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45 Cards in this Set

  • Front
  • Back
What is the Periodontal Assessment assessing for?
The presence or absence of disease:

• Amount of biofilm present
• Gingival description
• Calculus deposits
• Probing depths
• Bleeding upon probing
• Presence of recession
• Width of attached gingiva
• Clinical attachment loss/level
• Presence of mobility
• Furcation involvement
What should we review/consider before we begin the Periodontal Assessment?
What we know about this patient that may contribute to risk factors for periodontal disease such as:
• Personal information
• Health History and Vital Signs
• Dental History
• Dental IQ, Attitudes about health and healthcare
What are the 10 components of the Periodontal Assessment?
#1 Missing teeth
#2 Malposed teeth
#3 Recession
#4 Pocket depths and bleeding points
#5 Furcation involvement
#6 Attrition
#7 Mobility
#8 CAL (clinical attachment level)
#9 Width of attached gingiva (WAG)
#10 Other contributing factors
What are the other factors affecting periodontal health?
• Poor restorative margins
• Malposed and crowded teeth
• Missing teeth
• Oral habits such as grinding
• Systemic factors
We MUST have current radiographs to check for what seven things, prior to charting?
• Missing teeth
• Retained root tips
• Impacted teeth
• Retained deciduous teeth
• Supernumerary teeth
• Horizontal and vertical bone loss
How is #1 Missing Teeth recorded?
• Missing teeth are recorded with a large X through all aspects of the tooth after reviewing the radiographs and visual inspection.
How is #2 Malposed Teeth recorded?
•Malposed teeth are recorded with an arrow ( -> ) showing the direction of the rotation or a note is written explaining which teeth are crowded and the severity.
How is #3 Recession charted?
•Recession is charted as a RED LINE across the root surface with the number of millimeters of recession to the right of the red line
–It is not necessary to write “mm” next to the number, only the number of mm is required
–Dry the tooth with air or a 2x2 to help you look for demarcation between root and crown
–Remember your anatomy to help you decide if you are seeing root beyond margin of crown
How is Periodontal charting sequence determined?
•Determined by the system your office is using

•Computer assisted charting sequence may be different from manual charting
–Some computer systems are voice activated
–Some systems allow you to change the sequence
–Some systems have left and right-handed sequences
How is #4 Pocket Depths charted?
•Pocket depths are charted in BLACK INK
•Pocket depths 4mm and larger are then COLORED OVER with a YELLOW HIGHLIGHTER
How are Bleeding Points charted?
•Bleeding points, (BOP), are charted as RED DOTS next to the pocket depth number in the box

* Remember to go back and look at previously probed teeth as bleeding doesn’t always occur immediately—may take 30-60 seconds to appear *
What do you check for in fercation area? And how is it detected?
• Check for loss of bone and ligament support in the furcation area of the roots
• Early involvement may or may not be seen radiographically
- may only initially be detected with the probe
• Maxillary molar furcations are more difficult to see radiographically until involvement is more severe
• Use radiographs to help you determine possible presence of furcations
What does #5 Furcation Classifications quantify?
Quantifies the severity or extent of the furcation invasion.
What does Class I Furcation represent?
How is it charted?
• Concavity can be felt with probe
• Probe tip cannot enter the furcation area
• Charted IN GREEN as an INVERTED V in the area found

