Clerking of a perio patient
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Clerking of a perio patient



examination of the periodontium

examination of the periodontium
periodontal examination



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Clerking of a perio patient Presentation Transcript

  • 2. OUTLINE • INTRODUCTION • CASE HISTORY Personal details Chief Complaint History of Presenting Complaint Past Medical History Past Dental History Family History Social History Personal Habit
  • 3. OUTLINE • CLINICAL EXAMINATION General Examination Extraoral Examination Intraoral Examination(soft tissues, hard tissues, periodontium) • PERIODONTAL SCREENING AND RECORDING SYSTEM • CONCLUSION • REFERENCES
  • 4. INTRODUCTION • Treatment is secondary, the primary task for the clinician is to identify the problem and find its etiology. • Periodontal diagnosis should first determine whether dx is present; then identify its type;, extent, distribution, and severity; and finally provide an understanding of the underlying pathologic processes and its cause. • Hence, the case history and clinical examination are essential in diagnosing the periodontal diseases.
  • 5. CASE HISTORY • Case history is the information gathered from the patient and/or parent and/or guardian to aid in the overall diagnosis of the case. • It includes certain personal details, the chief complaint, past and present dental and medical history and any associated family history.
  • 6. Personal Details • Name • Age/ Date of Birth • Sex • Marital status • address & occupation • Race/ ethnicity
  • 7. Chief Complaint • The patient's chief complaint should be recorded in his or her own words. • It should mention the condi-tions the patient feels he / she is suffering from. • E.g i have a swelling in my mouth,my gum is paining me,I feel pain in my tooth when I eat.
  • 8. History of the Presenting Complaint Symptoms: Are subjective information reported by the patient. A report of patient’s own sensory experience. These are usually the 1st aspects of history to be recorded. • Onset of complaint. • Character of onset. • Severity of the complaint. • Course of complaint. • Duration. • Location of complaint. • Distribution
  • 9. • Prior occurrence. • Exacerbating factors . • Relieving factors . • Associated phenomenon. Fever, bleeding, bad odour Etiology Complication: consider whether speech, mastication, sleep or any other function have been affected. Treatment: Consider any previous treatment and their effectiveness.
  • 10. Past Medical History • Medical history puts physical examination into perspective by supplying information that should alert the examiner to suspected abnormalities. • Even in a life-threatening situation, once the immediate threat has been contained, a history should be obtained from the patient. • Recent hospitalization • Endocrine disorder • Gastrointestinal complaints • Last blood glucose study • fit/faint • Blood disorder
  • 11. • Pregnancy • Infection including HIV status • Allergy • Drug therapy
  • 12. Past Dental History • Frequency of visiting dentist and purpose of visit. • Assessment of past caries experience, restorative dental procedures. Administration of local anesthesia. • Past oral surgical procedures, bleeding & healing process. • Previous orthodontic treatment. • Periodontal disease & previous periodontal treatment. • History of denture wearing, cause of loss of teeth.
  • 13. Family History • Family history is taken to determine if there is a familial predisposition to diseases or if there are diseases in which inheritance is an important factor. • The dentist should inquire specifically about a family history of diabetes, cancer, heart disease, high blood pressure, seizure disorders, mental disorders, and other diseases that may be familial.
  • 14. Social History • Social history help explain untoward reactions to health problems and to the therapeutic recommendations. • For example, the alcoholic patient may be unwilling to follow recommendations about diet and oral hygiene. • Social history is therefore important in assessing whether a patient is in a high-risk group, for example, those with alcoholism, drug addiction, or contagious infections such as herpes, hepatitis, tuberculosis, or AIDS.
  • 15. Personal Habit • Oral hygiene habits: frequency & technique of tooth brushing & flossing. • Habits as nail biting, thumb sucking. • Parafunctional habits as bruxism, clenching & tapping. • Smoking habit • Consumption of CHO food:form,frequency
  • 16. CLINICAL EXAMINATION • Clinical examination consists of 3 main stages: 1. Observation of the patient’s general health and appearance. 2. Extraoral examination of the head and neck. 3. Examination of the intraoral tissues.
