DH114 Exam 3

What gingival characteristics do you assess?

1. Color

2. Size

3. Position of margin

4. Shape of margins and papillae

5. Texture and consistency

6. Bleeding or exudate

What does healthy tissue look like?

Color: Coral pink/pigmented

Margin: 1 to 2 mm coronal to CEJ

Size: Tissue fits snugly.

Texture: Normal, stippled

Consistency: Firm, resilient tissue

Shape: Tapers to meet tooth at a fine edge, papillae fill the embrasure space

No bleeding/exudate

What changes indicate disease?

Color - bright red, bluish purple, white, or pale pink

Size - may be enlarged

Margin - more than 2 mm coronal to CEJ (swelling) or apical to CEJ (recession)

Shape - rolled, thickened marginTexture: smooth, shiny, not stippled, fibrotic, nodular Consistency: soft, spongy, leatheryPapilla - may be rolled, blunted, bulbous, missing Bleeding/exudate may be present

Periodontal Attachment System

A group of structures that work together to attach the teeth to the skull

Junctional Epithelium

Attaches the gingiva to the tooth

Fibers of the Gingiva

Network of fibers that brace the free gingiva against the tooth

Periodontal Ligament Fibers

Surround the root; one end attaches to the alveolar bone, the other to the cementum of the root

Loss of Attachment

Damage to the structures that support the tooth

How does damage with loss of attachment occur?

1. Relocation of the junctional epithelium

2. Destruction of gingival fibers

3. Destruction of periodontal ligament

4. Loss of alveolar bone support

Gingivitis

Results in reversible damage to the gingiva. There is NO damage to the periodontal ligament or alveolar bone

Periodontitis

Damage to gingival connective tissue, periodontal ligament, and alveolar bone

Why are probing depths not enough information?

In determining how healthy a tooth is, you must know how much bone support it has.

Clinical Periodontal Assessment

Fact-gathering process designed to provide a comprehensive picture of the patient's periodontal health status

Soft Tissue Lesion

An area of abnormal appearing skin or mucosa that does not resemble the soft tissue surrounding it

Recession

When the gingival margin is apical to the CEJ

True or False? Recession=Bone Loss

TRUE

How do you measure recession?

Measure the distance from the gingival margin to the CEJ

Clinical Attachment Level

Estimated position of the structures that support the tooth as measured with a periodontal probe

What is the periodontal attachment system?

1. Junctional epithelium

2. Gingival fibers

3. Periodontal ligament fibers

4. Alveolar bone

What is used to calculate the clinical attachment level?

Gingival margin and probing depths

Horizontal Mobility

Ability to move the tooth in a facial to lingual direction

How do you assess horizontal mobility?

Using the ends of two handles, gently apply alternating pressure against the tooth, first from the facial and then from the lingual aspect

Vertical Mobility

Ability to depress the tooth in its socket

How do you assess vertical mobility?

Use the end of an instrument to exert gentle pressure against the occlusal surface or incisal edge of the tooth

Class 1 Mobility

Slight mobility, up to 1mm of horizontal displacement

Class 2 Mobility

Greater than 1mm but less than 2mm of horizontal displacement

Class 3 Mobility

Greater than 2mm of horizontal displacement OR vertical mobility

Furcation Involvement

Loss of alveolar bone and periodontal ligament fibers in the space between the roots of a multi-rooted tooth

Furcation Probe

Type of periodontal probe used to evaluate the bone support in the furcation areas of multi-rooted teeth

Class 1 Furcation Involvement

Concavity can be felt with the probe but it cannot enter the furcation

Class 2 Furcation Involvement

Probe tip can partially enter the furcation and extend about 1/3 of the tooth

Class 3 Furcation Involvement

Probe passes completely through furcation on mandibular molars and touches the lingual root on maxillary molars

Class 4 Furcation Involvement

Same as class 3 except the furcation is visible clinically due to tissue recession

Furcation Symbols

Class 1: Incomplete triangle

Class 2: Hollow triangle

Class 3: Filled in triangle

Class 4: Diamond

Necrotizing Ulcerative Gingivitis (NUG)

Acute infection of the gingiva characterized by gingival necrosis, bleeding and pain Presents with interdental necrosis, "punched out" ulcerated papillae, gingival bleeding and pain

Who does NUG typically effect?

Young adults (18-30)

Stressed out college students

What are predisposing factors to NUG?

1. Psychological stress and anxiety

2. Smoking

3. Pre-existing gingivitis and trauma

4. Poor oral hygiene

5. Deficient nutrition

6. HIV-positive

Linear Gingival Erythema (LGE)

Periodontal disorder limited to the soft tissue of the periodontium, appearing as a red line 2-3 mm in width adjacent to the free gingival margin, not significantly associated with increased levels of dental plaque

Peri-Implantitis

Destructive inflammatory process affecting the soft and hard tissues surrounding dental implants

Refractory Progressive Periodontitis and Juvenile Periodontitis

Several unclassified types of Rapid bone and attachment loss or slow but continuous bone and attachment loss

Gum Disease Risk Factors

Age (over 70% of 65 year old havePerio)

Smoking/Tobacco

Genetics

Stress

Medications

Systemic diseases (Cardiovascular disease, Diabetes,Rheumatoid arthritis)

Poor nutrition/obesity