* Most often on Buccal of mandibular molars. *
What does Class II Furcation represent?
How is it charted?
• Probe tip can partially enter the furcation
• Extends about one-third of the tooth
• NOT able to pass completely through
• Charted IN GREEN as a TRIANGLE (OUTLINE ONLY) in the area found
What does Class III Furcation represent?
How is it charted?
• Mandibular molars-probe passes completely through the furcation
• Maxillary molars-probe touches the palatal (lingual) root
• Charted IN GREEN as a TRIANGLE ( COLORED IN) in the area found
What does Class IV Furcation represent?
How is it charted?
• Same as a class III except that the furcation is visible clinically due to tissue recession
• Charted IN GREEN as a DIAMOND (COLORED IN) in the area found
What are #6 Attrition and Wear Facets and how are they recorded?
• Attrition is the wearing away of a tooth as a result of tooth-to-tooth contact
• Wear facets are shiny, flat, worn spots on the tooth surface, frequently on the side of a cusp
• Recorded by drawing TWO HORIZONTAL RED LINES across incisal edges of anterior teeth
–Wear facets on posterior teeth are documented in the comments area
What is #7 Mobility and what can it be a result of?
•Mobility is the loosening of the tooth in its socket.
•It may be a result of trauma or disease.
•In disease, it is a result of loss of bone support to the tooth.
What is Horizontal Mobility and how is it assessed?
• The ability to move the tooth in a facial-lingual direction in the socket.
• Assessed by putting the handles of two dental instruments on either side of the tooth and applying alternating moderate pressure— first one, then the other handle.
What is Vertical Mobility and how is it assessed?
• The ability to depress the tooth in its socket by exerting pressure using the end of an instrument handle against the occlusal or incisal surface of the tooth.
• The level of mobility must be severe to be able to depress the tooth.
What are the 3 Mobility Classifications and how are they charted?
• Class 1–Slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction
• Class 2–Moderate mobility, greater than 1 mm of horizontal displacement but less than 2mm in a facial-lingual direction
• Class 3–Severe mobility, greater than 1 mm of displacement in a facial-lingual direction combined with vertical displacement (tooth depressible in the socket)
• Charted in the specified mobility box
What is Fremitus? How is it determined? And how is it documented?
• Fremitus is palpable vibration or movement
• Tooth has excess contact forcing it to move
• Determined only on maxillary teeth with patient sitting upright
• Determined with Index finger at CEJ to feel for vibration as patient taps posterior teeth together
• Document tooth number and degree of movement as slight, moderate or severe.
– Severe can be observed visually
What is CAL and what does it refer to?
• Stands for Clinical Attachment Level
• Refers to the estimated position of the structures that support the tooth as measured with a periodontal probe.
•The CAL provides an estimate of a tooth’s stability and the loss of bone support.
•Can be used synonymously with Clinical Attachment Loss or the extent of periodontal support that has been destroyed around a tooth.
Where is CAL measured from and what does it indicate?
•Calculated measurements made from a fixed point that does not change—the CEJ.
•Because the bone level in health is approximately 2mm apical to the CEJ, the CAL provides a reliable indication of the extent of bone support for a tooth.
How do you calculate CAL when the gingival margin is AT THE CEJ?
CAL = probing depth + gingival recession
• Probing depth: 6mm
• Gingival recession: 0mm
• CAL = 6 + 0 = 6mm of attachment loss

* The pocket depth is the same as the CAL when gingival margin is at the CEJ *
How do you calculate CAL in the PRESENCE OF RECESSION?
CAL = probing depth + gingival recession
• Probing depth: 4mm
• Gingival recession: 2mm
• CAL = 4 + 2 = 6mm of attachment loss
How do you calculate CAL when gingival margin COVERS THE CEJ?
CAL = Probing depth - Gingival Margin ABOVE CEJ
• Probing depth: 9mm
•Gingival margin: 3mm above the CEJ
•CAL = 9 – 3 = 6mm of attachment loss
When and how does the CBC DH Clinic chart CAL?
• We only chart the CAL in the presence of recession.
• Charted in the separate box indicated by the letters CAL
• Add the recession plus the pocket depth and chart the sum of those numbers
What does #9 WAG stand for? What is its function? And what is used to assess it?
• Stands for Width of Attached Gingiva
•The function of the attached gingiva is to keep the free gingiva from being pulled away from the tooth.
•The probe is used to assess the width of attached gingiva.
How is WAG calculated?
WAG = MGJ to margin of gingival - depth of pocket

• First: identify the location of the mucogingival junction
• Second: measure from the junction to the margin of the gingiva
• MGJ : 4mm
• Depth of pocket: 2mm
WAG = 4 - 2 = 2mm of attached gingiva
What is considered minimal attached gingiva?
LESS THAN 2mm of attached gingiva
What is considered adequate attached gingiva?
2mm or more of attached gingiva
How is WAG charted?
• Anything less than 2mm is indicated by a RED ZIG-ZAG LINE on the root of the tooth

