Dental sharting

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Dental sharting

  1. 1. ‫بسم الله الرحمن الرحيم‬ ‫وسع ربنا كل شئ علما على الله توكلنا‬ ‫ربنا افتح بيننا وبين لومنا بالحك‬ ‫وانت خير الفاتحين‬ ‫صدق الله العظيم ” األعراف 98 “‬
  2. 2. Prof Dr.Eman Abd El -Sattar Tella
  3. 3. Importance of dental Charting 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
  4. 4. Clinical evaluation of the gingiva Describe observation using the evaluation Generalized Involves entire mouth Location Localized Confined to a single tooth or group of teeth Marginal Involves gingival margin including papillae Papillary Involves interdental papilla(e) only Distribution Diffuse Involves gingival margin including papillae and attached gingiva Severity Slight, Moderate, Severe
  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 : Quality Red, bright red, bluish red, gray Gingival color Generalized moderate marginal redness with localized bright Example red gingiva at # 46,45 & 34 Quality Enlarged 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 Consistency of gingiva Generalized moderate marginal sponginess more severe about Example #34-37 Surface Smooth, shiny, loss of stippling; or heavy deep stippling may Quality occur with fibrotic firm tissue Texture of gingiva Example Localized smooth gingiva facial # 13-15
  9. 9. 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.
  10. 10. 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 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 Location Localized May be measured Severity with probe from Gingival CEJ Recession Generalized slight (see chart) Example Localized 4mm#28 (Stillman's Cleft)
  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. Attachment level “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.
  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, Nature recurrent • Generalized moderate marginal bleeding on Example probing; profuse lingual # 32-29 & # 21
  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 Nature palpation (linger pressure) • Localized severe exudate on pressure Example at # 13, 47-45 &# 34- 32
  19. 19. Probe Furcation Area  Location • Furcation is accessible for probing • Mandibular molars from the facial and lingual Bifurcation • 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
  20. 20.  Classification of furcation involvement Class I  Incipient bone less  Partial bone loss (cul-de- Class II sac)
  21. 21.  Classification of furcation involvement  Total bone loss with through and through Class III opening of the furcation  Total bone loss with through-and-through opening ot the furcation Class IV with gingival recession exposing the furcation to view
  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 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. Open Contacts • Record on the tooth chart by parallel lines. Temporomandibular •Record any symptoms such as pain, tenderness sounds Joint Disorder (crepitation) or limitation of movement.
  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 Bone loss • Angular  Write tooth numbers. Furcation Involvement  Place a black dot in furcation on the dental charting (radiolucency between (See Key for Chart) 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.

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