Importance of dental Charting
1) To record the patient's periodontal condition at
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
Clinical evaluation of the gingiva
Describe observation using the evaluation
Generalized Involves entire mouth
Localized Confined to a single tooth or group of teeth
Marginal Involves gingival margin including papillae
Papillary Involves interdental papilla(e) only
Diffuse Involves gingival margin including papillae and attached
Severity Slight, Moderate, Severe
• Localized gingivitis is confined to the gingiva of a
single tooth or group of teeth while generalized
gingivitis involves the entire mouth.
• Marginal gingivitis involves the gingival margin and
may include a portion of the contiguous attached
• Papillary gingivitis involves the interdental papillae
and often extends into the adjacent portion of the
• Diffuse gingivitis affects the gingival margin, the
attached gingiva, and the interdental papille.
Record color, size, shape, consistency and
surface texture of the gingiva :
Quality Red, bright red, bluish red, gray
color Generalized moderate marginal redness with localized bright
Example red gingiva at # 46,45 & 34
Gingival size Generalized slight to moderate marginal enlargement with
Example localized severe enlargement about facial of # 47-45 & #23-34
Gingival Quality Bulbous, flattened, punched-out, cratered, rolled
shape Example Localized, moderately punched-out papillary gingiva at # 24
Quality Firm; spongy
of gingiva Generalized moderate marginal sponginess more severe about
Surface Smooth, shiny, loss of stippling; or heavy deep stippling may
Quality occur with fibrotic firm tissue
gingiva Example Localized smooth gingiva facial # 13-15
Healthy gingiva Mild gingivitis
Pale pink & stippled. Narrow Localized mild erythema & slight
distinguishable free gingival edema. Some stippling is lost.
margin. No bleeding on probing Minimal bleeding after probing.
Moderate gingivitis Severe gingivitis
Fiery redness, edematous &
Obvious erythema & edema. hyperplastic swelling, complete
No stippling, bleeding on absence of stippling, bleeding on
probing probing & spontaneous
Mild gingivitis in anterior area:
Mild erythema in maxilla. Slight
edematous swelling & erythema.
In mandible, slight edematous
swelling & erythema.
Papilla Bleeding Index: Grade 1
Stained plaque: Small plaque
accumulations arounds the necks
of the teeth & in interdental areas.
Moderate gingivitis in
anterior teeth :Erythema
& enlargement of gingiva
pronounced in mand than
Papilla Bleeding Index :
grade 3 & 4
Stained plaque : Moderate plaque
accumulation in maxilla. Heavier plaque in mandible.
Radiographically, no destruction of interdental bony septa.
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.
May be measured
Severity with probe from
“Probed Pocket Depth”
The probing depth is the distance from gingival margin to
which the probe penetrates into the pocket
Proceed from posterior teeth to midline for each quadrant,
all teeth from facial approach, then lingual for the entire
Insert probe at the distal line angle and "walk" distally
along the proximal surface; slant to accomodate the
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
“Probed Attachment level”
1) Inflammation in the gingiva fluctuates
and pocket depth varies.
2) Measuring attachment level from a
Rationale fixed point (CEJ) provides a more
accurate evaluation for comparison.
Bleeding on probing is a significant sign of inflammation
that appears early before tissue color changes.
• Spontaneous, upon provocation, acute, chronic,
• Generalized moderate marginal bleeding on
Example probing; profuse lingual # 32-29 & # 21
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
Nature palpation (linger
• Localized severe
exudate on pressure
at # 13, 47-45 &# 34-
• Furcation is accessible for probing
• Mandibular molars
from the facial and lingual
• Maxillary first • Furcation is accessible for probing
pre molars from the mesial and distal
• Furcation iis accessible for
Trifurcation • Maxillary molars probing fnbm the mesial and
distal and the facial
Classification of furcation
Class I Incipient bone less
Partial bone loss (cul-de-
Classification of furcation
Total bone loss with
through and through
Class III opening of the furcation
Total bone loss with
opening ot the furcation
Class IV with gingival recession
exposing the furcation to
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
Observe thin plaque by running an explorer5 over
the tooth surface at cervical third and thick
plaque by direct observation.
Write: light, medium, heavy.
Write: color, source when known, distribution;
localized, generalized, cervical third or surface;
intrinsic or extrinsic
• Pathologic migration occurs most frequently in
Pathologic Migration anterior teeth. Distinguish from "mesial drift” which
occurs in posterior teeth with healthy gingival
• Test for open contacts where food impaction can occur
by using dental floss.
• Record on the tooth chart by parallel lines.
Temporomandibular •Record any symptoms such as pain, tenderness sounds
Joint Disorder (crepitation) or limitation of movement.
Note tooth wear facets and occlusal and incisal
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 &
o Tapping = grading of an isolated tooth
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
o N normal
o + vibration felt
o 1 slight movement felt against finger
o 2 clearly palpable, movement visible
o 3 movement very apparent
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
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
Grade I: Slightly more than normal.
Grade II: Moderately more than normal.
Grade III: Severe mobility faciolingually and/or mesiodistally
combined with vartical displacement.
Write tooth numbers.
Place a black dot in furcation on the dental charting
(See Key for Chart)
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.
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.
-Caranza’s Clinical Periodontology, 10th ed.
WB Saunders, 2006.
-Color Atlas of Dental Medicine:
Periodontology By Klaus H. Rateitschak,