Sissy Kicklighter

Perio HW 2/23
Syllabus
1. Define Clinical periodontal assessment.
A fact-gathering process designed to provide a comprehensive picture of the
patients periodontal health status.
2. List and discuss the 2 types of periodontal assessments commonly used.
Periodontal screening- A periodontal screening exam is a rapid and efficient
information gathering process used to determine if a patient has health, gingivitis,
or periodontitis.
Comprehensive Periodontal screening An intensive information gathering process
used to gather detailed data needed to make a periodontal diagnosis and to
document the periodontal health status to allow for long term monitoring of the
patient.
3. Discuss the responsibilities and legal consideration of the periodontal
assessment.
Legal Considerations: Standard of Care
Dentist and Dental Hygienist have a legal responsibility to complete an accurate
and thorough periodontal assessment on every patient.
4. Discuss the PSR Screening Exam.
The PSR can help to identify those patients who need a comprehensive periodontal
assessment. The results of this screening exam are used to separate patients into
broad categories: those that have periodontal health, gingivitis or periodontitis.
5.

Name the components of a comprehensive periodontal assessment

Probing depth measurements, Bleeding on probing, Presence of exudates,

Level of free gingival margin
6. Describe how to assess each component of a comprehensive periodontal
assessment.
A. Probing depth measurements are made from the free gingival margin to
the base of the pocket.
B. Bleeding on Probing bleeding on gentle probing represents bleeding from
the soft tissue wall of a periodontal pocket where the wall of the pocket is
ulcerated.

C. A6C, Exudate- sometimes referred to as suppuration, is pus that can be

expressed from a periodontal pocket.
D. A6D, Level of free gingival margin: in health is found slightly coronal to
CEJ. In swelling or overgrowth of gingival, the FGM will be significantly
coronal to CEJ. If the FGM is apical to CEJ, this is called recession, and
some of the root is exposed.
E. d. Level of free gingival margin- Level of Mucogingival junction- represents
the junction between the keratinized gingiva and the nonkeratinized
mucosa the level of the MJ is used in determining the width of the
attached gingiva as will be described in fourth section.
F. e Tooth mobility and fremitus:
Horizontal- movement of the tooth in a facial to lingual direction, is
assessed by trapping the tooth between two dental instrument handles.
Vertical- the ability to depress the tooth in its socket, s assessed using the
end of an instrument handle to exert pressure against the occlusal or
incisal surface of the tooth.
a) Probing depth: round up measurements to the next higher mm if ex if
reading is 3.4mm we would record 4mm , the are recorded in six specific sites
such as distofacial, middle facial, mesiofacial, distolingual, middle lingual, and
mesiolingual.
b) Bleeding on probing: bleeding could occur immediately after inserting
probe , this will alert the clinician to observe each site for a few seconds
before moving to the next site. Make sure probiong pressure is between 10
and 20 g of pressure.
c) Exudate: pus that can be expressed from the periodontal pocket ,
composed mainly from dead white blood cells and occurs in sites of infection
and periodontal disease.
d) Level of free gingival margin: if it is coronal to the CEJ due to swelling ,
overgrowth and increase in fibrous connective tissue. If is apical to the CEJ
that is known as recession .
e) Level of mucogingival margin: represents the junction between the
keratinized gingiva and non keratinized mucosa this is use to determined the
width and the attached gingiva.
f)Tooth mobility and fremitus: movement of the teeth could be horizontal
moibility facial to lingual or vertical ability to depress the tooth in its socket.
Fremitus is the palpable or visible movement of a tooth when is in function
assess by placing finger against the facial aspect of the tooth.

g) Furcation involvement: probe is used to assess furcation involvement in

multirooted teeth this probes are curved and blunt-tipped to allow easy
access to the furcation areas.
h) Presence of plaque and calculus : this should be noted during the
assessment. Visual examination and tactile examination
I. Gingival inflammation
record overt signs of inflammation; erythema (redness), edema (swelling),
changes in color and contour such as red, bluish-red, purple; enlarged,
swollen; rolled, bulbous, blunted
J. Radiographic evidence of alveolar bone loss
alveolar bone loss is evident in patient's radiographs
K. Presence of local contributing factors
dental calculus, faulty restorations, developmental defects, dental decay, patient
habits, occlusal trauma
7. Calculation of the width of attached gingiva is determined by measuring the
gingiva from free gingival groove to the beginning of the mucogingival junction, and
subtract the probing depth of the sulcus.
8. Clinical attachment level is measured by using the probe to indicate the depth
between the FGM to the base of the sulcus or pocket.
9. Supplemental diagnostic test: Tests related to bacteria, tests that analyze gingival
crevicular fluid content, and tests for genetic susceptibility to periodontal tisease.
B13. Discuss the treatment and preventive measures involved in periodontal
occlusal trauma.
Changes are reversible if trauma is removed and treatment can involve a night
guard or occlusal adjustment
B14. Discuss temporomandibular disorders as related to the periodontium.
-Parafunctional occlusal forces result from tooth-to-tooth contact made when not
chewing such as clenching and grinding
Book
Ch. 17

1. The three major categories of periodontitis.

Chronic, aggressive, and less common types of periodontitis.
2. The systemic or genetic factors that may contribute to the initiation and
progression of periodontitis.
leukemia, aids/HIV, acquired neutropnia, familial and cyclic neutropenia,
downs syndrome, leukocyte adhesion deficiency syndromes, papillon-lefevre
syndrome, chediak-higashi syndrome, glycogen storage disease, infantile
genetic agranulocytosis, cohen syndrome, ehlers-danlos syndrome,
hypophosphatasia.

