Dr.

Wesam Azar JUST

WHY ??
* Frameworks to study the etiology and
pathogenesis

* Help establish diagnosis, determine prognosis,

and facilitate treatment planning

* Way of communicating in a common language

Signs and symptoms are confined to the gingiva

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

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

Reversibility of the disease by removing the etiology(ies)

Gingival Diseases
Extent :
Localized gingivitis:

Generalized gingivitis:

Gingival Diseases

Distribution:
Marginal gingivitis:

Diffuse gingivitis:

Gingival Diseases Severity

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 periodontitis or chronic adult periodontitis

Chronic Periodontitis
Distribution & Severity:

*Extent

* Localized <30% of sites affected * Generalized >30% of sites affected

*Severity:

* Mild: 1-2 mm CAL * Moderate: 3-4 mm CAL * Severe: 5 mm CAL

Chronic Periodontitis

How to write the diagnosis statement:

Extent + Severity + Chronic Periodontitis

*Localized mild/moderate/sever chronic periodontitis

*Generalized mild/moderate/sever chronic periodontitis

Chronic Periodontitis

Aggressive Periodontitis
Definition: A specific type of periodontitis with clearly identifiable clinical and laboratory findings that make it sufficiently different from Chronic Periodontitis

Aggressive Periodontitis

Localized Aggressive

Generalized 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 proximal attachment loss affecting at least three teeth other than first molars and incisors

Localized Aggressive Periodontitis

Generalized Aggressive Periodontitis

Characteristics of a healthy periodontium

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 alveolar bone crest 0.75-1.49mm below the cemento-enamel junction.

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

Extra Oral Examination

Inspection, palpation

Face and Lips.

Muscles of Mastication. Lymph Nodes.

Intra-Oral Examination
Examination of lining mucosa

Examination of the teeth: - Caries, restorations, crowns and bridges. - Overhanging restorations, open contacts. - Plaque and calculus. - Staining. - Assessment of occlusion.

Comprehensive Periodontal Assessment

Intensive 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 of Alveolar Bone Loss Presence of Local Contributing Factors

Plaque index

Silness and Le (1964).

28

Gingival Inflammation
Gingival index (Le and Silness1964).
Score 0 Description Normal gingival, no inflammation, no discoloration, no bleeding

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

bleeding

2 3

Moderate inflammation, erythema, swelling, bleeding on probing Severe inflammation, severe erythema and swelling, tendency toward spontaneous Hemorrhage, some ulceration

Bleeding on Probing
Insertion of probe to the bottom of pocket elicits bleeding in inflamed gingiva Non inflamed sited rarely bleed
Absence of bleeding an excellent predictor of periodontal stability

Purulent Exudate
appear at the gingival margin after digital pressure on the lateral aspect of the gingival margin.

Probing Depth
Distance between the free gingival margin and the base of the gingival crevice/pocket.

Probing Depth
Basic Principles Keep parallel to long axis of tooth Walk the probe If calculus is present go around it Apply no more than 20g of pressure Round to the nearest high millimeter
E.g. 3.5 mm will be 4 mm

Probing Depth
Six-point charting

Record readings greater then 3mm except when recession is present (record all readings)

Probing Depth

Gingival Recession

35

Apical migration of the gingival margin. Measured as the distance between CEJ and GM

Gingival Recession
(Miller Classification 1985)

No loss of Interdental papilla Not extend to the MGJ

No loss of Interdental papilla extend to the MGJ

loss of Interdental papilla extend to the MGJ

loss of bone & soft tissue around the entire tooth with open interdental area

Attachment Level
Is expressed as the distance from the cemento-enamel junction to the bottom of the pocket.

Attachment Level

CAL = PD

CAL = PD Overgrowth

CAL = PD + Recession

Width of Attached Gingiva

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

Width of Attached Gingiva

Keratinized gingiva less than 3 mm put *

41

Tooth Mobility
Movement of tooth in a facial to lingual direction

Tooth Mobility
Miller Index

43

Furcation Involvement
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
The site and extent must be recorded Degree 1: probe enters the furcation up to 1/3 the width of the
tooth

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

Furcation Involvement

Class I

Class II

Class III

Class IV

Glickman classification

Guidelines for completing the Periodontal Worksheet

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).

III

II

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

Saunders 2006

10th edition
Ch 7, 35

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