Gingival and Periodontal Examination and Charting PDF

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Professor Sharron Dierckens ...

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Gingival and Periodontal Examination and Charting

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gingival and periodontal examination is part of the assessment phase done after the medical and dental histories, and usually after the extra and intra oral exams we will review periodontal screening and recording (PSR) do not do PSR at SCC, but it is used at some offices we will also review the procedures for examining and charting the following…

1. Gingival Indices - used in clinical setting to determine and record the state of gingival health of a client - index is an expression of clinical observation in numeric values - at SCC we use a modified version of the GI (gingival index) to assess severity of gingivitis - based on colour, consistency, and bleeding on probing - refer to the Modified GI (Goulding/Niagara, 1994) used at SCC - has the above categories (0 to 3) and it also includes 4 and 5 (re: fibrotic tissue) - GI is found in the SCC dental chart on page 9 Criteria for GI (Silness and Loe, 1963) 0 = normal gingiva 1 = mild inflammation – slight change in colour, slight edema (no bleeding on probing) 2 = moderate inflammation – redness, edema, and glazing (bleeding on probing) 3 = severe inflammation — redness, edema and ulceration (spontaneous bleeding) 2. Gingival Findings (SCC Chart Page 9) 3. Pocket Depths - pocket is a diseased gingival sulcus - periodontal probe is used to accurately locate, assess, and measure pockets - pocket is measured from gingival margin to the base of the sulcus (MEASURE ENTIRE POCKET) - at SCC we record all probe depths (red if there is bleeding) - depth usually varies around an individual tooth (spot probing is inadequate) - six spots are distolingual, direct lingual, mesiolingual, distofacial, direct facial, mesiofacial

4. Gingival Height/Recession - the reduction of the height of the marginal gingiva to a location apical to the CEJ - signifies attachment loss, causes client discomfort, important in periodontal assessment - chart recession charted at SCC by a single line and mm 5. Attached Gingiva/Mucogingival Involvement - attached gingiva is continuous with the free gingiva (firm, dense, and stippled) - firmly attached to underlying connective tissue, tooth, and bone - mucogingival junction connects the attached gingiva and the alveolar mucosa - mucogingival line found on all F and L surfaces of all quads except the lingual of maxillary arch - periodontal probe measures amount of attached gingiva - first measure total width of the gingiva from free gingival margin to the mucogingival junction - the periodontal pocket is measured and it is subtracted from the previous measurement - less than 1 mm of attached gingiva is described as “inadequately attached gingiva” (IAG) - closely monitored for potential tooth loss (reduced vascular supply and periodontium) - includes tissues that support the teeth (gingiva, PDL and alveolar bone) in the area - in the absence of pocket formation, dentist may do gingival grafts to cover the root 6. Tooth Mobility - degree to which a tooth is able to move in a horizontal or apical direction - place instrument handle on the lingual of the tooth, gently push on facial with another instrument - [Slight] Class I (M1) when tooth can be moved up to 1mm in any direction - [Moderate] Class II (M2) when its moved more than 1mm in any direction (not depressible in socket) - [Severe] Class III (M3) when tooth moved in a buccolingual direction (depressible in the socket) 7. Furcations Involvement - loss of attachment between the roots of the posterior teeth - Class I is detectable furcation concavity but the probe can’t enter the furcation - Class II when a probe enters furcation from one side but wont pass through to opposite side - Class III when probe passes between roots through furcation (furcation covered by tissue) - Class IV is the same as III, but the furcation is clinically visible (not covered by soft tissue) - some textbooks only use Class I to III (No IV because soft tissue coverage is not a factor) 8. Clinical Attachment Level (CAL) - amount of space (in mm’s) between attached tissue (base of sulcus) and a fixed point (CEJ) - determined by comparing the distance from the base of the sulcus or pocket to the CEJ - in absence of inflammation and pocket formation, gingival groove is about 0.5 to 1.5 mm from GM - gingival groove is junction of free gingiva and attached gingiva (may have probe depth of 1 to 2 mm) - CAL would be 0 because the CEJ is below the gingival margin

GM at CEJ

CAL= pocket depth

GM apical to CEJ (recession)

CAL= pocket depth + recession

GM coronal to CEJ (gingival inflammation)

CAL= pocket depth- distance from GM to CEJ

Periodontal Screening and Recording (PSR) - assess the state of periodontal health in a rapid and effective manner - motivates clients to seek necessary complete periodontal assessment and tx. - specially designed probe is used that has a 0.5 mm ball on the working tip - ball aids in the detection of calculus, overhanging margins of restorations, tooth surface irregularities - also reduces the risk of over measurement - probe has a colour-coded area between 3.5 mm and 5.5 mm - teeth divided in sextants (each get code corresponding to deepest part of colour-coded probe) - 5 codes and an asterisk are used - table shows the clinical findings, code descriptions, and management guidelines in chart form - when code 4 is found, you do not have to probe the remaining teeth in that sextant - record 4 and move on to the next sextant - for codes 0, 1, 2, and 3, the sextant is completely probed - codes of 3 and 4 indicate comprehensive periodontal examination - to record findings a simple six-box form is use (1 box per sextant) - maxillary anteriors, max left, max right have 0 - mandibular right has 1, anteriors have 0, and left has 2* - * indicates furcation involvement, mobility, recession, mucogingival issues PERIODONTAL RECORDING

0

0

0

1

0

2*

Q: Why is it important to correctly chart missing teeth, unerupted teeth, impacted teeth, supernumerary teeth, malpositioned teeth, open contacts, poorly contoured restorations and crowns, prosthetic devices, and carious lesions prior to starting the gingival and periodontal examination and charting???

Clinical Findings

Code

Management

- coloured area of probe completely visible - no calculus, defective margins - no bleeding

- biofilm control - preventative care

- coloured area of probe completely visible - bleeding after probing

- biofilm control - preventative care

- coloured area of probe completely visible - biofilm control instruction - rough surfaces felt supra or sub gingival (calculus) - complete preventative care - defective restoration margins - calculus removal - correct irregular restorations

- coloured area of probe partly visible - requirements for codes 1 and 2 may be present -

- comprehensive periodontal assessment - treatment plan, counselling

- coloured area of probe completely disappears - probe depth more than 5.5mm

- comprehensive periodontal assessment - treatment plan, counselling

Probe Markings (mm) Examples

Description

1-2-3-5-7-8-9-10

Williams

Round, tapered, with colour code available

Glickman

Round, narrow diameter, fine

Merrit B

Round, longer lower shank, single shank bend

3-3-2

Michigan O and Marquis M-1

Round, tapered, fine narrow diameter

3-6-9-12 or 3-6-8-11

Michigan O, Marquis, Nordent, Nabers Q-2N

Round, tapered, fine, colour coded

Each mm to 15mm

UNC 15

Round and cooler coded at 5-10-15

3-5-7-10

Perioscreen

Round, cooler coded with green and red (perio)

3.5-5.5-8.5-11.5

WHO Probe

Round, tapered, fine, ball end, colour coded

None

Nabers, 1N, 2N

Curved, curved shank for furcation examination...