Dental sharting


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Dental sharting

  1. 1. ‫الرحيم‬ ‫الرحمن‬ ‫الله‬ ‫بسم‬ ‫توكلنا‬ ‫الله‬ ‫على‬ ‫علما‬ ‫شئ‬ ‫كل‬ ‫ربنا‬ ‫وسع‬ ‫بالحك‬ ‫لومنا‬ ‫وبين‬ ‫بيننا‬ ‫افتح‬ ‫ربنا‬ ‫الفاتحين‬ ‫خير‬ ‫وانت‬ ‫العظيم‬ ‫الله‬ ‫صدق‬”‫األعراف‬89“
  2. 2. Prof Dr.Eman Abd El -Sattar Tella
  3. 3. 1) To record the patient's periodontal condition at baseline 2) To establish effective patient communication about periodontal disease and its prevention and treatment. 3) To establish proper diagnosis and treatment planning. 4) To evaluate the response to therapy. 5) To serve as a baseline for future comparison at recall visits during maintenance phase Importance of dental Charting
  4. 4. Involves entire mouthGeneralized Location Confined to a single tooth or group of teethLocalized Involves gingival margin including papillaeMarginal Distribution Involves interdental papilla(e) onlyPapillary Involves gingival margin including papillae and attached gingiva Diffuse Slight, Moderate, SevereSeverity Clinical evaluation of the gingiva Describe observation using the evaluation
  5. 5. DISTRIBUTION • Localized gingivitis is confined to the gingiva of a single tooth or group of teeth while generalized gingivitis involves the entire mouth.
  6. 6. DISTRIBUTION • Marginal gingivitis involves the gingival margin and may include a portion of the contiguous attached gingiva. • Papillary gingivitis involves the interdental papillae and often extends into the adjacent portion of the gingival margin.
  7. 7. DISTRIBUTION • Diffuse gingivitis affects the gingival margin, the attached gingiva, and the interdental papille.
  8. 8. Record color, size, shape, consistency and surface texture of the gingiva : Red, bright red, bluish red, grayQuality Gingival color Generalized moderate marginal redness with localized bright red gingiva at # 46,45 & 34 Example EnlargedQuality Gingival size Generalized slight to moderate marginal enlargement with localized severe enlargement about facial of # 47-45 & #23-34 Example Bulbous, flattened, punched-out, cratered, rolledQualityGingival shape Localized, moderately punched-out papillary gingiva at # 24Example Firm; spongyQuality Consistency of gingiva Generalized moderate marginal sponginess more severe about #34-37 Example Smooth, shiny, loss of stippling; or heavy deep stippling may occur with fibrotic firm tissue QualitySurface Texture of gingiva Localized smooth gingiva facial # 13-15Example
  9. 9. Healthy gingiva Pale pink & stippled. Narrow distinguishable free gingival margin. No bleeding on probing Mild gingivitis Localized mild erythema & slight edema. Some stippling is lost. Minimal bleeding after probing.
  10. 10. Moderate gingivitis Obvious erythema & edema. No stippling, bleeding on probing Severe gingivitis Fiery redness, edematous & hyperplastic swelling, complete absence of stippling, bleeding on probing & spontaneous hemorrhage.
  11. 11. Mild gingivitis in anterior area: Mild erythema in maxilla. Slight edematous swelling & erythema. In mandible, slight edematous swelling & erythema. Papilla Bleeding Index: Grade 1 & 2 Stained plaque: Small plaque accumulations arounds the necks of the teeth & in interdental areas.
  12. 12. Moderate gingivitis in anterior teeth :Erythema & enlargement of gingiva pronounced in mand than in maxilla. Papilla Bleeding Index : grade 3 & 4 Stained plaque : Moderate plaque accumulation in maxilla. Heavier plaque in mandible. Radiographically, no destruction of interdental bony septa.
  13. 13. Gingival Recession Draw lines facial, lingual and palatal to represent the position of the gingival margin in relation to the tooth crown and the cementoenamel junction (CEJ) on the dental chart. On diagram record accurately the position of the free margin to show recession. Generalized or Localized Location Gingival Recession May be measured with probe from CEJ Severity Generalized slight (see chart) Localized 4mm#28 (Stillman's Cleft) Example
  14. 14. Pocket Depth “Probed Pocket Depth” The probing depth is the distance from gingival margin to which the probe penetrates into the pocket
  15. 15. Proceed from posterior teeth to midline for each quadrant, all teeth from facial approach, then lingual for the entire quadrant. Insert probe at the distal line angle and "walk" distally along the proximal surface; slant to accomodate the contact area. Return, the probe to the distal line angle; proceed around the mesial line angle and into the mesial proximal. Carefully diagonal probe to complete the proximal examination.
