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7/27/2019 Periodontal Examination and Indices
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Dr Hisham Al-Shorman
DENT 471
29/9/2013
PERIODONTAL EXAMINATIONAND CLINICAL INDICES
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PERIODONTAL EXAMINATION
Why do we do examination?
Diagnosis
Precautions
Special treatment needsPrognosis
Motivation and education
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Main components and rationaleDate
Patient personal data
Chief complaint - history of c/cMedical history
Diseases - complications
Medications
AllergiesSmoking
Etc..
Dental history and oral hygiene practice
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CLINICAL EXAMINATIONExtra-oral
Intra-oral lips, cheeks, tongue, etc
Periodontal Clinical appearance of gingiva and teeth
Specific examination, measurements and index
recording
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Is this gingiva inflamed?
gingivitis ?
Periodontitis?
If we disagree onsomething, how
to reach an
agreement?
Do we need
specific criteria?
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How about this?
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And this?
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If we can disagree on a single case, whatabout larges-scale studies where hundreds
or thousands of persons are examined (i.e.
epidemiological studies)
Clinicians focus on individual cases while
epidemiologists focus on the population as a
whole?
Recall your knowledge on epidemiology
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Epidemiology aims at:
Determining amount & distribution of disease Investigation of causes of disease
Applying this knowledge for control of disease
Therefore, it plays a crucial role in dentistryand medicine in general
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What factors we consider when
examining periodontal patient?Color
Size
Location
Bleeding
Pus discharge
Pocket formation
Gingiva recessionPlaque accumulation
Calculus deposition
Mobility
Exposure of root furcations
And others!
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Periodontal indices
These are a form of a tool that have beensuggested and accepted worldwide.
They are useful: To help establishing diagnoses
To minimize disputes
To help following-up patients in a systematic
and standardized manner. To facilitate communication between clinicians
worldwide
Etc
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What indices we have? Many!Plaque index
Gingival index
Modified gingival index
Periodontal index
Periodontal disease index
Mobility index
Furcation involvement
CPITNBleeding index
Papillary bleeding index
Etc
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Components of these indices are expressedin numbers:
Probing depth measurements CAL
OR in grades/ classes:
Furcation involvement
Mobility
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Some indices require the use of specific instrument
Periodontal probe
Nabers probe
Mouth mirror
Some requires only visual examination anddescription
Gingival recession
Dont worry, you will learn about the relevant indicesas you progress in your study,
But, for the present time, we will focus on the indices
that you will use in the clinic as a routine screening
measure
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PLAQUE INDEX (Silness and Le, 1964)
Both soft debris and mineralized depositsare recorded
Four surfaces of the teeth are examined :buccal, lingual, mesial and distal surfaces
Scores: 0,1,2, 3
Scores are averaged for the tooth
And then averaged for the patient
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CriteriaScore
No plaque in the gingival area0
A film of plaque adhering to the free gingival margin
and adjacent area of the tooth, NOT SEEN BY NAKED
EYE. The plaque may be recognized only by running
the probe across the tooth surface
1
Moderate accumulation of soft deposit s within the
gingival pocket, or the tooth and gingival marginwhich can be SEEN BY THE NAKED EYE
2
ABUNDANCE of soft matter within the gingival pocket
and/or on the tooth and gingival margin and adjacent
tooth surface
3
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Example:
if you examine your patient and recorded thefollowing readings for the PI:
Buccal: 2 - moderate Lingual: 1 - mild
Mesial: 2 - moderate
Distal: 3 - heavy
Plaque Index for the tooth = (2+1+2+3)/4= 2which indicates moderate plaqueaccumulation
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Interpretation
InterpretationAveragePlaqueIndex
No plaque accumulation< 0.1
Mild plaque accumulation0.1 1.0
Moderate plaque accumulation1.1 2.0
Heavy plaque accumulation2.1 3.0
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Periodontal indices are ideallyrecorded for all the
teeth in the mouth.
For practical reasons and to reduce the examination
time, certain teeth were suggested by Ramfjord and
this is widely accepted representative teeth:
Ramfjord index teeth: (3, 9, 12, 19, 25, 28)
6 1 4
4 1 6
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GINGIVAL INDEX (Silness and Le, 1963)
Each of the four gingival areas of the tooth (facial,
mesial, distal, and lingual) is assessed for
inflammation and given a score from 0 to 3
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AppearanceBleedingInflammationScore
NormalNoNone0
Slight change in color
and mild edema with
slight change in texture
NoMild1
Redness, hypertrophy,
edema and glazingOn probingModerate2
Marked redness,
hypertrophy, edema
and ulceration
SpontaneousSevere3
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InterpretationInterpretation
AverageGingivalIndex
No inflammation< 0.1
Mild inflammation0.1 1.0
Moderate inflammation1.1 2.0
Heavy inflammation2.1 3.0
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Examples
Mild inflammation Score 1
Sever inflammation Score 3
Moderate Inflammation Score 2
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CALCULUS INDEX
The calculus component of the periodontaldisease index (PDI) by Ramjford:
CriteriaScore
Absence of calculus0
Supragingival calculus extending only slightly
below free gingival margin (not more than 1
mm)
1
Moderate amounts of supra-gingival and sub-
gingival calculus or sub-gingival calculus
alone
2
Abundance of supra-gingival and sub-gingival
calculus3
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TEETH MOBILITY
Mobility beyond the physiologic range is abnormal
Mobility assessment (Miller Index):
CriteriaDegree
No movement noted clinicallyN
Mobility in both buccal and lingual directions
less than 1 mm1
Mobility in both buccal and lingual directions1 mm or more2
Mobility more than 1 mm in a buccolingualdirection as well as apico-occlusal direction3
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CLINICAL ATTACHMENT LEVEL (CAL)
It is the distance between the base of the
pocket and the CEJ
Two measurements are recorded using aperiodontal probe. The first is the probing
pocket depth (PPD) from the base of the pocket
to the gingival margin
The second measurement is from the gingival
margin to the CEJ
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If the gingival margin is apical to the CEJ,the two measurements are added together:
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If the gingival margin is coronal to the CEJ(i.e. CEJ is hidden), the attachment level is
calculated by subtracting the measurement
from the gingival margin to CEJ form the
probing pocket depth
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If the gingival margin is at the CEJ level, the
CAL is the same as the probing depth
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Probing Depth Measurement
Probes
Direction
Force
Illumination
Drying
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BLEEDING ON PROBING (BOP)Important indicator of gingival health
Even with no increased probing depth, BOP
indicates inflammationsRecorded after probing
Six sites per tooth
Designated by red dot
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FURCATION
Nabers probe
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Classification (Glickman,1953 )
Grade I
Incipient, early stage
Pocket is suprabony Mainly affects soft tissue
No radiographic changes
Grade II Cul-de-sac
More than a defect in the same
tooth do NOT communicate
+/- radiographic changes
VV
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Grade III Bone not attached to the dome of the defect
Probe may/may not pass through the
furcation
Add buccal & lingual dimensions,if >buccolingual dimension of the tooth, it
is grade III
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Grade IV Interradicular bone destroyed
Soft tissue recession furcation clinically
visible
A tunnel between the roots Probe passes trough the defect
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