Week 17 Ch 19/20: Clinical Periodontal Assessment

clinical periodontal assessment

used to gather information to diagnose conditions and develop individualized treatment plan; fact-gathering process

periodontal screening examination, comprehensive periodontal assessment

what are 2 types of periodontal assessment?

marquis probe

calibrated with colour code bands to indicate 3, 6, 9, 12mm levels of penetration

williams probe

calibrated with colour code bands to indicate 3, 5, 7, 10mm increments

marquis probe - michigan “o” with williams

markings at 1, 2, 3, 5, 7, 8, 9, 10mm (4/6 are missing); 3, 6, 8mm

horizontal tooth mobility

facial to lingual movement; apply light, alternating pressure in facial-lingual direction using blunt ends of two instrument handles; compare against stationary adjacent tooth

vertical tooth mobility

ability to depress tooth in socket; assess using blunt end of instrument handle to exert pressure against occlusal or incisal surface; many scales available for recording tooth mobility

class 1

slight mobility that is visually discernible; up to 1mm of horizontal displacement in a facial-lingual direction

class 2

moderate mobility that is visually discernible; greater than 1mm but less than 2mm of horizontal displacement in a facial-lingual direction

class 3

severe mobility that is visually discernible; greater than 2mm of displacement in a facial-lingual direction or vertical displacement (tooth depressible in the socket)

fremitus

palpable or visible movement of tooth when in function; assess by gently placing gloved index finger against facial aspect of tooth as patient either taps teeth together or simulates chewing movements; easy to detect with gentle finger pressure

keratinized gingiva

composed of free gingiva and attached gingiva

attached gingiva firm and dense

tightly connected to cementum or periosteum; lies between free gingiva and alveolar mucosa

attached gingiva

part of gingiva that is firm, dense and tightly connected to the cementum on the cervical-third of the root or to the periosteum of the alveolar bone; keeps free gingiva from being pulled away from tooth

more than 2mm

what is adequate WAG?

less than 2mm

what is inadequate WAG?

wkg-pd = wag

how to calculate wag?

probing depths

measured from the gingival margin to the base of the sulcus or periodontal pocket

CAL

measured from a fixed point - usually CEJ to the base of the sulcus or periodontal pocket

periodontal screening and recording (psr)

rapid, inexpensive screening process; helps separate patients into three broad categories - periodontal health, gingivitis or periodontitis

techniques for psr

one code per sextant - recorded 0-4 on most advanced area; WHO probe

code 0

marker is completely visible; no calculus; no bleeding

code 1

marker is completely visible; no calculus; bleeding

code 2

marker is completely visible; calculus; defective margins

code 3

marker is partially visible

code 4

marker is not visible

2 code 3s, 1 code 4, any code with *

what is indicated for complete periodontal assessment when doing psr?

asterisk symbol

indicates furcation, mobility, mucogingival problems, recession

supplemental diagnostic tests

used for patients with refractory forms of periodontitis; 3 general types - test related to bacteria, tests that analyze gingival crevicular fluid content, tests for genetic susceptibility to periodontal disease; no gold standard, should not be routinely ordered