What are the stages of asking questions when taking the history of a patient
- Presenting complaint
- History of Presenting Complaint
- Medical History
- Past Dental History: include oral hygiene regimen and diet
- Social History
- Family History
What is involved in the extra-oral examination of a patient
- Lip Seal
- Lymph nodes
What is included in the soft tissue examination of a patient
- Gingival appearance
- Oral Hygiene
- Complete the BPE
- Check tongue, cheeks, FoM, hard and soft palate
What is the purpose of special investigations
To go from a differential to a definitive diagnosis
Name some things that are included in the special investigations
- Radiographs: for caries and bone levels
- Plaque and bleeding scores
- Vitality testing
How should you structure the definitive diagnosis notes
- Start with notes about the gingival and soft tissues
- Then move to hard tissues
How do you structure the prognosis notes
- Breakdown each definitive diagnosis by providing a prognosis for each one, mention whether the prognosis is good, bad, excellent etc and then mention that might be needed to ensure that the prognosis is met e.g. reduced sugar frequency, change in brushing technique
What questions should we ask when a patient complains of bleeding gums
- Is there bleeding on brushing?
- Does it happen spontaneously
- When did you notice it?
- Is it getting worse?
- Have you noticed bad breath or a bad taste?
- Any loose teeth?
- Aware of any gum recession?
What questions should we ask when a patient complains of Gum Recession
- When did it start?
- Do you have any sensitivity?
- Ever have orthodontic treatment?
- Any gum bleeding?
- Any teeth loose?
What questions should we ask when a patient complains of mobile teeth
- when did you first notice the movement?
- Is it getting worse?
- bad taste or smell?
- Pain or discomfort?
- Prevent you from eating?
What drugs can cause drug-induced gingival hyperplasia
- Calcium channel blockers e.g. amlodipine, nifedipine
- Anticonvulsants (epilepsy): Phenytoin
- Immunosuppressant: Cyclosporin
What are some risk factors for periodontal disease
- Age (cumulative effect)
Is a high sugar diet considered a risk factor for periodontitis
Name some of the characteristics of the gingiva that should be assessed
- Surface texture
Damage to what structures in the periodontium cause loss of attachment
- Relocation of the junctional epithelium (from crown to down the root)
- Destruction of gingival fibres
- Destruction of periodontal ligament
- Loss of alveolar bone support
What should be done when the BPE has a score of 3
- 6PPC is required in that sextant
- Supra and sub gingival debridement
What should be done when the BPE has a score of 4/*
Requires full mouth 6PPC
What are the things included in the 6PPC ting
- Pocket depth
- Bleeding on probing
- Furcation involvement
Describe the grades of mobility
Grade I = up to 1mm in a horizontal direction
Grade II = greater than 1mm but less than 2mm in a horizontal direction
Grade III = greater than 2mm in a horizontal direction or vertical movement
What probe is used to measure furcations
What are the different grades of furcation involvement
Grade I = probe penetrates up to 3mm.
Grade 2 = probe penetrates greater than 3mm.
Grade 3 = through and through
What symbols are used to represent the different grades of furcation involvement
Grade 1 - triangle without the base
Grade 2 - triangle, not shaded in
Grade 3 - triangle, shaded in
How do we measure Clinical Attachment Loss
Probing depth + Recession
What is the bleeding score a measurement of
Measurement of inflammation at the gingival margin
What does bleeding on probing measure
BoP measures the presence of inflammatory lesions located at the base of the periodontal pocket