Preclin perio manual, exam 1 + perio chart distances

Infection control PPE

clinical gown, protective eyewear, mask, gloves

Clinical gown is not to be worn…

outside clinic patient areas, in restrooms, food service areas, non-patient floors, elevators

Mask

Change between patients or when visibly moist.

Do not wear under the chin, outside treatment operatory

Do not move mask with soiled gloves.

N95 masks need to be tested for their fit

Gloves

wash hands before putting on/after removal

don’t wear outside operatory

change when damaged

cover over cuff of gown and watch

never wash gloves

remove gloves whereby hands aren’t contaminated from outside of gloves

use new gloves for cleaning and disinfecting the operatory before/after pt tx

personal care, hair

med/long hair pinned back

cover facial hair with mask, no facial hair with N95

avoid touching with gloves

make sure hair cannot cause cross contamination

personal care, general hand care

Cover cracks/cuts

don’t injure hands during procedures

proper hand washing at beginning and end of each pt session

Percutaneous injury occurs and gloves are punctured: remove gloves → wash area with soap and water →follow exposure/ needle stick protocol

operatory protective equipment

disinfect operatory, cover all clinical contact areas with plastic barriers (headrest, handles, suction, air syringe, arm rests, light handles, chair buttons)

General reminders

plan ahead, avoid multiple trips outside tx area

analyze habits (keep hands away from mask, face, hair, clothing; touch only disinfected surfaces, don’t touch personal items with used gloves)

patient prep to minimize bacteria spread: provide pre-procedural mouth rinse, help pt develop habit of brushing before appt (provide OHI regimens and instruct pt)

What should we know how to do at the end of this series of clinical activities?

Applying proper ergonomic principles (positioning of pt and clinician posture)

Obtaining, reviewing, analyzing pt’s updated medical, social, dental history and entering into Salud

Performing extra-oral exam and entering into Salud

Performing comprehensive oral cancer screening by performing intra and extra oral conventional visual + tactile exam

Performing and recording components of intraoral and perio exam + entering into Salud

Analyzing radiographic findings and discussing important correlations with respective clinical findings

Successfully completing intra/extra oral exam on a classmate and discussing clinical findings in a professional manner

Demonstrate proper infection control standards when setting up and breaking down chair for each pt

What is specifically examined in the extra-oral exam

TMJ eval, muscle palpation, lymph node palpation, facial asymmetry

What is specifically examined in the intraoral+perio exam

probing depths, CAL, BOP, masticatory mucosa/attached gingiva, recession, mobility (miller’s classification), fremitus, furcation involvement (hamp’s/glickman’s classification), plaque index, gingiva exam (color, size, shape, consistency, texture), identification of calculus, evaluating pt’s oral hygiene

What structures are examined in the oral cancer screening

face, lips, upper/lower labial mucosa, buccal vestibule, gingiva, tongue dorsum, left and right margin of tongue, ventral tongue, floor of mouth, hard palate, oropharynx

how should periodontal instruments be held and positioned?

In a modified pen grasp

Establish a secure intraoral finger rest

Properly position the probe both interproximally and on buccal and lingual/palatal aspects of teeth

What should we be comfortable entering into the “periodontal exam” tab in salud

After demonstrating proper probing technique using a perio probe with William’s marking, enter PD, CAL, recession, masticatory mucosa, etc. into the pt’s chart

How should you position the probe while probing?

keep well adapted to tooth surface, use explorer throughout the entire dentition on all surfaces of teeth

What should you be able to differentiate while probing?

Differentiate how the explorer feels on enamel, cementum/dentin, calculus, restorative margins

Clinical appearance of supragingival calculus (white creamy- yellow) vs. subgingival (dark brown/black/green)

What is the explorer we use, what is it for?

ODU 11/12 explorer to identify intraoral calculus deposits, and use compressed air where possible

PD vs CAL

Salud calculates CAL based on data entered, but actual CAL is calculated knowing the CEJ position → local probing depths

Mouth mirror

ancillary instrument used to view patient’s oral cavity

we use double-sided mirrors, helpful in retraction and indirect vision on opposite side of the mirror

used with a light, modified-pen grasp grip for indirect vision, retraction, indirect illumination and trans-illumination

William’s-markings periodontal probe

current standard for periodontal assessment, stainless steel probe with an angle of 130 degrees between the handle and probe tip

Presently there are various probes available varying in their markings, color coding, diameter, geometry, working angle, etc.

List the specific williams probe markings, diameter, and total length. Which markings are missing and why?

Diameter= 1mm

Total length of 13mm with a blunt tip end

Markings are at 1mm, 2mm, 3mm, 5mm, 7mm, 8mm, 9mm and 10mm

4mm and 6mm readings are missing to improve visibility and reading

Rationale for probing

detect + measure loss or gain of attachment levels → determine extent of previous or ongoing periodontal disease activity

assess the efficacy of treatment done

used to accurately locate, assess, and measure the sulcus, and pocket depths.

How should the William’s probe be moved around each tooth, and the col space specifically

“walked” circumferentially around each surface of each tooth

If you don’t tip the probe into the col space, accurate measurement of this area is impossible

Naber’s probe

curved probe used for detecting horizontal furcation involvement on multi-rooted teeth

curved working blunt tip, double ended

non-calibrated and calibrated versions of the probe with markings at 3, 6, 9, 12 mm

ODU 11/12 explorer

detects calculus efficiently

circular cross section, explores proximal areas and deep periodontal pockets

shank design allows of assessment of root surfaces of anterior + posterior teeth, and deep + shallow pockets

double ended, two ends are mirror images of each other

long flexible shank allows excellent subgingival adaptation in deep pockets

Probing depth

FGM → deepest point of sulcus/probing

CAL

CEJ → deepest point of sulcus/probing

Recession

CEJ → FGM

Masticatory mucosa

FGM → MGJ

Attached KT

Deepest point of sulcus/probing → MGJ