بسم اهلل الرحمن الرحيم وسع ربنا كل شئ علما على اهلل توكلنا ربنا افتح بيننا وبين قومنا بالحق وانت خير الف اتحينصدق اهلل العظيم ” األعراف 98 “
Prof Dr.Eman Abd El -Sattar TellaFaculty of Dentistry,Umm Al QurraUniversity Makka,SA.
Importance of dental Charting1) To record the patients periodontal condition at baseline2) 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
Gingival evaluation of the gingivaDescribe 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) onlyDistribution Diffuse Involves gingival margin including papillae and attached gingiva Severity Slight, Moderate, Severe
DISTRIBUTION• Localized gingivitis is confined to the gingiva of a single tooth or group of teeth while generalized gingivitis involves the entire mouth.
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.
DISTRIBUTION• 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 Gingival color Generalized moderate marginal redness with localized bright Example red gingiva at # 46,45 & 34 Quality EnlargedGingival 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; spongyConsistency 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
Healthy gingiva Mild gingivitisPale 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 hemorrhage.
Mild gingivitis in anterior area:Mild erythema in maxilla. Slightedematous swelling & erythema.In mandible, slight edematousswelling & erythema.Papilla Bleeding Index: Grade 1&2Stained plaque: Small plaqueaccumulations arounds the necksof the teeth & in interdental areas.
Moderate gingivitis inanterior teeth :Erythema& enlargement of gingivapronounced in mand thanin maxilla.Papilla Bleeding Index :grade 3 & 4Stained plaque : Moderate plaqueaccumulation in maxilla. Heavier plaque in mandible.Radiographically, no destruction of interdental bony septa.
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 fromGingival CEJRecession Generalized slight (see chart) Example Localized 4mm#28 (Stillmans Cleft)
Pocket Depth “Probed Pocket Depth”The probing depth is the distance from gingival margin towhich the probe penetrates into the pocket
Proceed from posterior teeth to midline for each quadrant,all teeth from facial approach, then lingual for the entirequadrant.Insert probe at the distal line angle and "walk" distallyalong the proximal surface; slant to accomodate thecontact area.Return, the probe to the distal line angle; proceed aroundthe mesial line angle and into the mesial proximal.Carefully diagonal probe to complete the proximalexamination.
Attachment level “Probed Attachment level” 1) Inflammation in the gingiva fluctuates and pocket depth varies. 2) Measuring attachment level from aRationale fixed point (CEJ) provides a more accurate evaluation for comparison.
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 onExample probing; profuse lingual # 32-29 & # 21
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 uponNature palpation (linger pressure) • Localized severe exudate on pressureExample at # 13, 47-45 &# 34- 32
Probe Furcation Area Location • Furcation is accessible for probing • Mandibular molars from the facial and lingualBifurcation • Maxillary first • Furcation is accessible for probing pre molars from the mesial and distal • Furcation iis accessible forTrifurcation • Maxillary molars probing fnbm the mesial and distal and the facial
Classification of furcation involvementClass I Incipient bone less Partial bone loss (cul-de-Class II sac)
Classification of furcation involvement Total bone loss with through and throughClass III opening of the furcation Total bone loss with through-and-through opening ot the furcationClass IV with gingival recession exposing the furcation to view
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
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.
Dental stains` Write: color, source when known, distribution; localized, generalized, cervical third or surface; intrinsic or extrinsic
Functional relations • Pathologic migration occurs most frequently inPathologic 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.
Parafunctional Note tooth wear facets and occlusal and incisal wear. Question patient concerning habits such as bruxing, clenching, or tappingo Bruxism = grinding of teeth in directions different from normal chewing at nighto Clenching = closing of teeth in the chewing position at day & nighto Tapping = grading of an isolated tooth
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 analysisNOMINAL SCALEo N normalo + vibration felto 1 slight movement felt against fingero 2 clearly palpable, movement visibleo 3 movement very apparent
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.
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.
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.
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
Use of clinical photographs and study casts1. 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.