Periodontal examintation

2. The main concerns of the patient
SYMPTOMS:
Gingival Bleeding, Pain and Swelling.
Tooth mobility.
Bad breath and taste.

3. Bleeding
Bleeding
During Tooth
Spontaneous
Spontaneous
Spontaneous During Mastication
During Mastication Tooth Brushing
Tooth Brushing
Mastication Brushing
A sudden onset or deterioration may suggest an underlying systemic factors
AcutePeriodontal
Acute Periodontal
Acute Periodontal Pain
Pain Dentine
Lesions (NUG)
Lesions (NUG) Dentine
Lesions (NUG) Hypersensitivity
Hypersensitivity
Pulp and Periapical
Pulp and Periapical
Caries
Caries
Disease
Disease

4. Any
Any
Increased?
Increased?
Masticatory
Masticatory
When?
When?
(Duration) Difficulty
Difficulty
(Duration)
Tooth Mobility
Tooth Movility
Causes of tooth mobility:
 Marginal or apical inflammation.
 Loss of connective tissue attachment and
supporting bone, usually due to marginal
periodontal disease but occasionally due to
periapical disease.
 Apical root resorption.
 Increase in width of periodontal ligament,
usually due to occlusal forces.

5. OBJECTIVES:
1. To identify systemic factors which may help to
account for the periodontal condition, ex:
Pregnancy, Diabetes Mellitus.
2. To note the existence of systemic condition for
which especial precautions (ex. Antibiotic
prophylaxis) are required to safeguard the
patient during the periodontal therapy.
3. To note the presence of any transmissible
disease which may present a hazard to the
clinician, dental surgery staff or other patients.

6.  Patient's attitude toward dental health.
 Date and nature of the last dental treatment.
 Regularity of previous dental treatment.
 Oral hygiene habits.
a. Tooth brush (type and frequency)
b. Dental floss.
c. Others.
 Habits related to oral health or disease
(bruxism, smoking)

7. 1. Gingival Inflammation, Plaque and
Calculus
GINGIVITIS
GINGIVITIS
Changesofof
Changes Gingival
Gingival
Exudate
the colour
the colour Exudate
Enlargement
Enlargement
(edema or hyperplasia) Bleeding
Bleeding
(edema or hyperplasia)
Supuration, Ulceration
Supuration, Ulceration
or Sweeling (acute inflammation)
or Sweeling (acute inflammation)

8. 1. At the initial visit.
2. During the subsequent appointments to
control the progress of the treatment.

9. • Is used to:
1. Identify pockets which
bleed on probing.
2. To measures the
pockets depth.

10. The depth to which the periodontal probe
can penetrate beyond the gingival
margins depends on:
1. The amount of gingival enlargement.
2. The extent of connective tissue
attachment loss.
3. The resistance of the tissue to probing,
determined by the extent to which
gingival collagen has been replaced by
inflammatory infiltrate.

11. 4. The size, shape and tip diameter of the
probe.
5. Use of the probe, angle of insertion and
pressure applied.
6. The presence of obstructions such as
subgingival calculus.
7. The patient's reaction to the discomfort on
probing.

12. • Each tooth should be rocked between an
instrument handle and index finger in a
buccolingual direction and mesiodistal
direction (when the adjacent tooth is not
present).

13. • The amplitude of tooth movement of the
crown tip from its most extreme buccal (or
mesial) position to its most extreme lingual
or distal position should be observed:
Grade 1- Visible horizontal mobility up to 1 mm.
Grade 2- Visible horizontal mobility between 1 and
2 mm.
Grade 3- Visible horizontal mobility greater than 2
mm or rotation or vertical mobility (depression).

14. Parafunctional habits
• The occlusion should be examined for
detect premature or interfering contacts as
contributory factors.
• Vertical bone destructive pattern is often
associated with traumatic occlusion.

17. Overhanging
Restorations
Caries
Caries
Caries Missing
Teeth
Non-vital
Non-
vital Unerupted
Unerupted teeth
Teeth
Teeth teeth

19. • Radiographs may:
1. Show the proportion of support loss in
relation to root length, the pattern of
bone loss and the rate of destruction.
2. Reveal unerupted teeth, periapical
pathology, inadequate endodontic
treatment, proximal caries, overhanging
margins, etc.

21. Pulp Vitality Test
Teeth associated with deep
Teeth associated with deep To distinguish a periapical
To distinguish a periapical
Periodontal pocket
Periodontal pocket
(pulpitis or pulp necrosis)
from periodontal abscess
from periodontal abscess
Haematological investigations, ex: full
blood count in patients where blood
dyscrasias are suspected(neutropenia,
leukemia, etc)

22.  Tooth by tooth diagnosis.
 Whole dentition.
 For an individual patient.

23. It depends on:
• The adequacy of the diagnosis.
• The quality of the treatment, including home
care and recall maintenance.
Factors that may influence the prognosis:
 The extent and significance of mucogingival
problems.
 The extent of furcation lesions.
 The combined periodontal and endodontic lesions.
 The presence of the hopeless teeth.