Mucogingival examination tutorial PDF

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Prepared by Maria Tigner, professor dental Programs

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Mucogingival Examination Tutorial Mucogingival deformities and conditions – are significant alterations of the morphology, size, and interrelationships between the gingiva and the alveolar mucosa that may involve the underlying bone. Recession of the gingival margin is the most common mucogingival deformity. Frenum attachments - tension of a frenum may pull the gingiva away from the tooth and promote plaque biofilm accumulation and recession of the gingival margin. Lack of attached gingiva - very often results in mucogingival involvement.

Mucogingival examination 1. Marginal gingiva

a. Record in the perio chart the position of the marginal gingiva, when recession or inflammation is present.

b. In reality we should record 6 surfaces of recession, as we do record 6 surfaces of probing depths!!). But practically, this parameter is measured in millimeters as you make a drawing of the marginal gingiva on the perio chart, following the contour of the free gingiva, is not always uniform, it can “deep down” in the mesio buccal area of molars and premolars, perhaps as a result of tooth brushing trauma. An approximate drawing of the inflammation or recession is documented in the periochart; documenting this way the presence of problem areas. 2. Keratinized gingiva

a. Determine the total width of the keratinized gingiva. Use a periodontal probe to measure the distance from the gingival margin to the MG junction, place the perio probe on the surface of the gingival tissues.

b. Observe the characteristics of the keratinized gingiva, manipulate the tissue (stretching the mucosa of the lips or cheeks) to determine where is the mucogingival junction located. Remember that color variations also indicate this landmark. Mucogingival Examination Tutorial/ DH 03 / Periodontics I / Spring 2018

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Prepared by Maria Tigner, professor dental Programs

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3. Mucogingival junction

a. Identify the alveolar mucosa with its distinct redness and thinnest, different from gingiva or keratinized mucosa, both types of mucosa are separated by the mucogingival junction. The identification can also be done while pulling on the lips or cheeks to make this demarcation (mucogingival junction) more apparent. 4. Attached gingiva

a. Is the distance between the mucogingival junction and the deeper portion of the sulcus or coronal aspect of the JE (in health), or the distance between the mucogingival junction and the deepest part of the periodontal pocket (in disease).

Carranza

Very important!!! Keratinized gingiva is not the same as attached gingiva, a patient can have a deep pocket, with the mucosal surface composed by keratinized mucosa, but lacking attached mucosa because a periodontal pocket extends to the mucogingival junction.

Mucogingival Examination Tutorial/ DH 03 / Periodontics I / Spring 2018

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Prepared by Maria Tigner, professor dental Programs

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Carranza

5. Probing depth

a. Record the probing depth in the perio chart. b. Subtract the probing depth, from the amount of attached gingiva found. Fig 35-23 A and B pg 555 Carranza

c. This measurement is done by identifying the probing depth, then placing the periodontal probe on the mucosal surface (not inside the pocket!), at the same level or same estimated position of the probe when measuring the probing depth, now locate the mucogingival junction, and estimate the amount of attached gingiva left.

Mucogingival Examination Tutorial/ DH 03 / Periodontics I / Spring 2018

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Prepared by Maria Tigner, professor dental Programs

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d. Mucogingival involvement exists when there is no more attached gingiva, for a particular tooth or teeth, or if a very minimal amount is present (see the perio chart used at the clinic!). 6. To help establish the position of the mucogingival junction, you can also use a probe, place probe on surface of alveolar mucosa on a horizontal position and move it gently across the alveolar mucosa until the tissue stops moving (rolling or “making waves”). Fig 35-23 C Carranza 7. Sometimes there is no attached gingiva at all, can be seen more often in areas of frenum attachment such as in the lower labial, and lateral areas. 8. To determine the presence of mucogingival involvement in the areas of frenal attachment, stretch or retract the cheeks or lips laterally and watch for movement of the gingival margin. This indicates the presence of mucogingival involvement, or a strong possibility that a mucogingival defect may develop overtime. 9. When there is presence of keratinized gingiva, and a periodontal pocket, the potential for developing a mucogingival defect, is less, the keratinized gingiva imparts some stability to the area, but it is far from ideal as it lacks the attached mucosa. 10. Sometimes is unclear if the perio pocket has a suprabony or infrabony architecture, and if there is attached gingiva or not, or if there is keratinized gingiva but not attached gingiva. The tissues must be observed, and measured, to determine the presence of a mucogingival involvement or defect. 11. A mucogingival defect can also easily be recognizable, as is on the case of a significant recession that is at the mucogingival junction, or clearly it is located on alveolar mucosa.

Mucogingival Examination Tutorial/ DH 03 / Periodontics I / Spring 2018

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Prepared by Maria Tigner, professor dental Programs

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Observe and understand the following pictures.

Pictures from Weinberg: Pg 22 fig 16-13, 16-14, 16-15

Mucogingival Examination Tutorial/ DH 03 / Periodontics I / Spring 2018

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Prepared by Maria Tigner, professor dental Programs

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Weinberg

Please observe the table below, especially the mucogingival deformities and conditions around the teeth and edentulous ridges.

Resources Gehrig. Foundations of Periodontics for the dental hygienist. 4th ed. 2016. Lippincott, Williams & Wilkins. Weinberg. Comprehensive periodontics for the dental hygienist. 3th ed. 2010. Pearson. Newman, Takei, Carranza. Carranza’s clinical periodontology. 10th ed. 2006. Elsevier.

See also the table of Developmental or acquired deformities and conditions next page.

Mucogingival Examination Tutorial/ DH 03 / Periodontics I / Spring 2018

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Mucogingival Examination Tutorial/ DH 03 / Periodontics I / Spring 2018

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