AQ

Introduction to Periodontal Exam (Wilkins Chapter 20)

Learning Objectives

  • Describe components of a comprehensive periodontal examination

  • List instruments used for a periodontal examination

  • Explain technique for use of periodontal probe and explorers

  • Explain the purpose of maintaining an accurate, current periodontal assessment

  • Identify factors that the clinician should teach the patient regarding the periodontal assessment procedures

  • Given a scenario of patient assessment findings, the student should be able to accurately chart critical information

  • Accurately complete a periodontal summary statement for a given patient

Preparation and Charting

  • Before periodontal assessment, complete dental charting

  • Remove missing teeth and chart implants using XRAYS (USE XRAYS!)

Interpretation of Bone Loss and Disease

  • If a patient has bone loss, they have either had or have active periodontitis

  • Periodontitis = advanced form of gum disease that includes loss of bone, gum, and ligament

  • Loss of attachment = increased risk for tooth loss

  • You can assess tooth loss risk by examining radiographs closely: look for bone level changes, especially around multirooted teeth and furcations

The Periodontal Assessment: Scope

  • The periodontal assessment is comprehensive and includes multiple components and parameters

  • Aimed at forming an accurate, current periodontal status for diagnosis and treatment planning

Basic Instruments for Examination

  • Mouth mirror

  • Periodontal probe

  • Furcation probe

  • Subgingival explorer (e.g., ODU EXD11/12)

The Mouth Mirror: Purposes and Uses

  • Indirect vision

  • Indirect illumination

  • Transillumination

  • Retraction

  • Procedure to use: grasp and rest, retract as needed

  • Maintain clear vision during examination

Air-Water Syringe: Uses

  • Procedures to improve and facilitate examination

  • Improve visibility of the treatment area

  • Prepare teeth and/or gingiva for certain procedures

  • Precautions (keep area clean and dry as needed)

Explorers: General Purposes and Uses

  • Use tactile sense to detect texture and character of tooth surface

  • Define extent of needed instrumentation and guide technique

  • Evaluate for adequate calculus removal

Explorers: Basic Procedures

  • Use of sensory stimuli

  • Detect tooth surface irregularities

  • Three tactile sensations when probing/exploring:

    • Normal tooth surface

    • Irregularities created by elevations on the surface

    • Irregularities caused by depressions in the tooth surface

  • Types of stimuli: tactile, auditory

  • Reference for instrumentation concepts: Gehrig, J. S., Sroda, R., & Saccuzzo, D. (2025). Fundamentals of Periodontal Instrumentation and Advanced Root Instrumentation (9th ed.).

Subgingival Explorer: Procedures

  • Essentials for detection of tooth surface irregularities:

    • Light grasp

    • Consistent finger rest with light pressure

    • Keep only 1–2 mm of working end in contact with tooth

    • Use a “walking” stroke

    • Short, controlled strokes

Periodontal Probe: Types, Generations, and Uses

  • Types of probes

  • Four generations of manual periodontal probes

  • Purposes and uses

  • Description of manual periodontal probes (e.g., typical markings and grasp)

Manual Periodontal Probes (General)

  • Manual periodontal probes are used to measure pocket depth, assess attachment, and detect bleeding on probing

Guide to Periodontal Probing

  • Pocket characteristics and evaluation of tooth surface during probing

  • Calculus and other irregularities can be felt during probing

  • Factors affecting probe accuracy

  • Stage and extent of periodontal disease assessment

  • Placement problems with the probe can affect readings

Proximal Surface Probing

  • Approached from both facial and lingual aspects

  • Infections begin more frequently in the col area

  • Periodontal disease may have its deepest pockets directly under the contact area

Factors Affecting Probe Accuracy

  • Stage and extent of periodontal disease

  • The periodontal probe characteristics

  • Placement problems

  • (Reference: Gehrig, J. S., Sroda, R., & Saccuzzo, D. 2025)

Probing Procedure: Parameters of Care

  • Focus on accurate periodontal probing procedure

  • Considers depth measurements, probing technique, and recording of findings

Recording Periodontal Probing Readings

  • Typical readings are recorded as a sequence (A, B, C, D… or similarly labeled sites per tooth)

  • Instructions often show the order and placement of reading points across a sextant

Walking the Probe and Recording PD Depths

  • Use a walking stroke to record probing depths

  • Typical visual cues show a stepwise recording pattern

  • Example sequence of depths might be arranged in a grid per tooth (buccal, lingual, etc.)