  16. 16. Rationale Attachment level “Probed Attachment level” 1) Inflammation in the gingiva fluctuates and pocket depth varies. 2) Measuring attachment level from a fixed point (CEJ) provides a more accurate evaluation for comparison.
  17. 17. Gingival Bleeding  Bleeding on probing is a significant sign of inflammation that appears early before tissue color changes. • Spontaneous, upon provocation, acute, chronic, recurrent Nature • Generalized moderate marginal bleeding on probing; profuse lingual # 32-29 & # 21Example
  18. 18. Exudate  The index finger is placed along the lateral aspect of marginal gingiva and pressure is applied in a rolling motion toward the crown • Visible or upon palpation (linger pressure) Nature • Localized severe exudate on pressure at # 13, 47-45 &# 34- 32 Example
  19. 19. Probe Furcation Area  Location • Furcation is accessible for probing from the facial and lingual • Mandibular molars Bifurcation • Furcation is accessible for probing from the mesial and distal • Maxillary first pre molars • Furcation iis accessible for probing fnbm the mesial and distal and the facial • Maxillary molarsTrifurcation
  20. 20.  Classification of furcation involvement  Incipient bone lessClass I  Partial bone loss (cul-de- sac) Class II
  21. 21.  Classification of furcation involvement  Total bone loss with through and through opening of the furcation Class III  Total bone loss with through-and-through opening ot the furcation with gingival recession exposing the furcation to view Class IV
  22. 22. Mucogingival areas The width of the attached gingiva  When a pocket extends to or beyond the mucogingival junction, the probe may pass through the pocket directly into the alveolar mucosa. 1) On the external surface of the gingiva, measure from the margin of the gingiva to the mucogingival junction (total width of the gingiva). 2) Insert the probe into the sulcus or pocket and measure from the gingival margin to the junctional epithelium (probing depth). 3) The width of the attached gingiva = total width of gingiva - probing depth
  23. 23. Bacterial plaque  Observe thin plaque by running an explorer5 over the tooth surface at cervical third and thick plaque by direct observation.  Write: light, medium, heavy.
  24. 24. Calculus  Supragingival  Subgingival
  25. 25. Dental stains`  Write: color, source when known, distribution; localized, generalized, cervical third or surface; intrinsic or extrinsic
  26. 26. Functional relations • Pathologic migration occurs most frequently in anterior teeth. Distinguish from "mesial drift” which occurs in posterior teeth with healthy gingival Pathologic Migration • Test for open contacts where food impaction can occur by using dental floss. • Record on the tooth chart by parallel lines. Open Contacts •Record any symptoms such as pain, tenderness sounds (crepitation) or limitation of movement. Temporomandibular Joint Disorder
  27. 27. Parafunctional  Note tooth wear facets and occlusal and incisal wear.  Question patient concerning habits such as bruxing, clenching, or tapping o Bruxism = grinding of teeth in directions different from normal chewing at night o Clenching = closing of teeth in the chewing position at day & night o Tapping = grading of an isolated tooth
  28. 28. Fremitus  Fremitus is palpable_vibration (or) movement, It is an important sign during examination % of the occlusion, and is commonly used as an indicator of the need for further analysis NOMINAL SCALE o N normal o + vibration felt o 1 slight movement felt against finger o 2 clearly palpable, movement visible o 3 movement very apparent
  29. 29. Percussion  Percussion is the act of tapping a surface of a tooth with an instrument. Sensitivity to percussion is a manifestation of inflammation in the periodontal ligament.
  30. 30. Mobility  Position the patient in supine for clear visibility.  Stabilize the head. Motion of head can interfere with a true evaluation of tooth movement.  Begin with most posterior tooth and move systematically around each arch.  Use two single-ended metal instruments. Hold in modified pen grasp. Using wooden tongue depressors or plastic mirror handles is not good, because of their flexibility. Testing with fingers without the metal instruments can be misleading since the soft tissue moves.
  31. 31. Normal Mobility  Grade I: Slightly more than normal.  Grade II: Moderately more than normal.  Grade III: Severe mobility faciolingually and/or mesiodistally combined with vartical displacement.
  32. 32. Radiographic Examination • Horizontal • Angular Bone loss  Write tooth numbers.  Place a black dot in furcation on the dental charting (See Key for Chart) Furcation Involvement (radiolucency between roots) Lamina Dura
  33. 33. Use of clinical photographs and study casts 1. Clinical Photographs  Color photographs are useful for recording the appearance of the tissue before, and after treatment. 2. Casts  position of the gjngival margins  position and inclination of the teeth  proximal contact relationships  Food impactions areas. Finally casts also serve as visual aids in discussions with the patient and are useful for pre and post-treatment comparisons, as well as for reference at check-up visits.
  34. 34. References -Caranza’s Clinical Periodontology, 10th ed. WB Saunders, 2006. -Color Atlas of Dental Medicine: Periodontology By Klaus H. Rateitschak, Edith M.