Clinical Dh Tech Week 5 - Probing Basics

Front 1

Free Gingiva

Back 1

• The unattached portion of the gingiva that surrounds the tooth

• Surrounds the neck of the tooth in a turtleneck manner

Front 2

Gingival Sulcus

Back 2

• The v-shaped space between the free gingiva and the tooth surface

• The space where the periodontal probe is inserted to assess gingival health

Front 3

Interdental Gingiva

Back 3

• Portion of the gingiva that fills the area between two adjacent teeth apical to the contact area

• Facial papilla and lingual papailla

Front 4

Attached Gingiva

Back 4

• Part of the gingiva that is tightly connected to the cementum on the root and to the connective tissue cover of the alveolar bone

Front 5

Periodontal Pocket

Back 5

• A gingival sulcus that has deepened by disease

• Depth is greater than 3mm

• Forms from apical migration of the junctional epithelium and destruction of periodontal fibers of the bone

Front 6

Gingival pocket

Back 6

• A deepening of gingival sulcus caused y detachment of coronal portion of the junctional epithelium and swelling of tissue

Front 7

Probing Depth

Back 7

• The distance in mm from the gingival margin to the base of the sulcus or periodontal pocket as measured with a probe.

Front 8

Probing Depth in Health

Back 8

• A healthy sulcus is 1 to 3mm in depth

• The probe tip touches the tooth near the CEJ

Front 9

Probing Depth in Disease

Back 9

• A diseased sulcus is greater than 3mm in depth

• The probe tip touches the root below the CEJ

Front 10

Probing

Back 10

• The act of walking the tip of a probe along the base of a sulcus or pocket for the purpose of assessing the health status of the periodontal tissue

Front 11

Probe Tip

Back 11

• 1 to 2mm of the side of the probe

Front 12

Adaptation of Probe Tip

Back 12

• The probe is positioned parallel to the long axis of the tooth (Ice-cream Cone Shaped Angle)

• The probe working-end is positioned as parallel as possible to the root surface

• The probe must be parallel in the mesiodistal dimension and the faciolingual dimension

Front 13

Walking Stroke

Back 13

• A series of bobbing strokes that are made within the sulcus or pocket while keeping the probe tip against the tooth surface

• Used to cover the entire circumference of the sulcus

• Used to find pockets along the junctional epithelium which is not always a uniform depth

Front 14

Production of Walking Strokes

The 3 steps of probing:

Back 14

1. Insert the probe and lightly run the tip along the tooth surface until it encounters the soft tissue base of the sulcus or pocket

• The junctional epithelium that forms the base of the sulcus or pocket feels soft and flexible when touched with the probe

2. Create a walking stroke by moving the probe tip up and down in short bobbing strokes

3. Move forward in 1mm increments

• Probe is NOT removed from the sulcus with each stroke - repeatedly removing the probe can traumatize the tissue

Front 15

Stroke Pressure

Back 15

• A pressure exerted with the probe tip against the soft base of the sulcus or pocket should be between 10-20 grams

Front 16

Why is the probe bobbed in 1mm increments around the entire circumference of the tooth?

Back 16

• It is common for the depth of a pocket to be deeper in one place

• Walking around the entire circumference avoids missing a deeper area

Front 17

How are measurements recorded?

Back 17

• Record 6 areas per tooth (distobuccal/facial, buccal/facial, mesiobuccal/facial, mesiolingual, lingual and distolingual)

• record one reading per area (the deepest)

• Round up measurements to nearest full mm

Front 18

What steps are used to probe the cole?

(usually below the contact area

of two adjacent teeth)

Back 18

1. Touch the contact area - walk the probe between the teeth until it touches the contact area (if no adjacent tooth is present, estimate where contact area would be)

2. Tilt the probe - Pull out 1mm and slant the probe lightly so that the tip reaches under the contact area

3. Measure the cole - in this position, gently press downward to touch the soft tissue base (cole is measured from both the buccal/facial and the lingual of each tooth

Front 19

What difficulty is experienced

when probing the maxillary teeth?

And how is this resolved?

Back 19

Difficulty:

• Probing the distal surface of the maxillary molars because the mandible gets in the way.

To resolve this:

• reposition the hand to the side of the patient's face to reach the distal surface of maxillary molars (an extra-oral fulcrum may be needed)

Front 20

How are the pocket depths recorded for the buccal/facial aspects of each tooth?

Use tooth #6 as an example.

Back 20

1. Begin with section one - insert tip at the distofacial line angle and walk probe toward the distal surface (tilt probe for the cole) then remove probe and record deepest reading for section 1 (distofacial line angle to distal cole).

2. Continue to section 2-3 - reinsert tip at the distofacial line angle and walk probe toward the mesial surface (tilt probe for the cole) then remove tip and record deepest reading for section 2 (distofacial line angle to mesiofacial line angle) and section 3 (mesiofacial line angle to mesial cole)

Front 21

How are the pocket depths recorded for the lingual aspects of each tooth?

Use tooth #6 as an example.

Back 21

1. Begin with section 4 - insert tip at the mesiolingual line angle and walk probe toward the mesial surface (tilt probe for the cole) then remove probe and record deepest reading for section 4 (mesiolingual line angle to mesial cole).

2. Continue to section 5-6 - reinsert tip at the mesiolingual line angle and walk probe toward the distal surface (tilt probe for the cole) then remove tip and record deepest reading for section 5 (mesiolingual line angle to distolingual line angle) and section 6 (distolingual line angle to distal cole)

Front 22

What must you

ALWAY CHECK BEFORE YOU PROBE?

Back 22

"Me, My patient, My light, My instrument,

My fulcrum, and My adaptation."