Example: Periodontal Chart (Illustrative)

  • Periodontal chart includes:

    • Patient identifier and chart date

    • Probing depths (PD) per site

    • Clinical attachment level (CAL)

    • Bleeding on probing (BOP)

    • Plaque (plaque) and gingival margin (GM) readings

    • Mobility and furcation status

    • Implants (if present)

  • Example summary data:

    • Mean Probing Depth (PD): {Mean PD} = 3 { mm}

    • Mean Attachment Level (CAL): {Mean CAL} = -2.7 { mm}

    • Plaque: 48 { {%}}

    • Bleeding on Probing: 42 { {%}}

  • Chart entries are separated by tooth surface (Buccal, Lingual) and may include special notations for furcation and implants

Clinical Attachment Level (CAL)

  • CAL: distance from the Cementoenamel Junction (CEJ) to the base of the pocket/sulcus

  • CAL can be affected by gingival recession (apical shift of GM) or gingival overgrowth

  • Practical formula for CAL:

    • If recession present: {CAL} = {PD} + {(recession in mm)}

    • If GM is coronal to CEJ (enlarged gingiva without recession): {CAL} { may appear reduced}

Mobility Examination

  • Assess tooth mobility (rating scales vary by program)

Fremitus

  • Assess tooth vibratory sensation during function (e.g., occlusion) to evaluate subtle mobility/neural responses

Naber’s Furcation Examination

  • Use Naber's probe to assess furcation involvement

  • Key surfaces and measurements on interproximal furcations

  • Common practice: measure furcation involvement at the furcation entrances with special probes

Furcation Probing Instruments and Techniques

  • Naber's Probe: specialized for furcation assessment

  • UNC-15 Probe: commonly used for probing depth and recession measurements

  • Maxillary molar furcation assessment typically involves three locations per tooth to confirm involvement

  • Example: use three measurements to characterize the furcation status across a maxillary molar

Using Probes for Depths and Recession

  • UNC-15 probe commonly used to measure probing depths and recession distances

  • Example: measuring recession from CEJ to gingival margin (GM)

  • Recession measurement example: if PD = 3 mm and recession = 1 mm, then CAL = 4 mm

EPIC: Perio Charting in the Electronic Health Record

  • EPIC interface overview for periodontal charting

  • Sections include:

    • Hard Tissue Periodontal Exam

    • Soft Tissue

    • Tooth Chart

    • MIPACS (or similar) modules for charting and planning

  • Features:

    • Start Exam button to initiate periodontal assessment

    • Data entry fields for PD, GM, CAL, Bleed, Plaque, and Suppuration

    • Peri settings and navigation across facial/lingual surfaces

    • Auto-Plan Procedures and editing existing treatments

  • Practical workflow: move through facial and lingual surfaces, record findings, add periodontal comments, and save updates

Radiographic Assessment of Bone Level

  • Bone level evaluation is primarily done with bitewing radiographs

  • The interdental bone crest should be approximately 1-2 { mm} from the CEJ

  • The crest should run horizontally from the CEJ of one tooth to the CEJ of the adjacent tooth

  • Bacteria can cause the body to break down its own bone

Types of Bone Loss on Radiographs

  • Horizontal bone loss

  • Vertical (angular) bone loss

  • Other radiographic findings: calculus, overhanging restorations, dental caries, overhangs, tarter

Radiographic Findings and Other Considerations

  • Look for overhangs, calculus, decay, and restorations that contribute to periodontal pathology

  • Radiographs are essential for assessing bone loss patterns and treatment planning

Practical Takeaways and Ethical/Clinical Implications

  • Maintain precise and up-to-date periodontal assessments for accurate diagnosis and treatment planning

  • Use radiographs judiciously to assess bone levels and to plan interventions

  • Educate patients about the periodontal assessment procedures and findings to foster compliance

  • Ensure documentation is complete and legible to support continuity of care

Quick Reference: Key Measurements and Values (as in slides)

  • Bone crest distance from CEJ: 1-2 { mm}

  • Mean Probing Depth (example): 3 { mm}

  • Mean Attachment Level (example): -2.7 { mm}

  • Plaque prevalence (example): 48\%

  • Bleeding on Probing (example): 42\%

  • Recession measurement example: {CAL} = {PD} + {Recession} = 3 { mm} + 1 { mm} = 4 { mm}$$

Final Notes

  • The periodontal examination is an integrated process combining clinical measurements, probing technique, radiographic interpretation, and charting within an electronic record (e.g., EPIC) to support comprehensive patient care.