Term
| What is the Clinical Periodontal Assessment used for? |
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Definition
| a fact gathering process that provides a comprehensive picture of the patient's periodontal health status |
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Term
| What is one of the most important functions performed by the clinician? |
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Definition
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Term
| What does the information gathered during the CPA help us form? |
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Definition
| the basis of the individualized treatment plan for the patient |
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Term
| What are the objectives of the CPA?(4) |
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Definition
-look for signs of inflammation and damage to periodontium
-determine health or disease in periodomtium
-collect data to assign periodontal diagnosis
-collect baseline data for long term monitoring of perio disease activity |
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Term
| What is the dental hygienist's responsibilities when it comes to perio? |
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Definition
-periodontal screening and CPA
-treatment planning and nonsurgical therapy |
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Term
| What do dentist and DH's have a legal responsibility to do? |
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Definition
| to complete an accurate and through periodontal assessment on every patient |
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Term
| Failure to do what can lead to malpractice claims? |
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Definition
| failure to diagnose perio disease |
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Term
| Who has the LEGAL responsibility for treatment planning and diagnosing? |
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Definition
| the dentist, we can only give a Dh diagnosis(which is pretty much an intrepretation) |
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Term
| When is the perio assessment complete? |
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Definition
| when all of the information gathered has been accurately recorded in the patient chart |
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Term
| What does documentation measure? (over all) What does it monitor? |
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Definition
measures-treatment outcomes(prognosis)
monitors- periodontal health status over time |
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Term
| What serves as baseline data? |
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Definition
| findings documented during initial clinical perio assessment |
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Term
| What is baseline data used in? |
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Definition
| long term monitoring of the patient's perio health status Ex: are pockets getting deeper than initial reading? |
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Term
| What are the two types of perio assessments? |
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Definition
1. PSR
2. Comprehensive periodontal assessment(CPA) |
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Term
| Who was the PSR developed by? |
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Definition
| -ADA and American academy of periodontology |
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Term
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Definition
-determines periodontal health status of the patient
-helps identify those patients needing a more comprehensive perio assessment |
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Term
| What does someone's CAL have to be in order for them to be considered in active disease? |
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Definition
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Term
| What are the two categories the results of the PSR separate patients into? |
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Definition
1.periodontal health or gingivitis(no further assessment needed)
2.periodontitis (comprehensive perio assessment needed) |
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Term
| What does a comprehensive perio assessment tell us? |
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Definition
| the extent and severity of the periodontitis |
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Term
| What type of probe is used for the PSR? What is it like? |
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Definition
| WHO probe (world health organization probe), color coded reference mark between 3.5-5.5 mm |
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Term
| How are the results of the PSR recorded? |
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Definition
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Term
| How many codes do you get when doing a PSR on a patient? |
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Definition
| 6 total, one for each sextant |
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Term
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Definition
| no bleeding, calculus, marker is completely visible |
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Term
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Definition
| some bleeding upon probing, no calc, marker completely visible |
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Term
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Definition
| marker is completely visible, calculus present, defective margins |
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Term
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Definition
| marker is partially visible |
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Term
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Definition
| marker is no longer visible(completely in pocket) |
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Term
| What does a * in PSR scoring indicate? |
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Definition
| a muccogingival defect, mobility, furcation, recession |
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Term
| Which code do you have to get before you are required to stop and complete a comprehensive perio exam? |
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Definition
| two code 3 scores or one code 4 |
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Term
| What is a comprehensive periodontal assessment? |
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Definition
| an intensive clinical periodontal assessment used to gather information about the periodontium |
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Term
| What do we need to remember about probing depths? |
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Definition
| depth recorded may be more than histologic depths due to penetration or infmalled tissue(not always perio) |
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Term
| What are some factors that effect probing depths? |
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Definition
-force used
-size of probe
-placement and angulation
-type of probe
-tooth anatomy |
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Term
| What does a probing depth measure? |
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Definition
