Classfication of Periodontal Examination Charting

8/13/2019 Classfication of Periodontal Examination Charting

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Dr. Wesam Azar

JUST


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WHY ??

*Frameworks to study the etiology and

pathogenesis

*Help establish diagnosis, determine prognosis,

and facilitate treatment planning

*Way of communicating in a common language


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Signs and symptoms are confined to the gingiva

No attachment loss or on a periodontium withattachment loss that is not progressing

The presence of dental plaque to initiate and /orexacerbate the severity of lesion

Reversibility of the disease by removing theetiology(ies)


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Gingival Diseases

Extent :

Localized gingivitis:

Generalized gingivitis:


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Gingival Diseases

Distribution:

Marginal gingivitis:

Diffuse gingivitis:


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Gingival Diseases

Severity


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Chronic Periodontitis

Definition:

An infectious disease resulting in inflammation

within the supporting tissues of the teeth,progressive attachment and bone loss.

Replaces the older term adult periodontitisor chronic adult periodontitis


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Distribution & Severity:

*Extent* Localized 30% of sites affected

*Severity:*Mild: 1-2 mm CAL*Moderate: 3-4 mm CAL

* Severe: 5 mm CAL


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How to write the diagnosis statement:

Extent + Severity + Chronic Periodontitis

*Localized mild/moderate/sever chronic periodontitis

*Generalized mild/moderate/sever chronic periodontitis


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Aggressive Periodontitis

Definition:

A specific type of periodontitis with clearly

identifiable clinical and laboratory findings

that make it sufficiently different from



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Aggressive Periodontitis

Generalized AggressiveLocalized Aggressive

Attachment loss on at least two

permanent teeth, one of which

is a first molar and involving no

more than two teeth other than

first molars and incisors

Generalized proximalattachment loss affecting at

least three teeth other than first

molars and incisors


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Localized Aggressive Periodontitis


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Generalized Aggressive Periodontitis


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Pink, firm gingiva, with a knife edge gingival

margin, no signs of redness or edema.

Intact periodontal ligament with no attachment

loss.

Cementum covering the root surface with

inserting sharpeys fibers.

No alveolar bone loss with the level of alveolarbone crest 0.75-1.49mm below the cemento-enamel

junction.

Characteristics of a healthy periodontium


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Periodontal Screening Examination

Demographic information: Name, Date of Birth, Gender,

Occupation ..

C/C

History Medical history

Dental History

Family History

Smoking

Oral hygiene measures

Examination

Visual vs. Instrumentation


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Inspection, palpation

Face and Lips.

Muscles of Mastication.

Lymph Nodes.

Extra Oral Examination


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Examination of lining mucosa

Examination of the teeth:- Caries, restorations, crowns and bridges.

- Overhanging restorations, open contacts.

- Plaque and calculus.

- Staining.

- Assessment of occlusion.

Intra-Oral Examination


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Comprehensive Periodontal ssessmentIntensive clinical periodontal evaluation used to gather

information about the periodontium.

Oral Hygiene

Gingival Inflammation Probing Depth

Attachment level

Bleeding on Probing Presence of Exudate

Level of the free gingival

Margin

Mucogingival Junction

Tooth Mobility Furcation Involvement

Occlusion

Radiographic evidence ofAlveolar Bone Loss

Presence of Local

Contributing Factors


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Plaque indexSilness and Le (1964).

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Gingival Inflammation

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Score Description

0 Normal gingival, no inflammation, no discoloration, no bleeding

1 Mild inflammation, slight color change, mild alteration of gingival surface, no

bleeding

2 Moderate inflammation, erythema, swelling, bleeding on probing

3 Severe inflammation, severe erythema and swelling, tendency toward

spontaneous Hemorrhage, some ulceration

Gingival index (Le and Silness1964).


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Bleeding on Probing

Insertion of probe to the bottom

of pocket elicits bleeding in

inflamed gingiva

Noninflamed sited rarely bleed

Absence of bleeding an excellent

predictor of periodontal stability


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Probing Depth

Distance between the free gingival margin and thebase of the gingival crevice/pocket.
http://upload.wikimedia.org/wikipedia/commons/d/d3/Periodontalprobes09-09-2005.jpg


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Six-point charting

Record readings greater then 3mm except when recession

is present (record all readings)

Probing Depth


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Probing Depth


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Apical migration of the gingival margin.

Measured as the distance between CEJ and GM

Gingival Recession


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Gingival Recession

(Miller Classification 1985)

No loss of Interdental papillaNot extend to the MGJ

No loss of Interdental papillaextend to the MGJ

loss of Interdental papilla

extend to the MGJ

loss of bone & soft tissue around the

entire tooth with open interdentalarea


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Is expressed as the distance from the cemento-enamel

junction to the bottom of the pocket.

Attachment Level


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Attachment Level

CAL = PD CAL = PDOvergrowth CAL = PD + Recession


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Width of Attached Gingiva

Attached gingiva (AG) = Keratinizedgingiva(KG)free gingiva (PD)


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Width of Attached Gingiva

Keratinized gingiva less than 3 mm put *

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Movement of tooth in a facial to lingual direction

Tooth Mobility


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Tooth Mobility

Miller Index

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Extension of bone loss between

roots of teeth

broad term bifurcation of the mandibular

molars or maxillary premolars

trifurcation of the maxillary molars

The extent of involvement is

determined by exploration with a

curved probe (Naber's probe).

Furcation Involvement
http://upload.wikimedia.org/wikipedia/commons/d/d3/Periodontalprobes09-09-2005.jpg


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The site and extent must be recorded

Degree 1: probe enters the furcation up to 1/3 the width of thetooth

Degree 2: probe enters the furcation > than 1/3 but not the total

width of the tooth

Degree 3: a horizontal through and through destruction

Hamp et al 975



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Class IClass II

Class III Class IV

Glickman classification

Guidelines for completing the


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Write your name on top of sheet.

Start with PI and GI. If an indexed tooth is missing either choose an adjacent

one or the opposite side of same arch.

PD at deepest site, PD > 3mm , except when recession or if KG < 3mm.

Use color code. For BOP, place a red dot at bleeding site where PD is documented.

For recession, draw it with a red line

Calculate the CAL

Mobility value (I-III) is printed on occlusal surfaces of mobile teeth.

For furcation involvement use a red pencil and the following codes: Grade I:

Grade II:

Grade III and IV:

KG < 3 mm: draw an at root involved (Facial usually).

Guidelines for completing thePeriodontal Worksheet


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III II I


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ReferenceClinical Periodontology

Michael G Newman, Henri H. Takei, Fermin A. Carranza; Saunders WB.

Saunders

2006

10th edition

Ch 7, 35


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Classfication of Periodontal Examination Charting