* Charting and assessment are always done onthe Buccal aspect of the tooth *
Where are the "other localized factors" charted? And what are they?
Most other local factors should be written up in the “comments” area on the perio charting sheet such as:

• Fremitus
- List tooth numbers
• Widened PDL
- Indicated with tooth numbers
• Food impaction
- Written in comments area with tooth numbers and Hx information from the patient
- If the food impaction involves an open contact, you can chart the area with two small vertical lines between the teeth involved
• Overhanging margins (will be covered in the Dental Charting lecture)
• Clenching/grinding habit written in comments area with Hx
Why is the classification system for health and disease necessary?
• It establishing baseline data
• It sets a standard for recording the extent and severity of inflammation and destruction of supporting periodontal structures.
– Commonly used throughout the profession.
• It provides data from which you create your plan for DH therapy.
• It provides data for comparison at maintenance visits to help answer:
– Has therapy been successful?
– Is the patient’s home care effort successful?
– What else can be done to promote optimum health in a compromised situation?
– Additional DH therapy?
– Other oral hygiene aids?
– Referral to a periodontist for surgery?
What are the two main catagories of the American Academy of Pariodontology (AAP) classification? Who developed it? And why was it established?
• The two major categories are: Gingivitis and Periodontitis
• Developed by the American Dental Association
• It was established to identify distinct types of periodontal diseases by taking into consideration factors such as:
– Age of onset
– Clinical appearance
– Rate of disease progression
– Pathogenic microbial flora
– Systemic influences
What is the AAP primarily based on? What data is used to classify patients?
And what does it provide guidelines for?
• Primarily based on the severity of attachment loss.
• Clinician uses the clinical and radiographic data gathered and classifies the patient into one of the four Case Types, which are commonly required for insurance billing.
• Provide guidelines for treatment recommendations.
Which two APP Case Types are not used much any more?
Case Type 0 and Case Type V
What does Case Type 0 classify?
• Generalized healthy gingiva
• May have isolated areas of BOP (bleeding upon probing)
• No bone loss
• 1-3 mm pocket depth with isolated 4 mm
What does Case Type I classify?

• Generally inflamed as characterized by slight to moderate changes in color, contour, and consistency
• Radiographic findings:
- No evidence of bone loss
- Crestal lamina dura is present
- Alveolar bone level is within 1-2 mm of the CEJ area
• Bleeding may or may not be present
• Pocket depths 2-4 mm
• Pseudopockets may be present from 3-6 mm
- Usually due to partial eruption
What does Case Type II classify?
Early Pariodontitis:

• Generalized slight to moderate inflammation characterized by changes in color, contour, and consistency progressing into deeper periodontal structures.
• Bone loss evident from localized areas of recession
• Pocket depths 3-5 mm •Possible Class I furcation invasion areas
• Radiographic findings:
– Horizontal type bone loss, most commonly
– Slight loss of interdental septum
– Alveolar bone level is 3-4 mm from CEJ area
What does Case Type III classify?
Moderate Periodontitis:

• Advanced stages of inflammation characterized by increased destruction of periodontal structures and generalized bleeding upon probing.
• Pocket depths from 4-6 mm
• Class I and II furcation involvement may be evident with mobility
• Radiographic findings:
– Horizontal or vertical bone loss may be present
– Alveolar bone level is 4-6 mm from CEJ area
– Class I and II furcations
– Loss of 1/3 of supporting alveolar bone
What does Case Type IV classify?
Advanced Periodontitis:

• Further progression of inflammation with major loss of alveolar bone support.
• Bleeding upon probing and pocket depths >6 mm
• Radiographic findings:
– Horizontal and vertical bone loss
– Alveolar bone level is 6 mm or more from CEJ area
– Radiographic furcations evident
– Loss of over 1/3 of supporting alveolar bone
What does Case Type V classify?
Refractory and Juvenile Periodontitis:

• Condition that describes continued attachment loss in spite of “well-executed” periodontal therapy and proper oral hygiene.
• Other factors may include:
– Extent of disease prior to therapy
– Type of therapy provided (surgical vs. non-surgical)
– Tooth type and furcation involvement
– Species and strains of microflora
– Degree of host response