| from free gingival margin to base of the pocket(JE) |
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Term
| Where is the normal position of the JE? |
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Definition
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Term
| What should you do if you get a half number on a probing depth? How many numbers are recorded for each tooth? |
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Definition
-round UP the the next whole number
-six sites on each tooth |
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Term
| Where should the free gingival margin(FGM) usually be? |
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Definition
| slightly coronal to the CEJ(about 2 mm above) |
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Term
| What does a FGM significantly coronal to the CEJ indicate? |
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Definition
| gingival enlargement(edema) |
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Term
| What does a FGM at the CEj indicate? What about apically to the CEJ? |
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Definition
At CEJ-deviation from normal, early stages of attachment loss
Apical to CEJ-recession on gingival margin |
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Term
| What is clinical attachment loss(CAL)? |
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Definition
| pathologic destruction of gingival fibers with apical migration of the JE |
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Term
| What are the two components that must be considered to determine the CAL? |
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Definition
| gingival margin and probing depth |
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Term
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Definition
probe reading + or - how far the gingival margin is from the CEJ
-if above you subtract the number from the probe reading
-if below you add the number to the probe reading |
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Term
| How can you detect the CEJ with you probe when edema is present? |
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Definition
| probe, angle it out 45 degrees to the tooth, move probe up and down until you feel CEJ, measure from there |
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Term
| What is considered healthy position of the FGM? |
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Definition
| if you probe and get a reading of 1-3 mm, CAL will be zero |
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Term
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Definition
-gingival margin at CEJ= 0
-probing depth is 6
so 6-0=6 so the CAL= 6 |
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Term
| Another example of calculating CAL: |
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Definition
-gingival margin below CEJ= +2
-probing depth= 4
so 4+2= 6 CAL |
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Term
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Definition
| helps us accurately identify the level of periodontal attachment |
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Term
| What is always stable in recession or edema that provides a baseline for measurement? |
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Definition
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Term
| what is the muccogingival junction? |
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Definition
| junction between attached gingiva and alveolar mucosa |
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Term
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Definition
| because of color differences, alveolar mucosa is darker |
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Term
| Where are some areas where we want to examine the MGJ? |
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Definition
-frenum attachments
-gingival recession areas with minimal to no attached gingiva
-when base of the probe is at or beyond the MGJ |
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Term
| What is the attached gingiva? |
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Definition
| part that is firmly attached to underlying cementum and alveolar bone |
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Term
| What is the function of attached gingiva? |
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Definition
| to keep the free gingiva from being pulled away from the tooth(support) |
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Term
| What is the significance of attached gingiva? |
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Definition
-determine periodontal involvement
-restorative treatment planning |
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Term
| Where is the attached gingiva measured from? |
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Definition
| the base of the sulcus to muccogingival junction |
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Term
| where is the width of attached gingiva widest? Narrowest? |
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Definition
widest-anterior teeth
narrowest-premolar region |
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Term
| Where is the width of attached gingiva calculated for? (3) |
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Definition
-mand facial
-max facial
-mand lingual |
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Term
| What are the steps in measuring the attached gingiva? |
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Definition
1.measure total width of gingiva to MGJ
2.measure probing depth
3.subtract probing depth to get amount of attached gingiva! |
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Term
| What does bleeding upon probing indicate? |
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Definition
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Term
| Where does the blood come from? |
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Definition
| ulcerated soft tissue wall of periodontal pocket |
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Term
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Definition
| can be immediate or delayed |
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Term
| What thing that we do can cause bleeding? How can we prvent this? |
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Definition
| excessive force by us can cause bleeding, we need to only use 10-20 g of pressure |
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Term
| What is a blunted papilla an indication of? |
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Definition
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Term
| What is another term for exudate? |
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Definition
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Term
| What is pus made of? What does it look like? |
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Definition
| made of dead white blood cells, looks pale yellow and creamy, oozes out of pocket |
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Term
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Definition
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Term
| How is pus easiest to detect? |
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Definition
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Term
| How do you test horizontal tooth mobility? What is it? |
