this is gathered and is critical to have as a reference tool, a historical record and a patient educational resource
documentation of information
this stain has been attributed to flurorescent bactria and fungi such as penicillium and aspergillus.. occurs on gingival half of facial surfaces of anterior teeth
green stain
this discourages flossing
tight contact
this type of furcation classification is early stage furcation involvement with pocket formation into the flute of the furca that may include limited bone loss and without radiographic changes
grade I
what are the locations of bifurcation?
2 rooted mandibular molars on the buccal and lingual aspects
2 rooted maxilary first pre molars on the mesial and distal aspects
3 rooted maxillary molars on the buccal, mesiolingual and distolingual aspects
what type of furcation is present in a two rooted tooth?
bifurcation
this type of radiograph is more helpful with third molars and larger image diagnosis
panoramic
what is 85% of dental treatment related to?
diagnosis, treatment and prevention of plaque biofilm
this is the first stage in the dental hygiene progress of patient care
assessment
The medical history ensures patient safety, health and well being by aiding the clinician in the following:
evaluation oral manifestations of systemic disease
detecting systemic conditions that may affect the periodontal tissue response
detecting systemic and infectious conditions that require special precautions and modifications in treatment procedures
this is only an indication that destructive disease has occurred
clinical attachment loss
what are the reasons for 75% of extractions?
periodontal disease and dental caries
this is the loss of the tooth structure caused by chronic destructive processes other than dental caries
tooth wear
what sources can excessive ingestion of fluoride come from?
tooth paste, fluoride supplements and water can cause hypomineralization of enamel during development known as fluorosis
what type of color gingiva indicates chronic inflammation
dark red to cyanktic
what is the chief complain of erosion?
temperature and tactile sensitivity and increased staining in the wear lesions
this is early lesions are wide shallow or silky smooth concavities that are greater in width from chemical actions of acid… advanced lesions are denton involvement, restorations rising above adjacent tooth and from chemical actions of acids
erosion
in orange stain, what have been the responsible chromogenic organisms?
serratia marcesens and flavobacterium lutesecens
this is a green to yellow stain, most often seen in children and thought to be from biting fingernails
green stain
how can you access furcation of mandibular molars?
straight buccally and lingually between the mesial and distal roots
colored area of probe remains completely visible in the deepest crevice of the sextant… no calculus or defective margins are detected… gingival tissues are healthy with no BOP
code 0
this type of measurement is the distance between the gingival margin and the base of the gingival sulcus
pocket depth, probing depth or gingival sulcus depth
this is the distance between the CEJ and the most apical extent of the epithelial attachment
clinical attachment loss
these are stains that occur within the tooth structure and cannot be mechanically removed by scaling or polishing mainly from pre eruption and post eruption drug interactions
intrinsic stain
this is wedge shaped defects, concavities or notches… ditches, notches or indentations from mechanical process from foreign object usually a tooth brush..
abrasion
this type of furcation involvement of one or more furcations of a tooth with bone loss that does not extend beyond the dome of the root. with or without radiograph changes
grade II
flattening or well definided wear facets and ledges from tooth to tooth contact. can be related to deep over bite or cross bite
attrition
this is the measurement of boneloss within the bifurcation or trifurcation to the current bone level
vertical component
this type of stain occurs as a thin black line on the facial and lingual surfaces of the teeth of individuals who have excellent oral hygiene care
black stain
this symbol is added to the sextant score whenever findings indicate clinical abnormalities such as: furcation invasion, mobility, mucogingival problems, recession extending to the colored area of the probe (3.5 mm or greater )
code *
what is done with extra and intra oral assessment?
head and neck examination
oral mucosa assessment
distance between the CEJ and gingival margin
gingival recession
an implant is considered to have this when there is inflammation of the soft tissue surrounding the implant
peri implant mucositis
what is the chief complaint with attrition?
hot and cold sensitivity or sweets. tooth pain on incisal or occlusal edges when biting
this is the movement of a tooth or teeth beyond physiologic limits. it can be caused by factors affecting the PDL space and loss of alveolar bone.
