Periodontal Assessments Part 1 PDF

Periodontal Assessments Part 1 Foundations in Clinical Skills and Practice Sarah Balian GDC Learning Outcomes Intended Learning Outcomes By the end of this session students should be able to:  Define the term probing depth  Revise components of periodontal probing  Revise the limitations o...

Periodontal Assessments Part 1 Foundations in Clinical Skills and Practice Sarah Balian GDC Learning Outcomes Intended Learning Outcomes By the end of this session students should be able to:  Define the term probing depth  Revise components of periodontal probing  Revise the limitations of periodontal probing  Explain the location and method of undertaking a six point pocket chart  Describe the locations of the free gingival margin  Explain how to measure the free gingival margin  Explain Clinical Attachment Level and its relevance in the periodontal assessment  Explain how to calculate clinical attachment levels Probing Depth The ‘probing depth’ is the distance from the gingival margin to the bottom of the pocket. Measured to the nearest millimeter by means of a graduated periodontal probe with a standardised tip diameter (0.4mm – 0.5mm) Why is probe diameter important? Healthy sulcus vs unhealthy sulcus Think way back when! Probe Limitations features Walking Ergonomics Grip Adaptation Angulation 6 Point Pocket Chart (Pre-treatment Periodontal Assessment) 1 Distobuccal line angle to midline of distal surface 2 Buccal surface 3 Mesiobuccal line angle to mesial surface 4 Distolingual line angle to distal surface 5 Lingual surface 6 Mesiolingual angle to midline of mesial surface What is the issue with the six points terminology? In this example, the deepest reading would be recorded for the buccal reading. Which one is it? A,B or C? I feel like we do the same site twice… What are the limitations/errors of probing? Keeps coming back! Have you consolidated the posters? Article: Periodontal probing: What does it mean? M. A. Listgarten 32 teeth 6 points = 210 pocket depths Free Gingival Margin Level of the free gingival margin Gingival margin Gingival margin Natural position (0) covers CEJ (-’ve) apical CEJ (+’ve) Determining Level of Free Gingival Margin apical to CEJ Reason: Recession Charted as a +‘ve number Determining Level of Free Gingival Margin – coronal to CEJ Distance between CEJ and gingival ‘-ve number’ margin Summary Zero (0) – normal state gingival margin is slightly coronal to CEJ Negative number (-’ve) gingival margin significantly covers CEJ Positive number (+’ve) gingival margin apical to CEJ What does this all mean & why do we need to decipher this information? Assess true periodontal support around the tooth Clinical Attachment Levels CAL Clinical attachment Levels (CAL) Measure of true periodontal support around a tooth CAL provides an estimate of true periodontal stability & loss of support for a tooth CAL is measured is made from a fixed point on the tooth that does not change and that is the CEJ CAL is critical in distinguishing between gingivitis & periodontitis Inflammation with no clinical attachment loss is characteristic of gingivitis Inflammation with clinical attachment loss is characteristic of periodontitis Calculating CAL What do we need? 1. Probing depth 2. Level of gingival margin Calculating CAL when gingival margin is at normal level Gingival margin at natural location Probing depth 6mm Gingival margin level 0 Clinical attachment loss 6mm Calculating CAL when recession is present Gingival margin apical to CEJ Probing depth 4mm Gingival margin level (+)2mm Clinical attachment loss 6mm Calculating CAL when gingival margin covers the CEJ Gingival margin covers the CEJ Probing depth 9mm Gingival margin level (-)3mm Clinical attachment loss 6mm Example of charting Image references Understanding Periodontal Pockets (deardoctor.com) https://dentagama.com/news/gingival-hyperplasia https://www.jisponline.com/viewimage.asp?img=JIndianSocPeriodontol_2014_18_4_516_138747_u2.jpg