Perio Examination

Question 1

What is the overall appraisal of the patient?

Answer 1

• consideration of patient’s mental and emotional status, temperament, attitude, and physiologic age
  - should happen from the first meeting

Question 2

What is involved in the chief complaint of the patient?

Answer 2

• identifying problem
• severity/duration
• pain assessment
• urgency
• past treatment for problem

Question 3

What is the order of events in periodontal exam?

Answer 3

• first, overall appraisal of the patient
• chief complaint
• medical hx
• dental hx
• radiographs
• examination of teeth
• examination of periodontist

Question 4

Why is medical hx necessary for periodontal examination?

Answer 4

many reasons but importantly to asses factors to periodontal disease

Question 5

What must be completed before starting a periodontal examination?

Answer 5

hard and soft tissue examination

Question 6

T/F: you must record gingiva margin even if there isn’t recession.

Answer 6

False!
- only record gingival margin if recession is present

Question 7

How is gingival margin measured?

Answer 7

• take probe and place in center of gingival sulcus gently

Question 8

What are gingival margin measurements for gingivitis and periodontitis?

Answer 8

• 1-3mm
• > 3mm

Question 9

What is the 1st area of tooth in regards to perio?

Answer 9

distofacial line angle to midline of distal surface

Question 10

What is the 2nd area of tooth in regards to perio?

Answer 10

facial surface

Question 11

What is the 3rd area of tooth in regards to perio?

Answer 11

mesiofacial line angle to midline of mesial surface

Question 12

What is the 4th area of tooth in regards to perio?

Answer 12

distolingual line angle to midline of distal surface

Question 13

What is the 5th area of tooth in regards to perio?

Answer 13

lingual surface

Question 14

What is the 6th area of tooth in regards to perio?

Answer 14

mesiolingual line angle to midline of mesial surface

Question 15

What’s the importance of “walking the probe”?

Answer 15

• if there’s a deeper area in one section of the gingiva, then we could miss that if we just stuck it in one section
• allows you to find and record deepest depth

Question 16

How is the probe positioned when measuring depth?

Answer 16

parallel to line angle

Question 17

How are proximal surface depths taken?

Answer 17

• go in at an angle and then alter to make it parallel
  (never angle it greater than 10 degrees)

Question 18

How do you read the measurement of probing depth?

Answer 18

• measurement is made from gingival margin (top) to attached periodontal tissue (bottom)
• use the higher mark for final reading

Question 19

What are some examples of the health of the gingival tissue affecting the depth of penetration of probe tip?

Answer 19

• with very tight tissue or calculus present, probe might not penetrate to the base of pocket (give shorter depth)
• with inflammation, the tip can penetrate into the connective tissue

Question 20

T/F: You can sometimes feel calculus when probing.

Answer 20

True!

Question 21

T/F: BOP is not a marker of disease.

Answer 21

False!
It is a marker for disease and should be noted in the chart

Question 22

How is mucogingival examination performed?

Answer 22

• read from the gingival margin to the mucogingival junction
• subtract the probing depth from this to get the attached gingiva

Question 23

What is the range of gingival width?

Answer 23

1-10 mm

Question 23

Where is the more narrow gingiva in the mouth?

Answer 23

mandibular premolar region

Question 24

What is a periodontal pocket?

Answer 24

- formed due to disease/degeneration that cause **junctional epithelium to migrate apically** - tooth wall is cementum/partially enamel - **can be suprabony or intrabony**

Question 24

What is a gingival pocket?

Answer 24

- formed by gingival enlargement **without apical migration of junctional epithelium** - **all gingival pockets are suprabony** - NO bone loss - margin of gingiva has moved toward incisor/occlusal without deeper perio structures becoming involved - tooth wall is enamel

Question 25

What is probing depth vs attachment loss?

Answer 25

- probing depth is distance between the base of the pocket and gingival margin - attachment loss is distance between base of pocket and the CEJ

Question 26

When the gingival margin is located on the anatomic crown...

Answer 26

it coincides with the CEJ but usually located apically to the CEJ

Question 27

In presence of gingival recession, how is the clinical attachment level measured?

Answer 27

- directly from CEJ to attached tissue

Question 28

When gingival margin covers the CEJ, how is clinical attachment level measured?

Answer 28

- first CEJ is located and then distance to CEJ is measured and subtracted from probing depth

Question 29

When does the clinical attachment level equal the probing depth?

Answer 29

when gingival margin is at level of CEJ

Question 30

What is Miller's classification of gingival recession 1?

Answer 30

midfacial/midlingual recession that is not extended to mucogingival junction

Question 31

What is Miller's classification of gingival recession 2?

Answer 31

midfacial/midlingual recession that has extended to mucogingival junction

Question 32

What is Miller's classification of gingival recession 3?

Answer 32

midfacial/midlingual recession that has extended to mucogingival junction with interproximal bone loss

Question 33

What is Miller's classification of gingival recession 4?

Answer 33

midfacial/midlingual recession that has extended to mucogingival junction with severe interproximal bone loss

Question 34

What is disclosing solution used for?

Answer 34

plaque - good indicator

Question 35

What are the stages of mobility in teeth movement?

Answer 35

- grade 1: buccal/lingually <1 mm - grade 2: buccal/lingually >1mm - grade 3: depressible (incisal/apical or corona/apical)

Question 36

What is fremitus?

Answer 36

- functional mobility - can be felt before signs of mobility - due to parafunctional habits or bone loss

Question 36

How is fremitus checked?

Answer 36

- index finger on labial surface of tooth/teeth and patient is asked to grind/tap/protrude - any movements felt= fremitus

Question 37

What is the Naber's probe?

Answer 37

- furcation probe - used to detect furcation area - curved and blunt - non calibrated or calibrated

Question 38

What are the 4 classifications of furcation involvements?

Answer 38

- grade 1: incipient, depression that just catches the probe - grade 2: partial penetration of probe, cul-de-sac - grade 3: interradicular bone is completely absent, probing through and through - grade 4: gingiva recessed so furcation is clinically visible