Perio Exam and Assessment
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39 terms
Terms | Definitions |
|---|---|
 Perio Assessment: Assessing for... | The presence or absence of disease Amount of biofilm present Gingival description Calculus deposits Probing depths Bleeding upon probing Presence of recession Width of attached gingiva Clinical attachment loss/level Presence of mobility Furcation involvement |
| Other Factors affecting perio health | Poor restorative margins Malposed and crowded teeth Missing teeth Oral habits Systemic factors |
| Components of the Perio Assessment | Missing teeth, malposed teeth Recession Pocket depths and bleeding points Furcation involvement Attrition Mobility CAL (clinical attachment level) Width of attached gingiva (WAG) |
| How are missing teeth recorded on chart? | With a large X through all aspects of the tooth |
| How are malposed teeth recorded on the chart? | With an arrow showing the direction of the rotation or a note explaining which teeth are crowded and the severity |
| Some reasons to have current radiographs? | to check for missing teeth, retained root tips, impacted teeth, retained deciduous teeth, supernumerary teeth |
| How are pocke depths charted? | In black ink |
| How are bleeding points charted? | As red dots next to the pocket depth number in the box |
| How is recession charted? | As a red line across the root surface with the number of millimeters of recession to the right of the red line (dont have to write mm, just #) |
| How is attrition charted? | by drawing two horizontal red lines across the incisal edges of the anterior teeth and wear facets on post. teeth are documented in the comment area |
| What is horizontal mobility? | the ability to move the tooth in a facial-lingual direction in its socket |
| What is vertical mobility? | ability to depress the tooth in its socket |
| Mobility Classifications (1-3) | Class 1: Slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction Class 2: Moderate mobility, greater than 1 mm of horizontal displacement in a facial-lingual direction Class 3 :Severe mobility, greater than 1 mm of displacement in a facial-lingual direction combined with vertical displacement (tooth depressible in the socket) |
| How do you determine the total width of attached gingiva? | By measuring from the gingival margin to the mucogingival junction on the buccal/facial aspect of the tooth. You then measure the pocket depth on the straight buccal. Subtract the probing depth from the total width to get the width of attached gingiva. |
| Adequate width of attached gingiva is... | considered 2 mm or more of attached gingiva |
| Minimal width of attached gingiva is... | anything less than 2mm (indicated by a red, zig-zag line on the root of the tooth) |
| Clinical Attachement Level (CAL) | Refers to the estimated position of the structures that support the tooth as measured with a periodontal probe. The CAL provides an estimate of a tooth's stability and the loss of bone support. Can be used synonymously with clinical attachment loss or the extent of periodontal support that has been destroyed around a tooth. |
| How to calculate the CAL | Calculated from the CEJ (which is a fixed point that doesn't change) Because the bone level in health is approximately 2mm apical to the CEJ, the CAL provides a reliable indication of the extent of bone support for a tooth. |
| CAL with recession | calculate by adding the probing depth to the gingival margin level |
| CAL without recession | When the gingival margin is at the CEJ, no calculations are needed because the probing depth and the clinical attachment level are equal |
| CAL with gingival margin covering the CEJ | Subtract the gingival margin level from the probing depth when the gingival margin is coronal to the CEJ |
| Perio Charting Sequence | Determined by the system your office is using Computer assisted charting sequence may be different from manual charting -Some computer systems are voice activated -Some systems allow you to change the sequence -Some systems have left and right-handed sequences |
| Class I Furcation | Furcation can be felt with probe tip, however the probe cannot enter the furcation area, symbol ^ (upside down V)-green |
| Class II Furcation | The probe can partially enter the furcation, extending approx 1/3 of the width of the tooth but cannot pass completely through, symbol empty triangle-green |
| Class III Furcation | Man. Molars= the probe passes completely through furcation netween mesial and distal roots Max Molars= probe passes between the mesiobuccal and distobuccal roots and touches the palatal root, symbol colored in triangle-green |
| Class IV Furcation | Same as class III involvement except the entrance to furcation can be clinically seen due to tissue recession, symbol colored in diamond-green |
| Charting other localized factors | Most other local factors should be written up in "comments" area on the perio charting sheet such as: -Food impaction written in comments area with tooth numbers and Hx information from the patient -If the food impaction involves an open contact, you can chart the area with two small vertical lines between the teeth involved -Overhanging margins will be covered in the Dental Charting lecture -Clenching/grinding habit written in comments area with Hx |
| Reasons for Classifying health and disease? | -To establish baseline data -System sets a standard for recording the extent and severity of inflammation and destruction of supporting perio structures -Data to create plan for DH therapy -Data for Comparison at maintenance visits |
| What questions can you answer for Data for comparison at maintenance visits? | Has therapy been successful? Is the patient's home care effort successful? What else can be done to promote optimum health in a compromised situation? Additional DH therapy? Other oral hygiene aids? Referral to a periodontist for surgery? |
| 3 major categories of AAP classification? | Gingivitis and Periodontitis |
| AAP class system takes into consideration what factors when id perio diseases? | Age of onset Clinical appearance Rate of disease progression Pathogenic microbial flora Systemic influences |
| ADA Classification | Developed by the American Dental Association Primarily based on the severity of attachment loss. Clinician uses the clinical and radiographic data gathered and classifies the patient into one of the four Case Types. These Case Types are commonly required for insurance billing. Also provide guidelines for treatment recommendations. |
| Classification of Case Types | Case Type 0—Healthy gingiva Case Type I—Gingival Disease Case Type II—Early Periodontitis Case Type III—Moderate Periodontitis Case Type IV—Advanced Periodontitis Case Type V—Refractory Periodontitis |
| Case Type 0 | Generalized healthy gingiva May have isolated areas of BOP (bleeding upon probing) No bone loss 1-3 mm pocket depth with isolated 4 mm. |
| Case Type 1-Gingivitis | Generally inflamed as characterized by slight to moderate changes in color, contour, and consistency Radiographic findings: No evidence of bone loss, Crestal lamina dura is present, Alveolar bone level is within 1-2 mm of the CEJ area Bleeding may or may not be present Pocket depths 2-4 mm Pseudopockets may be present from 3-6 mm |
| Case II- Early Periodontitis | Generalized slight to moderate inflammation characterized by changes in color, contour, and consistency progressing into deeper periodontal structures. Bone loss evident from localized areas of recession Pocket depths 3-5 mm Possible Class I furcation invasion areas Radiographic findings: Horizontal type bone loss, most commonly, Slight loss of interdental septum,Alveolar bone level is 3-4 mm from CEJ area |
| Class III- Moderate Periodontitis | Advanced stages of inflammation characterized by increased destruction of periodontal structures and generalized bleeding upon probing. Pocket depths from 4-6 mm Class I and II furcation involvement may be evident with mobility Radiographic findings: Horizontal or vertical bone loss may be present, Alveolar bone level is 4-6 mm from CEJ area, Class I and II furcations,Loss of 1/3 of supporting alveolar bone |
| Class IV- Advanced Periodontitis | Further progression of inflammation with major loss of alveolar bone support. Bleeding upon probing and pocket depths 4-7+ mm Radiographic findings: Horizontal and vertical bone loss, Alveolar bone level is 6 mm or more from CEJ area, Radiographic furcations evident, Loss of over 1/3 of supporting alveolar bone |
| Class V-Refractory Periodontitis | Condition that describes continued attachment loss in spite of "well-executed" periodontal therapy and proper oral hygiene. Other factors may include: Extent of disease prior to therapy, Type of therapy provided (surgical vs. non-surgical), Tooth type and furcation involvement, Species and strains of microflora, Degree of host response |
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