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Diagnosis of
Periodontal
Diseases
Prepared & Designed by
Muhammed M. Nasser
General Introduction
essential to intelligent treatment
first determine
determined after careful analysis of the
case history and evaluation the clinical signs and symptoms, as
well as the result of various tests
The diagnosis is includes
Overall apprasial of the patient
Social history
Medical History
The importance of the medical history should be explained to the patients
special precautions modifications in
treatment procedure
play in the cause of
periodontal disease.
The possibility that oral infections
patient under the care of a physician is the problem? Its duration and
nature.
hospitalization and operation , kind of operation, and
complications
hematologic, endocrine, infectious, cardiovascular
medications
The Medical history should include
reference to the following:
History of allergy
Family medical history
Abnormal bleeding tendencies
The Medical history should include
reference to the following:
Dental History
bleeding gum loose of teeth of the teeth with the appearance of spaces
foul test
• Sensitivity when chewing sensitivity to cold & hot sensitivity to inhaled air
visit to the dentist treatment and
cleaning by a dentist
patient’s oral hygiene regimen
orthodontic treatment
Pain in the teeth or in the gingiva
Do the teeth feel “loose” or insecure? difficulty in chewing mobility
The Dental History should include
reference to the following:
dental habits
habits
History of previous periodontal problems
removable prosthesis
implants
The Dental History should include
reference to the following:
Intraoral Radiographic Survey
minimum of 14 intraoral films four posterior
bite-wing films Panoramic radiographs
of
developmental anomalies, pathologic lesions fractures
dental screening examinations of large groups
and severity of bone destruction
Casts
position of the gingival margins (recession)
position and inclination of the teeth
Proximal contact relationships food impaction areas
lingual-cuspal relationships
visual aids in discussions with the patient
pretreatment and posttreatment comparisons reference at recall visits
of implant placement
Clinical Photographs
recording the appearance of the tissue before and after
treatment
Examination
Oral Hygiene
food debris plaque stains
Disclosing solution
Oral Malodor
fetor ex ore fetor oris halitosis
oral or extraoral diseases
Examination of Lymph Nodes
periodontal, periapical, and other oral diseases
examine and evaluate head and neck lymph nodes.
enlarged, palpable, tender, and fairly immobil
skin may be red and warm
herpetic
gingivostomatitis, necrotizing ulcerative gingivitis (NUG), and acute periodontal abscesses
Examination of the Teeth and Implants
caries poor restorations developmental defects anomalies of
tooth form wasting hypersensitivity proximal contact relationships
stability, position, and number of implants and their relationship to the adjacent
natural dentition
Periimplantitis
pockets Probing
use plastic instrument
Dental Plaque & Calculus
Supragingival directly observed
subgingival checked to the level of gingival
attachment
Warm water deflect the gingiva
Wasting Disease of the Teeth
gradual loss of tooth substance formation of
smooth, polished surfaces
1. Erosion
2. Abrasion
3. Attrition
4. Abfraction.
Erosion
corrosion wedge-shaped depression in the cervical area of the facial
tooth surface.
surfaces are smooth, hard, and polished group of teeth
Decalcification by acidic beverages, or citrus fruits, combined
with the effect of acid salivary secretion
Abrasion
mechanical wear other than that of mastication
saucer-shaped or wedge shaped smooth, shiny surface
starts on exposed cementum surfaces
abrasive dentifrice Aggressive tooth brushing hard tooth brush
Horizontal brushing at right angles
Attrition
occlusal wear functional contacts
, occlusal, and approximal tooth surfaces
physiologic
Occlusal or incisal surfaces worn by attrition are called facets
Attrition
correlated with age older adults
Abfraction
occlusal loading tooth flexure and mechanical microfractures
cervical area
Examination of the Periodontium
systematic starting in the molar region
important to detect the earliest signs of gingival and periodontal disease
Gingiva
keratinized mucosa collar around
each tooth coral pink
Localized gingival inflammation
Generalized gingival inflammation
color, size, contour, consistency, surface texture,
position, ease of bleeding, and pain
Color changes in the gingiva
redder
Changes in the size of the
gingiva
In disease, the size is increased enlargement
Changes in the consistency of
the gingiva
(edematous) and reparative (fibrotic) changes coexist
Gingival Index (GI) (Loe, 1967)
measures the degree of gingival iflammation
distal facial papilla,
facial margin, mesial facial papilla, lingual gingival margin
Score of gingival index
Score 0
Score 1 No bleeding on probing
Score 2 Bleeding on probing
Score 3 Ulceration spontaneous
