periodontal examination and indices

7/27/2019 Periodontal Examination and Indices

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Dr Hisham Al-Shorman

DENT 471

29/9/2013

PERIODONTAL EXAMINATIONAND CLINICAL INDICES


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PERIODONTAL EXAMINATION

Why do we do examination?

Diagnosis

Precautions

Special treatment needsPrognosis

Motivation and education


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Main components and rationaleDate

Patient personal data

Chief complaint - history of c/cMedical history

Diseases - complications

Medications

AllergiesSmoking

Etc..

Dental history and oral hygiene practice


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CLINICAL EXAMINATIONExtra-oral

Intra-oral lips, cheeks, tongue, etc

Periodontal Clinical appearance of gingiva and teeth

Specific examination, measurements and index

recording


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Is this gingiva inflamed?

gingivitis ?

Periodontitis?

If we disagree onsomething, how

to reach an

agreement?

Do we need

specific criteria?


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How about this?


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And this?


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If we can disagree on a single case, whatabout larges-scale studies where hundreds

or thousands of persons are examined (i.e.

epidemiological studies)

Clinicians focus on individual cases while

epidemiologists focus on the population as a

whole?

Recall your knowledge on epidemiology


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Epidemiology aims at:

Determining amount & distribution of disease Investigation of causes of disease

Applying this knowledge for control of disease

Therefore, it plays a crucial role in dentistryand medicine in general


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What factors we consider when

examining periodontal patient?Color

Size

Location

Bleeding

Pus discharge

Pocket formation

Gingiva recessionPlaque accumulation

Calculus deposition

Mobility

Exposure of root furcations

And others!


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Periodontal indices

These are a form of a tool that have beensuggested and accepted worldwide.

They are useful: To help establishing diagnoses

To minimize disputes

To help following-up patients in a systematic

and standardized manner. To facilitate communication between clinicians

worldwide

Etc


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What indices we have? Many!Plaque index

Gingival index

Modified gingival index

Periodontal index

Periodontal disease index

Mobility index

Furcation involvement

CPITNBleeding index

Papillary bleeding index

Etc


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Components of these indices are expressedin numbers:

Probing depth measurements CAL

OR in grades/ classes:

Furcation involvement

Mobility


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Some indices require the use of specific instrument

Periodontal probe

Nabers probe

Mouth mirror

Some requires only visual examination anddescription

Gingival recession

Dont worry, you will learn about the relevant indicesas you progress in your study,

But, for the present time, we will focus on the indices

that you will use in the clinic as a routine screening

measure


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PLAQUE INDEX (Silness and Le, 1964)

Both soft debris and mineralized depositsare recorded

Four surfaces of the teeth are examined :buccal, lingual, mesial and distal surfaces

Scores: 0,1,2, 3

Scores are averaged for the tooth

And then averaged for the patient


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CriteriaScore

No plaque in the gingival area0

A film of plaque adhering to the free gingival margin

and adjacent area of the tooth, NOT SEEN BY NAKED

EYE. The plaque may be recognized only by running

the probe across the tooth surface

1

Moderate accumulation of soft deposit s within the

gingival pocket, or the tooth and gingival marginwhich can be SEEN BY THE NAKED EYE

2

ABUNDANCE of soft matter within the gingival pocket

and/or on the tooth and gingival margin and adjacent

tooth surface

3


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Example:

if you examine your patient and recorded thefollowing readings for the PI:

Buccal: 2 - moderate Lingual: 1 - mild

Mesial: 2 - moderate

Distal: 3 - heavy

Plaque Index for the tooth = (2+1+2+3)/4= 2which indicates moderate plaqueaccumulation


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Interpretation

InterpretationAveragePlaqueIndex

No plaque accumulation< 0.1

Mild plaque accumulation0.1 1.0

Moderate plaque accumulation1.1 2.0

Heavy plaque accumulation2.1 3.0


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Periodontal indices are ideallyrecorded for all the

teeth in the mouth.

For practical reasons and to reduce the examination

time, certain teeth were suggested by Ramfjord and

this is widely accepted representative teeth:

Ramfjord index teeth: (3, 9, 12, 19, 25, 28)

6 1 4

4 1 6


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GINGIVAL INDEX (Silness and Le, 1963)

Each of the four gingival areas of the tooth (facial,

mesial, distal, and lingual) is assessed for

inflammation and given a score from 0 to 3


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AppearanceBleedingInflammationScore

NormalNoNone0

Slight change in color

and mild edema with

slight change in texture

NoMild1

Redness, hypertrophy,

edema and glazingOn probingModerate2

Marked redness,

hypertrophy, edema

and ulceration

SpontaneousSevere3


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InterpretationInterpretation

AverageGingivalIndex

No inflammation< 0.1

Mild inflammation0.1 1.0

Moderate inflammation1.1 2.0

Heavy inflammation2.1 3.0


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Examples

Mild inflammation Score 1

Sever inflammation Score 3

Moderate Inflammation Score 2


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CALCULUS INDEX

The calculus component of the periodontaldisease index (PDI) by Ramjford:

CriteriaScore

Absence of calculus0

Supragingival calculus extending only slightly

below free gingival margin (not more than 1

mm)

1

Moderate amounts of supra-gingival and sub-

gingival calculus or sub-gingival calculus

alone

2

Abundance of supra-gingival and sub-gingival

calculus3


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TEETH MOBILITY

Mobility beyond the physiologic range is abnormal

Mobility assessment (Miller Index):

CriteriaDegree

No movement noted clinicallyN

Mobility in both buccal and lingual directions

less than 1 mm1

Mobility in both buccal and lingual directions1 mm or more2

Mobility more than 1 mm in a buccolingualdirection as well as apico-occlusal direction3


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CLINICAL ATTACHMENT LEVEL (CAL)

It is the distance between the base of the

pocket and the CEJ

Two measurements are recorded using aperiodontal probe. The first is the probing

pocket depth (PPD) from the base of the pocket

to the gingival margin

The second measurement is from the gingival

margin to the CEJ


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If the gingival margin is apical to the CEJ,the two measurements are added together:


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If the gingival margin is coronal to the CEJ(i.e. CEJ is hidden), the attachment level is

calculated by subtracting the measurement

from the gingival margin to CEJ form the

probing pocket depth


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If the gingival margin is at the CEJ level, the

CAL is the same as the probing depth


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Probing Depth Measurement

Probes

Direction

Force

Illumination

Drying


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BLEEDING ON PROBING (BOP)Important indicator of gingival health

Even with no increased probing depth, BOP

indicates inflammationsRecorded after probing

Six sites per tooth

Designated by red dot


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FURCATION

Nabers probe


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Classification (Glickman,1953 )

Grade I

Incipient, early stage

Pocket is suprabony Mainly affects soft tissue

No radiographic changes

Grade II Cul-de-sac

More than a defect in the same

tooth do NOT communicate

+/- radiographic changes

VV


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Grade III Bone not attached to the dome of the defect

Probe may/may not pass through the

furcation

Add buccal & lingual dimensions,if >buccolingual dimension of the tooth, it

is grade III


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Grade IV Interradicular bone destroyed

Soft tissue recession furcation clinically

visible

A tunnel between the roots Probe passes trough the defect


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