classfication of periodontal examination charting
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Dr. Wesam Azar
JUST
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WHY ??
*Frameworks to study the etiology and
pathogenesis
*Help establish diagnosis, determine prognosis,
and facilitate treatment planning
*Way of communicating in a common language
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Signs and symptoms are confined to the gingiva
No attachment loss or on a periodontium withattachment loss that is not progressing
The presence of dental plaque to initiate and /orexacerbate the severity of lesion
Reversibility of the disease by removing theetiology(ies)
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Gingival Diseases
Extent :
Localized gingivitis:
Generalized gingivitis:
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Gingival Diseases
Distribution:
Marginal gingivitis:
Diffuse gingivitis:
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Gingival Diseases
Severity
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Chronic Periodontitis
Definition:
An infectious disease resulting in inflammation
within the supporting tissues of the teeth,progressive attachment and bone loss.
Replaces the older term adult periodontitisor chronic adult periodontitis
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Chronic Periodontitis
Distribution & Severity:
*Extent* Localized 30% of sites affected
*Severity:*Mild: 1-2 mm CAL*Moderate: 3-4 mm CAL
* Severe: 5 mm CAL
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Chronic Periodontitis
How to write the diagnosis statement:
Extent + Severity + Chronic Periodontitis
*Localized mild/moderate/sever chronic periodontitis
*Generalized mild/moderate/sever chronic periodontitis
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Chronic Periodontitis
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Aggressive Periodontitis
Definition:
A specific type of periodontitis with clearly
identifiable clinical and laboratory findings
that make it sufficiently different from
Chronic Periodontitis
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Aggressive Periodontitis
Generalized AggressiveLocalized Aggressive
Attachment loss on at least two
permanent teeth, one of which
is a first molar and involving no
more than two teeth other than
first molars and incisors
Generalized proximalattachment loss affecting at
least three teeth other than first
molars and incisors
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Localized Aggressive Periodontitis
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Generalized Aggressive Periodontitis
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Pink, firm gingiva, with a knife edge gingival
margin, no signs of redness or edema.
Intact periodontal ligament with no attachment
loss.
Cementum covering the root surface with
inserting sharpeys fibers.
No alveolar bone loss with the level of alveolarbone crest 0.75-1.49mm below the cemento-enamel
junction.
Characteristics of a healthy periodontium
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Periodontal Screening Examination
Demographic information: Name, Date of Birth, Gender,
Occupation ..
C/C
History Medical history
Dental History
Family History
Smoking
Oral hygiene measures
Examination
Visual vs. Instrumentation
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Inspection, palpation
Face and Lips.
Muscles of Mastication.
Lymph Nodes.
Extra Oral Examination
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Examination of lining mucosa
Examination of the teeth:- Caries, restorations, crowns and bridges.
- Overhanging restorations, open contacts.
- Plaque and calculus.
- Staining.
- Assessment of occlusion.
Intra-Oral Examination
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Comprehensive Periodontal ssessmentIntensive clinical periodontal evaluation used to gather
information about the periodontium.
Oral Hygiene
Gingival Inflammation Probing Depth
Attachment level
Bleeding on Probing Presence of Exudate
Level of the free gingival
Margin
Mucogingival Junction
Tooth Mobility Furcation Involvement
Occlusion
Radiographic evidence ofAlveolar Bone Loss
Presence of Local
Contributing Factors
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Plaque indexSilness and Le (1964).
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Gingival Inflammation
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Score Description
0 Normal gingival, no inflammation, no discoloration, no bleeding
1 Mild inflammation, slight color change, mild alteration of gingival surface, no
bleeding
2 Moderate inflammation, erythema, swelling, bleeding on probing
3 Severe inflammation, severe erythema and swelling, tendency toward
spontaneous Hemorrhage, some ulceration
Gingival index (Le and Silness1964).
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Bleeding on Probing
Insertion of probe to the bottom
of pocket elicits bleeding in
inflamed gingiva
Noninflamed sited rarely bleed
Absence of bleeding an excellent
predictor of periodontal stability
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Probing Depth
Distance between the free gingival margin and thebase of the gingival crevice/pocket.
http://upload.wikimedia.org/wikipedia/commons/d/d3/Periodontalprobes09-09-2005.jpg -
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Six-point charting
Record readings greater then 3mm except when recession
is present (record all readings)
Probing Depth
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Probing Depth
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Apical migration of the gingival margin.
Measured as the distance between CEJ and GM
Gingival Recession
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Gingival Recession
(Miller Classification 1985)
No loss of Interdental papillaNot extend to the MGJ
No loss of Interdental papillaextend to the MGJ
loss of Interdental papilla
extend to the MGJ
loss of bone & soft tissue around the
entire tooth with open interdentalarea
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Is expressed as the distance from the cemento-enamel
junction to the bottom of the pocket.
Attachment Level
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Attachment Level
CAL = PD CAL = PDOvergrowth CAL = PD + Recession
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Width of Attached Gingiva
Attached gingiva (AG) = Keratinizedgingiva(KG)free gingiva (PD)
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Width of Attached Gingiva
Keratinized gingiva less than 3 mm put *
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Movement of tooth in a facial to lingual direction
Tooth Mobility
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Tooth Mobility
Miller Index
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Extension of bone loss between
roots of teeth
broad term bifurcation of the mandibular
molars or maxillary premolars
trifurcation of the maxillary molars
The extent of involvement is
determined by exploration with a
curved probe (Naber's probe).
Furcation Involvement
http://upload.wikimedia.org/wikipedia/commons/d/d3/Periodontalprobes09-09-2005.jpg -
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Furcation Involvement
The site and extent must be recorded
Degree 1: probe enters the furcation up to 1/3 the width of thetooth
Degree 2: probe enters the furcation > than 1/3 but not the total
width of the tooth
Degree 3: a horizontal through and through destruction
Hamp et al 975
Furcation Involvement
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Furcation Involvement
Class IClass II
Class III Class IV
Glickman classification
Guidelines for completing the
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Write your name on top of sheet.
Start with PI and GI. If an indexed tooth is missing either choose an adjacent
one or the opposite side of same arch.
PD at deepest site, PD > 3mm , except when recession or if KG < 3mm.
Use color code. For BOP, place a red dot at bleeding site where PD is documented.
For recession, draw it with a red line
Calculate the CAL
Mobility value (I-III) is printed on occlusal surfaces of mobile teeth.
For furcation involvement use a red pencil and the following codes: Grade I:
Grade II:
Grade III and IV:
KG < 3 mm: draw an at root involved (Facial usually).
Guidelines for completing thePeriodontal Worksheet
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III II I
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ReferenceClinical Periodontology
Michael G Newman, Henri H. Takei, Fermin A. Carranza; Saunders WB.
Saunders
2006
10th edition
Ch 7, 35
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Periodontal
ScreenRisk Assessment
Screen
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