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 Examination

Presented by:

Michelle R. Mould, RDH, MSDH Ed.

What is it and why should I care?

• Identify:

• Health vs. Disease• Risk factors

• Extent of damage toperiodontium

• Necessary fordiagnosis, treatmentplanning, &maintenance

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What do I need?

• Knowledge of periodontium

 – normal/health

 – abnormal/disease

• Periodontal Probe

• Mirror

• Radiographs

• Eyes

 – Direct and Indirect vision

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Comprehensive Periodontal Exam

Gingival description

Probing depths/CAL

Furcation involvement

Mobility

Gingival bleeding(BOP)

Suppuration(Pus/Exudate)

Bone loss

(Radiographs)

Biofilm/Calculus ID

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Gingival Description

• Detailed

 – Color

 – Consistency

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 – on our

 – Texture

• Health vs. Disease

How are these different?

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What do you see?

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Facial Lingual

What do you see?

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What do you see?

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What do you see?

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Diseased Gingiva

Rolled margins, blunted papilla Spongy tissue

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Gingival Cleft

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To what are the arrows pointing?

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Mucogingival Examination

• Evaluate width ofattached gingiva usingprobe

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• Gingival recession

• MG defect

MG Defects

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Gingival Recession

Measure recession fromCEJ to GM Tension test

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Frenum Attachment

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Health or Disease?

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Probing

• Goal

 – Measure changes in periodontal health

• Evaluate

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 – 

 – Probing depths

 – Bleeding

 – Suppuration

 – Furcations

Probing Depths

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UNC 12 Periodontal Probe

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Bleeding on Probing

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Clinical Attachment Level(CAL)

• Most accurate measure of attachment loss

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• Measurement from the CEJ to GM

• Three possible relationships – Gingival margin at CEJ

 – Gingival margin apical to CEJ (visible recession)

 – Gingival margin coronal to CEJ (hyperplasia)

CAL

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GM at CEJ

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GM Apical to CEJ

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GM Coronal to CEJ

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Sample CAL Charting

What is CAL?

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Furcations• Multi-rooted teeth

 – area where roots divide

 – 2 roots = bifurcation

 – 3 roots = trifurcation

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• Health

 – no bone loss

 – not clinically visible or detectable with probe

• Disease

 – bone loss

 – furcation may be visible or detectable with probe

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Detection Radiographic Evidence

Furc at ion Morphology

Mandibular Molars

Maxillary First Premolars

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Maxillary Molars: B and L

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Furca t ion Assessment

Class I

• Entrance to furcationcan be felt with probe

• Probe tip cannot entert e urcat on area

• Differentiate betweennormal rootdepression andfurcation

Class II

• Probe tip can partiallyenter furcation

• Extends about one- third of tooth

• NOT able to passcompletely through

Class III

• Mandibular molars

 – probe passescompletely throughfurcation

• Maxillary molars

 – probe touches thepalatal (lingual) root

Class IV

• Same as class IIIexcept furcation isclinically visible due to

tissue recession

????????????? 

Meow! 

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SymbolsClass I Class II

SymbolsClass III Class IV

Sample Furcation Charting Bone Loss: Health vs. Disease

Normal level of alveolar crest is about 2 mm apical to CEJ

Where is the junctional epithelium  in health?

Tooth Mobility

• Distinguish between physiologic orpathologic

•

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 – normal or expected mobility

• Pathologic – horizontal or vertical movement of tooth

beyond physiologic limit

Causes of Mobility

• Alveolar bone loss

• Inflammation

• Occlusal Forces

 – Primary

 – Secondary

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Tooth Mobility

• Evaluate with mirrorhandles

• Horizontal mobility

  – ucco ngua or

faciolingual) movement

 – Adjacent tooth is observedas a point of reference

• Vertical mobility

 – Depressible in socket

Measuring Mobility

• 1 = Slight mobility, greaterthan normal; up to 1mmbuccolingually

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= , -mm buccolingually, novertical displacement

• 3 = Severe mobility, >2 mmbuccolingually withvertical displacement

Mobility Check

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Depressible in Socket

Fremitus

• Press index fingers besidemaxillary teeth

• Ask patient to “tap-tap-tap”

teeth together

• Vibration may be felt indicatingpremature contact which may

indicate mobility

• Technique used with occlusalanalysis or adjustment

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Biofilm ID

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Calc ID

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Periodontal Charting

Black• Probing depths

Blue• Exudate/Pus• Recession

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• RecessionRed• Furcations• Bleeding on Probing• Migration• Mucogingival defects• Mobility**