LO 2- Part 1 Flashcards
Describe clinical periodontal assessments
- Used to gather information to diagnose conditions and develop individualized treatment plan
- Used to gather information about periodontium
- Involves recording and interpreting: Clinical features; Radiographic features
- Can use electronic tools such as electronic probes
Objectives:
1. Detect clinical signs of inflammation
2. Identify existing damage to periodontium
3. Provide data for diagnosis, tooth-by-tooth prognosis
4. Document features for baseline for long-term monitoring
Describe documentation of clinical assessment findings
- Necessary to complete clinical periodontal assessment
- Importance cannot be overstated
- Documented findings provide baseline data used - To evaluate success of periodontal therapy episode; For long-term monitoring
List the components of a complete periodontal assessment
- Gingival Index
- Plaque Index
- Bleeding Index
- Calculus Detection
- Probing depth
- Bleeding on probing (BOP)
- Level of free gingival margin
- Presence of exudate
- Tooth mobility & Fremitus
- Furcation involvement
- Radiographs
- Mucogingival Involvement
- Determining Clinical Attachment Level
- Periodontal Screening Record (PSR)
- Other Assessments
How is gingiva assessed?
Assess tissue color, contour, consistency, and texture.
How do you evaluate gingival inflammation?
- Erythema (redness)
- Edema (swelling)
- Gingival color
- Contour
What is important to understand about gingival inflammation?
- Inflammation can be present in deeper structures
- Must correlate visual signs with other signs, such as - Bleeding on probing or presence of exudate
What is important to understand about presence of plaque biofilm on the teeth?
- Contains living periodontal pathogens that can lead to gingivitis and periodontitis
- Can identify using disclosing dyes or by moving tip of explorer or probe along tooth surface
- Usually recorded in terms of percentage of tooth surfaces evident at gingival margin
Describe the plaque index
0 – no plaque
1 – Thin plaque layer at GM – only detectable with explorer or probe
2 – Moderate layer at GM, plaque visible
3 – Abundant plaque along GM, IP spaces filled
How do you calculate plaque index?
- Count the number of teeth present
- Multiply by the number of surfaces
- Add the numbers you detected
- Divide by the number of surfaces
Describe the relevance of calculus deposits
Local contributing factor (LCF) that must be removed for successful treatment - Doesn’t cause disease but contributes to it
Located through:
1. Direct visual examination
2. Visually when using air
3. Tactile examination
Describe Abledent calculus detection
Client flow: HH, EOE, IOE (or re-eval), HT (rads?), GI, PI then Calculus detection is done prior to Periodontal Assessment
3 components to calculus detection:
1. Recording deposits on Abeldent Perio Odontogram
2. Deposit Detection Statement insert
3. Count # of deposits/quad and Total - Record in T’x progress notes, Word Doc or Calculus Detection Statement line (can be deleted after)
Describe the Abeldent Calculus Odontogram
- Only reflects if surface has calculus - ie does not record Degree/Amount
- Does not record sub/supra
- Does not record generalized or localized
Describe adding clinical forms for deposit detection
- Choose “Deposit Detection Statements” from “Add Clinical Form”
- Select appropriate boxes to reflect your findings:
- Extent: Generalized or Localized?
- Location: Sub or Supra-gingival calculus?
- Degree/amount: Scanty, light, moderate, heavy?
Describe the level of the mucogingival junction
- Represents junction between keratinized and nonkeratinized gingiva
- Mucogingival junction usually readily visible
- Occasionally difficult to detect visually
Describe attached gingiva
- Keeps free gingiva from being pulled away from tooth
- Protects gingiva from trauma
- Width not measured on palate
- Does not include any portion of gingiva separated from tooth by a crevice, sulcus, or periodontal pocket
- Width not synonymous with width of keratinized tissue
How is width of attached gingiva measured?
- Width of keratinized gingiva measured from free gingival margin to mucogingival junction
- Measure probing depth, then subtract from total width
What is the etiology of WAG/MAG?
- Lack of attached gingiva
- Frenum pull
- Excessive recession
When is the width of attached gingiva considered minimally attached?
1mm or less
Describe probing depth measurements
- Made from free gingival margin to base of pocket
- Probing depths recorded to nearest full millimeter
- Record at six specific sites - (i) distofacial, (ii) middle facial, (iii) mesiofacial, (iv) distolingual, (v) middle lingual, and (vi) mesiolingual
Describe bleeding on probing
- Represents bleeding from soft tissue wall of periodontal pocket where wall is ulcerated
- Can be immediate or delayed after probing
When/ how do you record BOP
- AS you are probing watch for Bleeding On Probing (BOP) or delayed BOP
- Keep lip, cheek, tongue retracted for a bit after probing to wait for BOP
- Switching the Bleed Icon on and off can be cumbersome so maybe probe several surfaces then record BOP
How do you calculate bleeding index (BI)
(# of bleeding site X 100) / (# of teeth probed X 6 (sites probed per tooth))
Describe the presence of exudate
- Exudate is also called suppuration or pus
- Represents dead white blood cells
- Can only occur in infection
- Pale yellow material that oozes from the orifice of a pocket
- Pus that can be expressed from periodontal pocket
- Pale-yellow discharge oozing from orifice of pocket
- Easiest to detect when gingiva is manipulated
Describe horizontal tooth mobility
- Facial-to-lingual movement
- Apply light, alternating pressure in facial-lingual direction using blunt ends of two instrument handles
- Compare against stationary adjacent tooth
