Chapter 16 - Periodontal assessment
Periodontal screening - quick examination of a patient's periodontal health. Check for tooth loss, migration, and mobility and recession, redness, suppuration and swellings
Periodontal assessment - Provides the baseline for the long term monitoring of periodontal disease activity
In the clinic it includes description of the gingiva and perio probing
Monitoring - often performed a few times a year - necessary to maintain periodontal health. It is important to document everything that can be measured because that will make it easier to evaluate changes in periodontal tissues
Outcome measure - used to evaluate the success of periodontal procedure - like placing arrestin and checking some time later to evaluate probing and attachment
Severity - total destruction and healing that occur during the lifetime of a tooth - how much bone loss and attachment loss has occured
disease activity - current or ongoing loss of soft-tissue attachment (destruction of the gingival fibers and apical migration of the JE with bone loss)
Usually occurs in periods of active destruction and periods of inactivity
Periodontal Terminology
The most common method for measuring the gingival crevice is perio probing. This tool is used to estimate clinical attachment level and the total support for the tooth
Clinically, the probing depth is defined as the distance from the gingival margin to the most apical extent of the probe. usually between 0.5 and 2mm.
Probing can help evaluate disease activity and aid the clinician in determining severity and extent of attachment loss
Level of Attachment
The CEJ is a stable reference point that does not move over time which makes it a good reference point for assessing recession
Other uses of probes
can establish bleeding, amount of recession, width/consistency of the gingiva
PSR - quick system for detecting and monitoring; requires use of a specific probe and assigns sextants codes 0-4. a code of 3 or 4 indicates a more comprehensive periodontal exam due to the possible presence of disease
Examination techniques
There are 6 probing depths that need to be recorded per tooth. Most common errors occur in the interporximal sites where the probe needs to be angled so that the tip reaches the col area
Bleeding sites also need to be annotated in the chart
Clinical attachment level also has to be calculated and noted int he patients chart. It is determined by adding the gingival recession to the probing depth. In the case of inflammation, the amount of inflammation is subtracted from the probing depth
Gingival position
In health, the margin is 0.5-2mm above the CEJ. anything higher indicates a pocket. A pocket can be localized to one or two teeth or generalized across a sextant. Inflammation and overgrowth of the gingiva will add to the probe reading and should be evaluated further to determine true attachment level and pocket depth
To measure recession, use the probe to measure from the gingiva to the CEJ
Recession can be due to tissue trauma, orthodontic movement, other dental procedures, or destructive periodontal disease.
It is important to determine the cause of the recession in order to carry out th best treatment
If the gingiva is recessed past the CEJ, it will lead to exposed root surfaces. Root surfaces that are exposed are more prone to caries and sensitivity. Critical pH for root surfaces is 6.7 -
Mucogingival examination - recording the free gingival margin on the chart will identify the presence or absence of gingival recession or overgrowth
Determine the width and height of keratinized gingiva
The width iof the keratinized gingiva s the distance from the gingival margin to the mucogingival junction
The width of the attached gingiva is subtracting the probing depth from the amount of keratinized gingiva
Mucogingival involvement exists when no attached gingiva is present on a tooth
Suppuration - purulent or pus; clinical feature of inflammation
Tooth mobility
Physiologic - limited to the width of the periodontal ligament space - natural small movement of tooth in the pocket
Pathologic mobility - Results from bone loss, gingival inflammation, periapical pathology, normonal imbalance, or occlusal trauma
Measurement - use the handles of two instruments onto the teeth and applying force to assess movement
Fremitus - vibrational movement of a tooth under occlusal forces
Pathologic tooth migration - teeth moving over time; increased spacing between teeth, dramatic overjet, rotation, etc.
Furcation involvement - occurs when interradicular bone destruction occurs
Measured as horizontal or vertical; Grades I, II, II, IV
tooth aachment is an important aspect to measure because it is a big indicator of periodontal support and a large part of what a dental hygienist's job. Monitoring fo the attachment level can help determine treatment options to avoid further attachment loss and possible loss of the tooth