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Periodontal examintation
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SYMPTOMS:
Gingival Bleeding, Pain and Swelling.
Tooth mobility.
Bad breath and taste.
The main concerns of the patient
Bleeding
Spontaneous During Mastication Tooth Brushing
A sudden onset or deterioration may suggest an underlying systemic factorsA sudden onset or deterioration may suggest an underlying systemic factors
PainAcute Periodontal Lesions (NUG)
CariesPulp and Periapical
Disease
Dentine Hypersensitivity
Bleeding
Spontaneous During Mastication
Bleeding
Spontaneous Tooth BrushingDuring Mastication
Bleeding
Spontaneous
Pain
Tooth BrushingDuring Mastication
Bleeding
Spontaneous
Acute Periodontal Lesions (NUG)
Pain
Tooth BrushingDuring Mastication
Bleeding
Spontaneous
Caries
Pain
Tooth BrushingDuring Mastication
Bleeding
Spontaneous
Pulp and Periapical Disease
Caries
Pain
Tooth BrushingDuring Mastication
Bleeding
Spontaneous
Dentine Hypersensitivity
Pulp and Periapical Disease
Caries
Acute Periodontal Lesions (NUG)
Pain
Tooth Brushing
During Mastication
Bleeding
Spontaneous
Causes of tooth mobility: Marginal or apical inflammation. Loss of connective tissue attachment and
supporting bone, usually due to marginal periodontal disease but occasionally due to periapical disease.
Apical root resorption. Increase in width of periodontal ligament,
usually due to occlusal forces.
Tooth Movility
Any Increased?
When?(Duration)
Masticatory Difficulty
Any Increased?
When?(Duration)
Masticatory Difficulty
Any Increased?
When?(Duration)
Tooth Mobility
Masticatory Difficulty
Any Increased?When?
(Duration)
OBJECTIVES:1. To identify systemic factors which may help to
account for the periodontal condition, ex: Pregnancy, Diabetes Mellitus.
2. To note the existence of systemic condition for which especial precautions (ex. Antibiotic prophylaxis) are required to safeguard the patient during the periodontal therapy.
3. To note the presence of any transmissible disease which may present a hazard to the clinician, dental surgery staff or other patients.
Patient's attitude toward dental health. Date and nature of the last dental treatment. Regularity of previous dental treatment. Oral hygiene habits. a. Tooth brush (type and frequency)
b. Dental floss. c. Others. Habits related to oral health or disease
(bruxism, smoking)
1. Gingival Inflammation, Plaque and Calculus
GINGIVITIS
Changes of the colour
Enlargement(edema or hyperplasia)
GingivalExudate
Bleeding
Supuration, Ulcerationor Sweeling (acute inflammation)
GINGIVITIS
Changes of the colour
GingivalExudate
Bleeding
GINGIVITIS
Changes of the colour
GingivalExudate
Supuration, Ulcerationor Sweeling (acute inflammation)
Bleeding
GINGIVITIS
Changes of the colour
GingivalExudate
Enlargement(edema or hyperplasia)
Supuration, Ulcerationor Sweeling (acute inflammation)
Bleeding
GINGIVITIS
Changes of the colour
GingivalExudate
1. At the initial visit.
2. During the subsequent appointments to control the progress of the treatment.
• Is used to:
1. Identify pockets which
bleed on probing.
2. To measures the
pockets depth.
The depth to which the periodontal probe can penetrate beyond the gingival
margins depends on:
1. The amount of gingival enlargement.
2. The extent of connective tissue attachment loss.
3. The resistance of the tissue to probing, determined by the extent to which gingival collagen has been replaced by inflammatory infiltrate.
4. The size, shape and tip diameter of the probe.
5. Use of the probe, angle of insertion and pressure applied.
6. The presence of obstructions such as subgingival calculus.
7. The patient's reaction to the discomfort on probing.
• Each tooth should be rocked between an instrument handle and index finger in a buccolingual direction and mesiodistal direction (when the adjacent tooth is not present).
• The amplitude of tooth movement of the crown tip from its most extreme buccal (or mesial) position to its most extreme lingual or distal position should be observed:
Grade 1- Visible horizontal mobility up to 1 mm.Grade 2- Visible horizontal mobility between 1 and
2 mm.Grade 3- Visible horizontal mobility greater than 2
mm or rotation or vertical mobility (depression).
• The occlusion should be examined for detect premature or interfering contacts as contributory factors.
• Vertical bone destructive pattern is often associated with traumatic occlusion.
Parafunctional habits
Non- vitalTeeth Unerupted teethUnerupted teeth
Non- vitalTeeth Unerupted teeth
Caries
Unerupted teeth
Caries
Non- vitalTeeth Unerupted teeth
Caries
Unerupted teethNon- vitalTeeth
Unerupted teeth
Missing Teeth
Overhanging Restorations
• Radiographs may:
1. Show the proportion of support loss in relation to root length, the pattern of bone loss and the rate of destruction.
2. Reveal unerupted teeth, periapical pathology, inadequate endodontic treatment, proximal caries, overhanging margins, etc.
Pulp Vitality Test
Haematological investigations, ex: full blood count in patients where blood dyscrasias are suspected(neutropenia, leukemia, etc)
Teeth associated with deepPeriodontal pocket
(pulpitis or pulp necrosis)
To distinguish a periapical from periodontal abscess
Teeth associated with deepPeriodontal pocket
To distinguish a periapical from periodontal abscess
Tooth by tooth diagnosis.
Whole dentition.
For an individual patient.
It depends on:• The adequacy of the diagnosis.• The quality of the treatment, including home
care and recall maintenance.
Factors that may influence the prognosis:The extent and significance of mucogingival
problems.The extent of furcation lesions.The combined periodontal and endodontic lesions.The presence of the hopeless teeth.