4

For a periodontal exam, we will start by doing an _____ and _____ oral exam

intra and extra

why do we do an intra and extra oral exam

to detect non-periodontal oral diseases or conditions

Next, we want to do an examination of the ____ and dental _____ to evaluate the topography of the ____ and related structures

teeth

implants

gingiva

• this is when we would measure probing depths, the width of keratinized tissue, gingival recession, and attachment level. To evaluate the health of the subgingival area with measures such as bleeding on probing and suppuration; to assess clinical furcation status; and to detect endodontic–periodontal lesions.

Next, we want to do an assessment of the presence, degree, and/or distribution of _____, _____, and ____ inflammation

plaque

calculus

gingival

We will want to conduct a ____ examination including caries assessment, proximal contact relationships, the status of dental restorations and prosthetic appliances, and other tooth- or implant-related problems.

dental

We will want to do an ____ examination that includes, but may not be limited to, determining the degree of _____ of teeth and dental implants, _____ patterns and discrepancy, and determination of fremitus.

occlusal

mobility

occlusal

We also want interpretation of current and comprehensive diagnostic-quality ____ to visualize each tooth and/or implant in its entirety and assess the quality/quantity of ____ and establish bone loss patterns.

radiograph

bone

• will start with a CMS or pano (CMS more accurate)

we will evaluate for potential ____-_____ interrelationships

periodontal-systemic

we will assess for the need of and suitability of dental ____ or other tooth replacement options

implants

We will have determination and assessment of patient _____ _____ such as age, diabetes, smoking, cardiovascular disease, and other systemic conditions associated with the development or progression of periodontal disease.

risk factors

what is an important consideration of cardiovascular problems we want to address on the medical history?

hypertension

what is an important consideration of endocrine problems we want to address on the medical history?

diabetes

what is an important consideration of hematology problems we want to address on the medical history?

coagulation disorders

what is an important consideration of musculo-skeletal problems we want to address on the medical history?

joint replacement

what is an important consideration of social habits we want to address on the medical history?

tobacco use

why do we do intra and extra oral examinations

to identify non-periodontal lesions

when do we do intra and extraoral examinations

after going over the medical history and making sure it is clear to proceed

how do we do an intra oral or extra oral exam

observing (looking)

palpating (touching)

interrogating (asking)

***look for asymmetries***

what is the sequence of an intra and extral oral exam

neck, parotid gland, base of the mandible, face, lips, cheeks, palate, tonsils, tongue, then gingival tissues

slight bone loss

<15% BL

moderate bone loss

15-33% BL

severe bone loss

>33% BL

CMS is done at ____ and every ___ years

baseline

5

for a periodontal exam, we do 4 vertical BW at ___ to ___ month intervals

18-24

mainly for preventive reasons to rule out PD disease

dental implants get xrays every ___ months

12

the marquid PD probe measures in __mm increments

3

what is the equation for CAL

CAL = PD (probe depth) + REC(recession)

any part of the root is available for _____, so if you are seeing the root this means there is ____

attachment

CAL

does suppuration automatically indicate periodontitis

no

______ is a very good predictor of how severe PD disease is

mobility

Class I mobility

slightly mobile, up to 1mm horizontal

Class II mobility

moderate mobility, >1mm horizontal

Class III mobility

severe mobility, >1mm horizontal and vertical

Class I furcation involvement

horizontal loss of PD tissue <= 3mmC

Class II furcation involvement

horizontal loss of periodontal tissue support > 3 mm, but not through and through defect

Class III furcation involvement

through and through defect

If there is class II furcation involvement on more than one surface, it is probably class ___

III

_____ indices may be recorded mainly to track changes and is done prior to probing

plaque

important for patient education

calculus detection is ____ and ____

visual and tactile

____ can be used and is mainly for patient eduction and done after completing the exam

disclosing

calc is detected using the

11/12 explorere

when examining the gingiva, we want to assess the presence of ______ and make a description of ____ features

inflammation

gingival

contour (knife vs bulbous), color, texture (firm vs shiny)

with a ____ tissue phenotype we are more likely to see recession

thin

when doing a transmucosal probing (through the gums to the tooth) a thick phenotype measures ____ mm

>2

when doing a transmucosal probing (through the gums to the tooth) a medium phenotype is _____ mm

1.5-2

when doing a transmucosal probing (through the gums to the tooth) a thin phenotype is ___mm

<1.5

we will also want to determine the width of the band of _____ ____

keratinized tissue

calculate the amount of attached gingiva and subtract PD

why do we need to measure the width of the band of keratinized tissue

to identify mucogingival defects

additional diagnostic tests may need to be done when…

- Periodontal disease that did not respond to initial therapy

- “Aggressive periodontitis”

- Medically compromised patients

- Advanced / Complex case

- Research purposes

what kind of additional tests can we do

- Bacterial cultures

- Gingival crevicular fluid (GCF) or Saliva molecular assays

- Imaging techniques: Cone-beam compute tomography (CBCT), MRI

- Laboratory tests: Neutrophil function, Erythrocyte count, HbA1c (for Diabetic patients)

when we see tooth wear, this can be related to what

parafunctional habits (bruxism)

eating disorders (bulimia, etc)

other (acid diet, chewing pen, etc)