  • 17. General Observation • Note problems such as: 1. Body weight/ fit of clothes 2. Breathlessness 3. Complexion 4. Exposed skin areas 5. Facial scarring
  • 18. Extra-Oral Examination • Examine the face for facial assymetry. • Check for bony discontinuity. • TMJ examination for TMJ disorder • Examine the submandibular lymph for lymphadenopathy. • Examine the lip for competence,angular chelitis etc • Examine for nerve dysfunction
  • 19. Intra-Oral Examination • The entire oral cavity should be carefully examined. • Soft tissue Examination: examine the mucosa of the lip, cheek, floor of the mouth, tongue, gingiva and palate for: Discoloration Swelling Discharge Ulceration Tenderness Numbness Recession
  • 20. • Hard tissue Examination: the teeth are examined for: • caries • developmental defect • anomalies of tooth form & number • Wasting • Dental stains • Hypersensitivity • Proximal contact relationship. • Mobility(physiologic or pathologic)
  • 21. • Sensitivity to percussion • Dentition with the jaw closed
  • 22. Examination of the Periodontium • The periodontal examination should be systematic, starting in the molar region in either the maxilla or the mandible and proceeding around each arch. Plaque and calculus: the presence of supragingival plaque and calculus can be directly observed and the amount measured with a calibrated probe. For the detection of subgingival calculus , each tooth surface is carefully checked to the level of the gingival attachment with a sharp no.17 explorer.
  • 23. Gingiva: consider the colour, size, contour, consistency, surface texture, position, ease of bleeding, and pain. The distribution of gingival disease and its acuteness or chronicity should also be noted. Periodontal pockets: presence and distribution on each tooth surface, pocket depth, level of attachment on the root, and type of pocket(suprabony/ intrabony) must be considered. Probing technique-the probe should be inserted paprallel to the vertical axis of the tooth and ‘walked’ circumferentially around each surface of each tooth to detect the area of deepest penetration.
  • 24. Level of attachment vs pocket depth • Pocket depth is the distance between the base of the pocket and the gingival margin while level of attachment is the distance btw the base of the pocket and a fixed point on the crown e.g. CEJ • Pocket depth may be unrelated to the existing attachment of the tooth while changes in level of attachment can be due only to gain or loss of attachment and afford a better indication of periodontal destruction. • Shallow pockets attached at the level of the apical 3rd of the root connote more severe destruction than deep pockets attached at the coronal 3rd of the roots.
  • 25. Degree of gingival recession: the measurement is taken with a periodontal probe from the CEJ to the gingival crest.
  • 26. The Periodontal Screening and Recording (PSR) System • The PSR system is designed for easier & faster recording of the periodontal status of a patient by a GP or a dental hygienist. • It uses a specially designed probe that has a 0.5mm ball tip and is colour coded from 3.5- 5.5mm. • Patient mouth is divided into 6 sextants. • Each tooth is probed, with the clinician walking the probe around the tooth: MB, midB, DB, & the corresponding lingual/palatal areas. • The deepest finding is recorded in each sextant along with other findings, according to the following code:
  • 27. • Code 0: No pockets >3.5 mm, no calculus/overhangs, no bleeding after probing (black band completely visible) • Code 1: No pockets >3.5 mm, no calculus/overhangs, but bleeding after probing (black band completely visible) • Code 2: No pockets >3.5 mm, but supra- or subgingival calculus/overhangs (black band completely visible) • Code 3: Probing depth 3.5-5.5 mm (black band partially visible, indicating pocket of 4-5 mm) • Code 4: Probing depth >5.5 mm (black band entirely within the pocket, indicating pocket of 6 mm or more) • Code *: Furcation involvement , tooth mobility, or gingival recession extending to the colored band of the probe.
  • 28. • Both the number and the * should be recorded if a furcation/mobility/g. recession is detected - e.g. the score for a sextant could be 3* (e.g. indicating probing depth 3.5-5.5 mm PLUS furcation involvement in the sextant).
  • 29. CONCLUSION • The interest should be in the patient who has the disease and not simply in the disease itself. • Diagnosis must therefore include a general evaluation of the patient and consideration of the oral cavity.
  • 30. References • Caranza’s Clinical Periodontology 9th edition • Periodontal Medicine by Rose et al • Article on BPE by British Society of Periodontology 2011 • Oral Diagnosis by Warren Birnbaum & Stephen Dunne
  • 31. THANK YOU