Professional Documents
Culture Documents
Tutorial 1
Introduction to Periodontal
Examination
Dr C Gonzales-Marin
c.gonzalesmarin@qmul.ac.uk
Learning Outcomes
You should be able to:
Discuss the scores of the BPE and the related indication for
treatment
Recognise when to carry out a full-mouth periodontal
examination based on the BPE scores
Describe step-by-step how to complete a full-mouth
periodontal examination
Correctly identify anatomical references to measure probing
depth, recession and clinical attachment loss
Describe the classification for tooth mobility and furcation
and how to record this in a full-mouth periodontal chart
Cont
nd
2 Part
Discuss the role of a full-mouth periodontal chart to help
determine the correct diagnosis in conjunction with the
patients history, risk factors for periodontal disease and
radiograph
Discuss the importance of monitoring plaque and
bleeding scores as part of the periodontal treatment
Discuss the aims of a review session and making
arrangements for appropriate recall time
HISTORY TAKING
COMPLAINT OF
HISTORY OF PRESENT
COMPLAINT
MEDICAL HISTORY
SOCIAL HISTORY
PAST DENTAL HISTORY
EXAMINATION
EXTRAORAL EXAM
INTRAORAL EXAM
Soft tissues: description
Hard tissues: charting/
occlusion
Periodontal tissues: gingival
characteristics, OH, BPE
DIFERENTIAL DIAGNOSIS
SPECIAL INVESTIGATIONS:
Radiographs, full mouth
periodontal chart, vitality
test and palpation (ENDO),
impressions (PROS), baseline
plaque and bleeding scores
DEFINITIVE DIAGNOSIS
PROGNOSIS
TREATMENT PLANNING
(Em.; Stabiliz.+Review; Rest.)
D&T:
Periodontal Diagnosis Periodontal Treatment Review
Periodontal Maintenance RECALL
Mobile teeth
SMOKING
Cigarette smoking is the 2nd most important Risk
Factor in periodontal disease.
Exposure time and quantity
When, How many, How long?
INTRAORAL
EXAMINATION
What is periodontal
health?
Disease
Health
Describe gingiva
Systematic approach
1. Colour
2. Size
3. Shape
4. Contour
5. Consistency
6. Surface texture
7. Position
* Transition 4_ Tutorial 1
Localized, diffuse, intensely red area facial of UR2 and darkpink marginal changes in remaining anterior teeth
Gingivitis
vs
Periodontitis
BPE
Score
Disease
Treatment
No disease
No need
Bleeding
OHI
Pocket >3.5
OHI, RSD
Pocket >5.5
OHI, RSD,
assess need
complex tx,
referral?
Furcation
=4
PERIODONTAL
LIGAMENT
CEMENTUM
ALVEOLAR
BONE
Measurements Recorded
Measurements are
recorded for six specific
sites on each tooth.
INTERPROXIMAL
READINGS
Limitations of Measurements
Various factors can affect accuracy and
repeatability of measurements:
Position of gingival margin
Interference from calculus deposits,
overhanging restorations
Amount of pressure applied
Misread probe calibrations
Probe position in healthy and diseased
pockets
CONCEPT 2: Recession
Measurement of the Gingival margin
(GM-CEJ)
Recession
Recession ?
Recording Positive(+) or
Negative (-)
When recording recession of the gingival margin, think:
How much gingival tissue would be added (+) to return
margin to normal position?
When recording gingival margin that covers CEJ, think:
How much gingival tissue would be taken away (-) to return
margin to normal position?
Example: Mr Smith
Tooth A
What is the probing
depth?
What is the GM-CEJ
distance?
What is the CAL?
Tooth B
What is the probing
depth?
What is the GM-CEJ
distance?
What is the CAL?
Tooth C
What is the probing
depth?
What is the GM-CEJ
distance?
What is the CAL?
Bleeding
score
vs.
Bleeding
on probing
Mobility- technique
Classification of Mobility
Class 1
Class 2
Class 3
Furcation
Furcation Anatomy
Furcation entrance and where
to measure from
Nabers Probe
3
OBS: Consider that 1st clear band
of Nabers probe measures 3mm
Full-Mouth Periodontal
Examination (6PPC)
Step-by-step
Highlight or circle the POCKETS, or use a colour code to help understanding the problem
In the example: Mild= yellow (4mm) Moderate = pink (5-6mm) Severe= orange (7+)
v
5 date
123
4 ...
3 date 123
6 date
. .
123
123
456 789
No mobility [or]
date
date
date
Highlight the
pockets
PRACTICAL
FMPC - Lab1/Clinic1
Learning Outcomes
By the end of the session you should be able to:
Demonstrate the correct use of a Williams probe to measure
the probing depth at 6 sites around each tooth
Identify factors that can affect the accuracy of periodontal
probing
Demonstrate the technique for assessing tooth mobility and
furcation
Demonstrate how to describe and interpret the information
collected through a full-mouth periodontal examination
Perform a full-mouth periodontal examination in your clinical
partner
Individually:
Sign attendance, log-in to QMplus tutorial, prepare your bay (15 min)
BPE Exam (10 minutes)
Self-Assessment Form: Full-Mouth Periodontal Chart (60min)
BPE
Williams probe
Full-Mouth Periodontal Chart
Clinical Attachment Loss
Tooth mobility
Furcation Involvement
Knowledge/Practical
Knowledge/Practical
Knowledge
Knowledge
Knowledge
Practical
Practical
Knowledge
Knowledge
Knowledge/
Practical
Practical
Please
remember