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Definition
| it is the movement of a tooth in a facial to lingual direction, use back of mirror and test stick(one on F and one on L) and push back and fourth to see if the tooth moves, use tooth next to it as a reference poitn |
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Term
| What is vertical tooth mobility? |
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Definition
| the movement of a tooth up and down in the socket |
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Term
| How many classes are in the mobility rating scale? |
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Definition
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Term
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Definition
| up to 1 mm horizontal displacement in facial-lingial direction |
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Term
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Definition
| greater than 1 mm but less than 2 mm of horizontal displacement in a facial-lingial direction |
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Term
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Definition
| greater than 2 mm horizontal displacement or ANY vertical displacement |
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Term
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Definition
| a palpable or visible movement(vibration) of a tooth when IN FUNCTION |
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Term
| How do you assess fremitus? |
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Definition
| place a gloved index finger against the facial of a tooth and have the patient tap teeth together or simulate chewing, feel for vibrations |
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Term
| What is furcation involvement? |
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Definition
| occurs on multirooted teeth when periodontal infection invades the bone around the roots |
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Term
| What does furcation involvement typically signals? |
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Definition
| the need for periodontal surgery |
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Term
| What is furcation involvement typically measured with? |
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Definition
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Term
| Which teeth are bifurcated? |
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Definition
-mand molars(buccal/lingial furcations)
-max 1st promolar(mesial/distal furcations) |
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Term
| Which teeth are trifurcated? |
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Definition
| maxillary molars(buccal, mesial, distal furcations) |
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Term
| What is the root trunk dimension? |
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Definition
| distance between the roof of the furca to CEJ |
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Term
| How many classes are involved in furcation classification? |
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Definition
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Term
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Definition
| curvature of 5concavity can be felt with probe tip, the probe penetrates no more than 1 mm |
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Term
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Definition
| probe tip penetrates into the furcation greater than 1 mm but does not pass through |
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Term
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Definition
| probe passes completely through the furcation but gingiv ais covering other side so you cannot clincially see it |
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Term
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Definition
| same as class II but entrance to furca is clinically visible because of recession of the gingival margin |
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Term
| What are the furcation class symbols for charting? |
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Definition
Class I= V
Class II- outline of a triangle, not colored in
Class III-triangle colored in
Class IV- Diamond colored in |
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Term
| Does calculus cause perio? |
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Definition
| it is a contributing factor for the disease but it does not cause it |
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Term
| How can you determine if calculus deposits are present? (3 ways) |
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Definition
1.direct visual examination
2.visually when using air
3.tactile examination |
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Term
| How can plaque be identified? |
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Definition
| with a disclosing solution |
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Term
| How do you calculate plaque indicies? |
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Definition
| (total number or surfaces with plaque divided by total number of tooth surfaces)x by 100 to get percent |
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Term
| What are the signs of inflammation we should record? |
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Definition
-erythemia
-edema
-changes in color and contour |
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Term
| What do we use as a supplemental assesment for bone loss with the CPA? |
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Definition
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Term
| CPA includes identification of... |
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Definition
| local contributing factors and systemic factors |
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Term
| What are some supplemental tests that can be done to determine severity of disease? |
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Definition
-bacterial tests
-analysis of gingival crevicular fluid
-genetic susceptibility tests |
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Term
| What are the three bacterial tests? |
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Definition
-phase contrast microscopy study
-culture and sensitivity(determine sensitivity of bacteria to antibiotics)
-DNA probe analysis (identify specific periodontal pathogens in a patients mouth) |
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Term
| What is crevicular flow like in health? |
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Definition
| slight in health, increases with disease |
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Term
| Where does crevicular fluid originate? |
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Definition
| in connective tissue and flows into pocket |
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Term
| What does crevicular fluid contain? |
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Definition
| markers for periodontal disease progression |
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Term
| Higher levels of what may predispose patients to more inflammation? |
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Definition
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