The Periodontal Examination

The Periodontal ExaminationHope you studiedComprehensive Perio ExamRequires understanding of the whole patientRFPDental HistoryFamily & Social HistoryOral HygieneSmoking History

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Medical HistoryCardiovascular/Circulatory (Infective Endocarditis)Bleeding Disorder(LA, Multiple appt.)Infective risks(Special IC measures)Allergic reactions (Latex, LA, medications)

4Symptoms of Periodontal DiseaseBleedingMobilityPain (Hypersensitivty/pulpal) Halitosis and bad tasteRecessionSwelling Signs of Periodontal Disease Gingiva Erythematous and swollen Recession Also helps identify ALOral Hygiene Levels of plaque and calculus Occlusal changes Drifting of teethMucogingival changes Biotype of gingivae, frenal attachments MigrationMobilityBleeding and SuppurationProbing depth Furcation

Bleeding on Probing Does not indicate disease severity or progression of the diseaseAbsence is a good predictive (98.5%) indicator of gingival stabilitySuppuration, or pus in pocket should also be recorded. Tiny drop/ Profuse bleeding and suppuration should be notedPeriodontal Probing Depth Inflammed tissue offers less resistance to perio probe penetration, deeper PD-Increased force on pocket = deeper PD-Depending on the gingival inflammation, the probe will stop at different points about the connective tissue attachment (Includes the gingival attachment and the PDL)-Due to probe force being non-standardised, probe depths are +/- 1.0mm-If no effort made to standardise probe force and consider level of inflammation, probe depths +/- 2.0mm

Attachment LossCalculated from PPD + Recession Less than 4mm = Mild-Moderate PeriodontitisMore than 4mm = Severe PeriodontitisFurcation Involvement Classified using Nabers probe/sickle explorerDegree I: Less than 1/3 tooth or horizontal probing depth of up to 3mm

Degree 2: 1 site with at more than 1/3 tooth or horizontal probing depth >3mm

Degree 3: Through-and-through destruction or 2 or more sites with > 1/3 tooth

MobilityMiller IndexDegree 0: Physiological mobility. 0.1-0.2mm mobility horizontallyDegree 1: Crown mobile up to 1mm horizontallyDegree 2: Crown mobile from 1-2mm horizontallyDegree 3: Crown mobile >2mm horizontally, moves vertically, may be rotated, depressed in socket, etc. Always consider CAUSE of mobility; perio, hyperocclusion, parafunction, etc.Special InvestigationsRadiographs* Plaque Index (and General Calculus)Percussion TestsOcclusal analysis Diagnosis GingivitisMild-Moderate PeriodontitisAdvanced/SeverePeriodontitis Furcation involvement Periodontitis PPD1-3mm, possibly Pseudopockets >3mm4-6mm6+BOPYesYesYesYesBL/ALNo AL or BLTends to have horizontal or angular bone loss. Infrabony lesions can be classed as 1,2 or 3 wall defects*Tends to have horizontal or angular bone loss. Infrabony lesions can be classed as 1,2 or 3 wall defects*N/A: Adjunctive diagnosis for multirooted teeth. Superficial if Degree 1 FI, else considered deep Questions?