3. Describe the impact of PMN (neutrophils) dysfunction.

Occurs in patients of any age, seen in young children beginning with the
eruption of primary teeth. Characterized by severe bone loss and tooth loss,
associated with systemic conditions that interfere with the bodys resistance
to bacterial infection, previously known as generalized prepubertal
periodontitis.

4. Define necrotizing periodontal diseases and describe associated tissue damage.

It is an inflammatory destructive infection of periodontal tissues that involve tissue
necrosis. Both NUG and NUP are painful infections with ulceration, swelling and
sloughing off of dead epithelial tissue from the gingiva.
5. Compare and Contrast clinical findings of necrotizing ulcerative gingivitis and
Necrotizing Ulcerative Periodontitis.
NUG- Tissue necrosis that is limited to the gingival tissues
NUP- Tissue necrosis that the gingival tissues combined with loss of attachment and
alveolar bone loss.
NUP is painful infection characterized by necrosis of gingival tissues, periodontal
ligament, and alveolar bone. Is extremely rapid and destructive form of
periodontitis that can produce loss of periodontal attachment within days. Box 17.7
and 17.8
6. Compare and Contrast tissue destruction in chronic periodontitis and Necrotizing
Ulcerative Periodontitis.

NUP is painful infection characterized by necrosis of gingival tissues, periodontal

ligament, and alveolar bone. Is extremely rapid and destructive form of
periodontitis that can produce loss of periodontal attachment within days.
Necrotizing periodontal disease is painful infection, primarily involving the
interdental and marginal gingiva. Characterized by ulcerated and necrotic papillae
and gingival margins, giving the appearance that he papillae and gingival margins
have been punched-out or cratered. The ulcerated margin is bounded by a red
halo.

7. Identify factors that may contribute to the initiation and progression of

periodontitis
Necrotizing periodontal disease is painful infection, primarily involving the
interdental and marginal gingiva. Characterized by ulcerated and necrotic papillae
and gingival margins, giving the appearance that he papillae and gingival margins
have been punched-out or cratered. The ulcerated margin is bounded by a red
halo.
9. Define secondary occlusal trauma and explain how it can lead to rapid bone loss.
Secondary occlusal trauma- is injury as the result of occlusal forces applied to a
tooth or teeth that have previously experience attachment loss and or bone loss. In
this type of occlusal trauma, the periodontium was unhealthy before experiencing
excessive occlusal forces.
Chapter 18:
1. Educate patients at risk for cardiovascular diseases about the possible impact of
periodontal infection on cardiovascular heath and encourage oral disease
prevention and treatment services. Chart 18.1 18.2
2. Educate pregnant women and those planning pregnancy regarding th possible
impact of periodontal infection on pregnancy regarding the possible impact of
periodontal infection on pregnancy outcomes and encourage preventive oral care
and treatment services. Chart 18.3
3. Educate patients with diabetes about the probable bidirectional association
between periodontal disease and diabetes and encourage oral disease prevention
and treatment services. Chart 18.4
4. Educate family members and caregivers about the association between
periodontal disease and pneumonia in health compromised seniors residing in
hospitals and long term care.

Pneumonia its cause by the inhalation of microorganism, this infections of the lungs
is contracted during a stay in the hospital, this is a result from organisms call PRPs
(potential respiratory pathogens) generally found in the GI tract . it tends to be
more serious because during the hospital stays the defend mechanisms against
infection are often impaired , periodontitis and poor oral health with long term stays
especially in patients that are quite ill.
Ch 19:
1. Explain which members of the dental team are resposable for the clinical
periodontal assessment.
The dentist and the dental hygienist share the responsibility for periodontal
screening. The dentist is responsible for the assignment of the diagnosis and
with the hygienist input the dentis plans the nonsurgical periodontal therapy.
2. Compared and contrast a periodontal screening examination and a
comprehensive periodontal assessment.
Periodontal screening examination determines the periodontal health status
of the patients , and efficient , easy-to-use screening system for detection of
periodontal disease using the color-coded reference mark and identifies the
need for a more comprehensive periodontal assessment. Comprehensive
periodontal assessment is the intensive clinical periodontal evaluation used
to gather information about the periodontium major components are probing
depth and bleeding on probing.
3. Describe hot to perform one type of periodontal examination.
Periodontal screening examination: probe is walked circumferentially around
each tooth in the sextant being examined , colored coded reference mark is
monitored continuously as the probe is walked around each tooth. Code mark
reference will be a) completely visible, b) partially visible, or c) not visible at
all.
Chapter 19
4. Name the components of a comprehensive periodontal assessment
- Probing depth measurements
- Bleeding on probing
- Presence of exudate
- Level of free gingival margin
5. Describe how to evaluate each component of a comprehensive periodontal
assessment

- Probing depth measurements: measurements are made from the free

gingival margin to the base of the pocket
- Bleeding on probing: bleeding on gentle probing represents bleeding from
the soft tissue wall of a periodontal pocket where the wall of the pocket is
ulcerated
- Presence of exudate: pus that can be expressed from a periodontal pocket.
Pale yellow or oozing from the orifice of a pocket
- Level of free gingival margin: Calculate level of FGM in relationship to CEJ.

6. Explain how to calculate width of attached gingiva

- Measure the width of the gingiva (gingival margin to the mucogingival
junction) and subtract the probing depth from the total width
7. Explain how to calculate clinical attachment level given several different
clinical scenarios
1. Recession of the gingival margin: Distance between CEJ and gingival
margin
2. Gingival margin significantly coronal to CEJ: estimate distance between the
margin and CEJ by positioning the tip of the probe at a 45 degree angle to the
tooth, slowly move probe beneath the gingival margin until the junction
between the enamel and cementum is detected, measure the distance
between the gingival margin and the CEJ.