical movement

Question 21

What causes mobility of teeth?

Answer 21

Alveolar bone loss

Question 22

What is the function of carrying out radiographic assessment in periodontics?

Answer 22

Determine any alveolar bone loss and other pathology present in the oral cavity

Question 23

What are 3 most common radiographic views in periodontics?

Answer 23

1. OPT
2. Bite-wings
3. IOPAs

Question 24

Describe an OPT with regards to periodontics

Answer 24

- Provides overview of all teeth, jaws and sinuses - Poor quality anteriorly due to superimposition of cervical spine - Good screening radiographs - Increased radiations vs bitewings and IOPAs

Question 24

Describe an OPT with regards to periodontics

Answer 24

- Provides overview of all teeth, jaws and sinuses - Poor quality anteriorly due to superimposition of cervical spine - Good screening radiographs - Increased radiations vs bitewings and IOPAs

Question 25

Describe a bitewing with regards to periodontics

Answer 25

- Excellent quality - Posterior teeth only - Does not show apices of roots so may not show full extent of bone loss

Question 26

Describe an IOPA as a periodontal radiograph

Answer 26

- Excellent quality - Gold standard - Shows all tooth and root and periapical bone

Question 27

What mnemonic is used to decide on choice of radiographs?

Answer 27

ALARP - As Low As Reasonably Practicable

Question 28

What radiographs are likely to be taken for generalised moderate to advanced periodontal disease?

Answer 28

OPT plus anterior IOPAs

Question 29

What radiographs are likely to be taken for generalised mild periodontal disease?

Answer 29

Bitewings and anterior IOPAs

Question 30

What radiographs are likely to be taken for localised advanced periodontal disease?

Answer 30

Additional IOPAs of areas affected

Question 31

Name 9 things to look for on a radiographic examination

Answer 31

- Bone Loss (severity and pattern) - Presence of sub-gingival calculus - Caries - Restoration margins - Peri-apical radiolucencies - Presence of furcation lesions - Widening of PDL - Root form - Any associated pathology