pathologic or abnormal mobility
what are the common locations of erosion?
cervical and buccal surfaces of maxillary teeth… occlusal surfaces and buccal surfaces of mandibular teeth
lingual surfaces of anterior and posterior maxillary teeth… buccal surfaces of mandibular posterior teeth
what are some characteristics of implant failure?
most common in maxillary
occur more often in diabetics
higher risk with history of head and neck radiation
higher risk in smokers
increased with occlusal loading
greater with bruxism
what things are assessed with periodontal assessment?
prove depth clinical attachment loss bleeding and suppuration furcation involvement tooth mobility tooth migration implant status
this reflects the history of periodontal disease and does not assess the disease activity
radiographic image assessment of bone loss
the presence of this along with bleeding on probing and periodontal pockets can indicate that a site is in an active disease state and attachment loss is increasing
suppuration or pus
how are stains documented?
according to color… (brown, black, green blue, gray, yellow, or orange)
location (tooth surface, intrinsic or extrinsic)
extent (amount of tooth surface or tissue covered, localized or generalized)
intensity (light moderate or heavy)
what is the most common occurring stain?
brown stain
where is abrasion most commonly located?
buccal surface at CEJ and incisal and occlusal surfaces
what type of implants maintain their probing depths after initial healing?
healthy
these are most helpful in decay detection and bone loss
bitewings and periapical
what do probing depths provide information for?
pocket depths- can be used to compare over time
CAL- used to determine progression of disease
furcation involvement- helps determine viability of the tooth
bone loss
what is the patients chief complaint with abfraction?
hot and cold sensitivity, pain when biting and food trap
colored area of probe remains completely visible in deepest probing depth in sextant… supra or subgingival calculus is detected or defective margins are detected
code 2
what are the classifications of blacks cavity?
class 1: pit and fissure (occlusal surfaces of premolars or molars, occlusal 2 thirds of facials and lingual, lingual surface of max incisors)
class 2: proximal in premolars and molars
class 3: proximal in incisors and canines (does not involve incisal edge)
class 4: proximal in inciors and canines and involves incisal edge
class 5: gingival third cavities (does not include pit and fissure)
class 6: incisal edge and cusp tip
these are necessary to capture an image with existing perio disease
vertical bite wings
this is loosely attached, moveable tissue that is not keratinized… it begins at the mucogingival junction and is continuous with the lining mucosa of the oral cavity
alveolar mucosa
how is the width of the attached gingiva determined by?
subtracting the sulcus or pocket depth from the total width of the keratinized gingiva (from
the gingival margin to the mucogingival junction)
what do all patients require?
regular comprehensive periodontal assessments to detail their status, provide a historical accounting and alert the hygiene standards to evidence of disease activity
why is it essential to take and record vital signs?
because of the connection between oral health and general health
how do you determine the correct measurement of pseudopocket?
the cal is subtracted from pocket depth
these are pigmented deposits on the tooth surface that results from the pigmentation of ordinarily colorless acquired pellicular and dental biofilm by chromogenic bacteria foods and chemicals
extrinsic stains
colored area of probe remains completely visible in deepest probing depth of sextant… no calculus or defective margins BUT there is BOP
code 1
this is V or wedge shaped lesions with sharp edges that are greater in depth than width generally supragingival…. mechanical process from tooth flexhre by eccentric occlusal brushing
abfraction
what is essential to asses changes in the disease over time
accurate records
how can you access maxillary molars?
buccally between the mesial buccal and distobuccal roots and access distolingually between the palatial and distobuccal root
how should mobility be assessed by?
placing the handles of metal instruments next to the tooth and applying pressure in the buccal-lingual direction and apically
this is the least common of stain and may occur on both facial and lingual surfaces of anterior teeth… associated wit poor oral hygiene
orange stain
this allows you to assess immediate needs and is a critical part of establishing rapport with the patient and developing a treatment plan that meets the patients personal goals of care
chief complaint
how can visualization for the patient be achieved?
