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Chapter 15 Clinical Examination Gingival Assessment (Assessment (Color:…
Chapter 15 Clinical Examination Gingival Assessment
THE PURPOSE OF PERFORMING A GINGIVAL ASSESSMENT IS TO EVALUATE THE CONDITION OF THE GINGIVAL TISSUES AND TO DETERMINE THE INFLAMMATORY AND NON INFLAMMATORY CHANGES, IT IS THE ESSENTIAL STEPS IN I.D. INFLAMMATORY PERIODONTAL DISEASES
Inflammation occurs in response to the presence of irritation to the tissue caused by dental plaque. inflammation is the host's response to the irritation which stimulates tissue repair
Gingival Overgrowth can be caused by hormones, drugs, systemic conditions. It can cover the tooth and is seen generalized throughout the mouth
Gingival Bleeding: This is the next step in gingival examination
BOP : occurs during probing and is documented in the perio chart as a red dot and it determines a deeper inflammatory involvement
Marginal bleeding indicated gingival inflammation and should be documented if bleeding is seen within 30 seconded of using a stoke method or wooden or plastic wedge
Some visually inflamed gingival sites do not bleed, like smokers may have deep pockets but they might not bleed. Aspirin use for 7 days or more can increase the appearance of bleeding on probing
Inflammation risk factors
Poor Home Care
Hormone changes puberty, menopause, pregnancy, controceptives
systemic diseases like diabetes mellitus, leukemia HIV
eruption of permanent dentition
drugs such as phenytoin, valproate, cyclosporine, calcium channel blocker
Assessment
Compare gingiva to adjacent areas
Signs : Redness(rubor), Swelling (tumor), and heat (calor). Pain (dolor) and loss of function (functio lasesa) may be seen in advance stages
Color: Healthy is a salmon pink
color is affected by vascularity, epithelial keratinization, the presence of melanin and thickness of epithelium
Red(erythema) or lightish white severe periodontal disease
it can also be deeper red or bluish red (cyanotic)
Color may look healthy superficial but disease can still be present with inflammation
Melanin can be found in people of certain racial background, or amalgam tattoos can change the tissue color too
Countour
Determined by the shape and position of teeth and the size and location of the contact area. it can be different when comparing posterior to anterior
Healthy contour of gingiva: Marginal gingiva= knifed edge with pymidal papilla shape
Unhealthy Contour= rolled margins and embrasure spacing with blunted interdental papilla
Consistency: can be determined when pressing lightly with a probe, it refers to the firmness of the connective tissue
Firm and resilient when pressed doesn't always = health
edematou= loss of collagen and vascular permeability resulting in fluid accumulation
Fibrotic = seen in smokers where the tissue is hard and nonresilient and is not compressible
Retractable = loss of collagen fibers which causes papilla and margins to be retractable
Texture: assessed by drying the tissue
Stippling can indicate both health or chronic inflammation
In the absence of stipping the gingiva is smooth or shiny both care found in healthy and unhealthy