PERIO 1. Introduction Part 1
Transcript of PERIO 1. Introduction Part 1
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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 periodontalexamination 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…
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2
nd
Part • Discuss the role of a full-mouth periodontal chart to help
determine the correct diagnosis in conjunction with the
patient’s 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
(WILL BE DELIVERED LATER THIS YEAR)
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RECAP from Transition 4:
History and Examination
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The Periodontal Patient
• HISTORY TAKING
• COMPLAINT OF
• HISTORY OF PRESENTCOMPLAINT
• 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 mouthperiodontal chart, vitalitytest and palpation (ENDO),impressions (PROS), baselineplaque and bleeding scores
DEFINITIVE DIAGNOSIS
PROGNOSIS
TREATMENT PLANNING
(Em.; Stabiliz.+Review; Rest.)
FOLLOW-UP (Maintenance Phase)
• RECALL
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H&E:
Assess Periodontal Health
and
Oral Hygiene Behavior
Aetiology of Periodontal Disease: Infection (plaque)
Pathophysiology: Inflammatory/Immune Reaction
• by taking relevant history,
• performing clinical examination
• results from special test (probing, mobility, radiographs, etc)
• recording and monitoring dental plaque
Periodontal Diagnosis Periodontal Treatment Review
Periodontal Maintenance RECALL
D&T:
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Most Common Periodontal C/O•C/O + HPC
Check- up (Perio Disease no signs or symptoms)
Bleeding gums
- Is it bleeding on brushing? Is it spontaneous?
- When it started?
- Do you feel any mobility? Is it increasing?- Do you notice any bad breath or bad taste?
- Did you notice that your gums are pulled away?
Gum recession
- When did it started?
- Do you have any sensitivity?
- How often do you brush your teeth?
- Review brushing technique
- Did you have “orthodontic” treatment before? (braces)
- Any bleeding on brushing/mobility?
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• Mobile teeth
• When this was noticed first?
• Is it increasing?
• Any specific tooth, more than one? Which ones?
• Change in position?
• Any bad breath or bad taste?
• Pain?
•
Any diagnostic of periodontal disease?• Any previous treatment? By who? When? What treatment?
• Does this prevent you from eating?
• Patient’s needs and desires for treatment
• Expectations for treatment outcome – aesthetics may be compromised
• Patient’s demands may not be congruent
• COMMUNICATION is important
• Specialist referral?
Discuss Patient’s Expectations
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Medical History and Perio
• Some systemic diseases, conditions or behavioural factors may play arole in the cause of the disease
• The presence of conditions may require special precautions ormodification of treatment
• Oral infections may have an influence on occurrence and severity ofsystemic diseases
• Check for:• Bleeding disorders: Anaemia
• Liver disease. eg. cirrhosis, impaired coagulation
• Diabetes. Increased risk factor for PD
• Cardiovascular diseases, HBP… medication?
• Drug-induced gingival hyperplasia:• calcium channel blockers: amlodipine, nifedipine
• Anticonvulsants (epilepsy): phenytoin
• Immunosuppressant: cyclosporine
• Hormone-related conditions and Pregnancy
•
Allergies
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Social History and Perio•
Priorities and attitude to dental care• Availability for treatment
• Problems attending many appointments, lengthyappointments
SMOKING
• Cigarette smoking is the 2nd most important RiskFactor in periodontal disease.
•
Exposure time and quantity• When, How many, How long?
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Family History and Perio
• Family history of periodontitis (Aggressive
Periodontitis)
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Past Dental History and Perio
• Signs and symptoms of periodontitis noted by the patient:• Tooth migration
• Increasing mobility of the teeth
• Bleeding gums
• Food impaction• Difficulties in chewing
• Frequency and duration of daily toothbrushing
• Knowledge about interdental cleansing and use of
mouthwash• Previous periodontal treatment and maintenance
• Use of prosthesis or need for one
• Previous or current orthodontic treatment
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INTRAORAL
EXAMINATION
What is periodontalhealth?
HealthDisease
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Healthy Gingival Tissues
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Describe gingiva
Systematic approach
1. Colour
2. Size
3. Shape
4. Contour
5. Consistency
6. Surface texture
7. Position
* Transition 4_ Tutorial 1
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Localized, diffuse, intensely red area facial of UR2 and dark-
pink marginal changes in remaining anterior teeth
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Generalized diffuse gingivitis involves the
marginal, papillary, and attached gingivae
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Discoloration of the gingiva caused by embedded
metal particles (amalgam)
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Gingival inflammation and enlargement associated with
orthodontic appliance and poor oral hygiene
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Gingival enlargement associated with phenytoin therapy. Note the
prominent papillary lesions and the firm, nodular surface
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Twelve-year-old female with a primary medical diagnosis of
leukaemia that exhibits swollen/spongy gingiva
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Clinical image of plaque-related moderate chronic
periodontitis with 3 to 4 mm clinical attachment loss in
53-year-old male smoker
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Gingivitis
vs
Periodontitis
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Screening for Periodontal
Disease
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BPE
Score Disease Treatment
0 No disease No need
1 Bleeding OHI
2 Plaque retentive OHI, remove
factors
3 Pocket >3.5 OHI, RSD
4 Pocket >5.5 OHI, RSD,
assess need
complex tx,
referral?