direct observation using a mirror
intraoral photographs to view soft tissue conditions, enamel, cracks, dental caries, and oral abnormalities
radiographic images to point out bone loss, dental caries, furcations in molars and hard tissue abnormalities
what type of gingival tissues indicate inflammation?
bright red
colored area of probe remains partly visible in the deepest probing area in the sextant
code 3
what things are looked at in the dentition assessment?
caries restorations overhanging margins proximal contact relationships tooth abnormalities parafunctional habits tooth wear sensitivity and hypersensitivity
this furcation is extensive bone loss permitting complete passage throughout the furcation with clinically visible furcation openings
grade IV
what does the documentation of calculus include?
description type (supra or sub)
location (tooth surface, gen. or local., interprox. or marginal)
quantity (heavy, moderate or light)
nature (white, chalky, spicules, rings, black and tenacious)
what is found in the oral hygiene assessment?
plaque biofilm
calculus
stain
where are the common locations for attrition ?
incisal or occclusal surfaces. buccal and lingual
what are the reasoning we use probe measurements?
assess periodontal disease status
used to support treatment planning decisions
used to design individual plans of treatment and home care
used to evaluate success
when inflammation progresses to include a loss of the peri implant bone, it is considered to have ?
peri implantitis
what type of furcation is present in three rooted tooth?
may be bifurcation or tri furcation(if involved all three roots)
what are the codes of the periodontal screening and recording system?
Code 0, 1, 2, 3, 4 and *
how long should you wait before you probe an implant?
never for the first three months
this cannot detect disease activity or predict destruction
periodontal probing measurements
what do you use to probe or scale and implant?
plastic instruments
this type of furcation is extension of bone loss beyond the dome of the root and may permit probing through the furcation. with radiolucency in the furcation crotch
grade III
where are the common locations for abfraction?
cervical surfaces. mostly buccal and usually in incisors and pre molars
this stain is more common in women, caused by chromogenic bacteria and me be insoluble ferric sulfide
black stain
this medicine has been shown for causing intrinsic staining and is used for acne treatment, rosacea, rheumatoid arthritis and perio…
minocylcine
these subject the teeth to forces outside the normal scope of functional occlusion and include tooth to tooth contact, contact between teeth and soft tissue and contact between teeth and foreign objects
parafunctional habits
this type of contact packs food especially in meats
open contact
the information and procedures essential to the assessment of patients perio status include:
the chief complaint
medical and dental history
clinical examination
radiographic examination
this is the measurement of bone loss horizontally under the anatomical crown of the tooth
horizontal component
what are the three types of oral mucosa that line the oral cavity?
masticatory, specialized and lining
this provides a baseline assessment and comparisons overtime, and what do they include?
gingival descriptive categories…. include color, contour, consistency, and texture
how is the contour or shape or form of healthy marginal gingiva?
scalloped… healthy interdental is knife like tissues that fill the embrasures
this is recession plus pocket depth
CAL
this is area between the roots
furcation
this is normal movement within the teeth, and is most noticeable in the morning… supported by the PDL
Physiologic mobility
how should the consistency of healthy gingiva be?
firm and stippled or orange peel texture
this does not mean that disease is active, however, sites that exhibit this over time are more likely to present with increasing attachment loss
bleeding on proving
what is the most important parameter for the assessment of the failure of an implant?
mobility
what is the patients cheif complaint with abrasion?
sensitivity to brushing, temperature, sweets and tactile pressure… aesthetic concerns
how many stages or grades are there or Glickman index of furcation classifications?
grade I through grade IV
what things are looked at with radiographic assessment?
interdental septa
bone destruction
furcation areas
dental implants
this is a key instructional strategy for helping patients understand their oral health status
visualization
colored area of probe completely disappears indicating probing depth greater than 5.5 mm
code 4
what is the color of a normal margin and attached gingiva?
pale, coral pink
what provides the most accurate and reliable means of asssesing progression and remission of periodontal disease?
CAL
these are ideal for assessment of bone height in patients without periodontal disease
horizontal bitewings
this stain is bacteria free, may be caused by chlorhexadine stannous fluoride and most common cause is coffee, tea, smoking or soda
brown stain