* Furcation = 4
WHEN DO WE NEED TO COMPLETE A 6PPC?
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BPE test in LAB!
(next week)
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Periodontal Attachment System
in Health
GINGIVA
PERIODONTALLIGAMENT
ALVEOLAR
BONE
CEMENTUM
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Position of the Gingival Margin
• In periodontitis, the
gingival margin may
remain near the CEJ.
• This creates a deep
periodontal pocket.
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Recession of Gingival Margin
• Gingival margin has
receded and tooth roots
are visible
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The gingiva can mask bone loss
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What to register in the 6PPC?
• Teeth not present
• Probing depth at 6 sites/tooth
• Recession
*Clinical Attachment Loss• Mobility
• Furcation
• Bleeding on probing (6 sites)
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Measurements Recorded
• Measurements are
recorded for six specificsites on each tooth.
FOR PROBING DEPTH
FOR RECESION
FOR BLEEDING ON PROBING
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Record the Deepest
Measurement
• In this example, the
deepest reading would berecorded for the facial
reading (yellow shade in
previous slide).
• That reading is the one
taken at point C.
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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
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CONCEPT 2: Recession
Measurement of the Gingival margin
(GM-CEJ)
Recession Recession ?
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1. Margin Slightly Coronal to CEJ
• The natural position of the
gingival margin in health
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2. Margin Apical to CEJ
• Seen on these three
anterior teeth
• Termed “recession”
• Common in periodontitis
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3. Margin Covers CEJ
• The gingival margin
significantly covers CEJ
•
Commonly seen ingingivitis caused by
medications (Gingival
hyperplasia)
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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?”
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CONCEPT 3: Clinical Attachment Loss
Measurement CAL = base pocket-CEJ
OR CAL= Probing depth + Recession
How
much
boneloss?
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• What is the probing
depth?
• What is the GM-CEJ
distance?
• What is the CAL?
Tooth B
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Tooth C
• What is the probing
depth?
• What is the GM-CEJ
distance?
• What is the CAL?
Bl di Bleeding
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Bleeding
score
• Bleeding score is a measurement
of inflammation at gingival margin
• It relates to the oral hygiene
status of the patient
• Ideal for OH control and
monitoring in long-term
Bleeding
on probingvs.
• Recorded as part of the 6PPC during probing
• Measure presence of inflammatory lesions located
at the base of the periodontal pocket
• Insertion of probe elicits bleeding if gingiva is
inflamed and the pocket epithelium is atrophic
or ulcerated.
• Red dot on top of PD measurement (at 6 sites/tooth)
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Mobility - technique
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Classification of Mobility
Class 1 Slight mobility, up to 1 mm of horizontal
displacement in a facial-lingual direction
Class 2 Greater than 1 mm but less than 2mm ofhorizontal displacement in a facial-lingual
direction
Class 3 Greater than 2 mm of horizontal displacementin a facial-lingual direction or vertical mobility
F i
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Furcation
Furcation Anatomy
Furcation entrance and where
to measure from
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Nabers Probe
Rating furcation involvement
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Rating furcation involvement
3
3
OBS: Consider that 1st clear band
of Naber’s probe measures 3mm
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Full-Mouth Periodontal
Examination (6PPC)
Step-by-step
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5
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6
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8
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8
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+)
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Name of the patient
date
date
date
123 456 789
date
date
date
123 123 123
No mobility [or] 1 2
v
. . . . . .
1
2
3
4
5
6
7
Highlight the
pockets
PRACTICAL
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PRACTICAL
FMPC - Lab1/Clinic1
Learning OutcomesBy 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
Bring your handbook!
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g y
Lab 1: Full-Mouth Periodontal Chart • WHEN: 8th and 12th December
MON 1-3pm/MON 3-5pm/FRI 9-11am/FRI 11-1pm
• WHERE: LABORATORY 3rd Floor
• 2 hour session/ 2 groups/ 2 tutors
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
• Clear-up your bays (10min)
•On-line Feedback
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Please
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Please
remember