bleeding
Gingival bleeding
varies in severity, duration and the ease with which it is provoked
Bleeding on probing early diagnosis
and prevention of more advanced gingival inflammation one of the
earliest visual signs of inflammation
whether
the lesions are in an active or inactive state
Bleeding on probing (BOP)
periodontal probe inserted to the ―bottom of the gingival/periodontal pocket
moved gently along the tooth (root) surface
positive
inflamed
Plaque Index
Silness and Loe in 1964
all teeth selected teeth
No substitution for any missing tooth
all surfaces
measures the thickness of plaque on the gingival one third of the teeth
Plaque Index
0
1
can not be seen with the naked eye disclosing solution using
probe
2
seen with the naked eye
3 soft matter within the gingival pocket on the tooth and gingival
margin
Calculus Index (CI)
CI 0 No
CI 1 Supragingival calculus not more than 1/3
CI 2 Supragingival calculus covering more than 1/3 not more than 2/3
flecks of subgingival calculus
CI 3 Supragingival calculus covering more than two-thirds
continuous heavy band of subgingival calculus
Pockets
Depth of sulcus:
Pockets:
pathologically deepened of
gingival sulcus
gingival pocket
periodontal pocket
Pockets
generally painless localized
or sometimes radiating pain or sensation of pressure after eating
foul taste sensitivity to hot and cold
toothache
bleeding
suppuration loose, extruded teeth
Pockets
Gingival pocket: pseudopocket or false pocket
gingivitis gingival enlargement
Periodontal pocket: periodontitis apical
migration of junctional epithelium destruction to the supporting
periodontal tissues
Suprabony pocket:
Infrabony pocket:
Gingival pocket
Periodontal pocket
Suprabony pocket Intrabody pocket
Detection of Pockets
careful exploration with a periodontal probe
Assessment of probing pocket depth (PPD)
examine all sites of all teeth for the presence or
absence of periodontal lesions be should be inserted parallel to the
vertical axis of the tooth and “walked” circumferentially around each surface
of each tooth to detect the areas of deepest penetration
single-rooted teeth examinated at four sites
multirooted teeth at six sites
distance from the gingival margin to the
bottom of the gingival sulcus/pocket
Clinical Attachment Level (CAL)
more accurate indicator
measured from a fixed point on the tooth that doesn’t change, the CEJ
Thank You

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Diagnosis of Periodontal Diseases

  • 1. Diagnosis of Periodontal Diseases Prepared & Designed by Muhammed M. Nasser
  • 2. General Introduction essential to intelligent treatment first determine determined after careful analysis of the case history and evaluation the clinical signs and symptoms, as well as the result of various tests
  • 3. The diagnosis is includes
  • 4. Overall apprasial of the patient
  • 6. Medical History The importance of the medical history should be explained to the patients special precautions modifications in treatment procedure play in the cause of periodontal disease. The possibility that oral infections
  • 7. patient under the care of a physician is the problem? Its duration and nature. hospitalization and operation , kind of operation, and complications hematologic, endocrine, infectious, cardiovascular medications The Medical history should include reference to the following:
  • 8. History of allergy Family medical history Abnormal bleeding tendencies The Medical history should include reference to the following:
  • 9. Dental History bleeding gum loose of teeth of the teeth with the appearance of spaces foul test • Sensitivity when chewing sensitivity to cold & hot sensitivity to inhaled air
  • 10. visit to the dentist treatment and cleaning by a dentist patient’s oral hygiene regimen orthodontic treatment Pain in the teeth or in the gingiva Do the teeth feel “loose” or insecure? difficulty in chewing mobility The Dental History should include reference to the following:
  • 11. dental habits habits History of previous periodontal problems removable prosthesis implants The Dental History should include reference to the following:
  • 12. Intraoral Radiographic Survey minimum of 14 intraoral films four posterior bite-wing films Panoramic radiographs of developmental anomalies, pathologic lesions fractures dental screening examinations of large groups and severity of bone destruction
  • 13. Casts position of the gingival margins (recession) position and inclination of the teeth Proximal contact relationships food impaction areas lingual-cuspal relationships visual aids in discussions with the patient pretreatment and posttreatment comparisons reference at recall visits of implant placement
  • 14. Clinical Photographs recording the appearance of the tissue before and after treatment
  • 16. Oral Hygiene food debris plaque stains Disclosing solution
  • 17. Oral Malodor fetor ex ore fetor oris halitosis oral or extraoral diseases
  • 18. Examination of Lymph Nodes periodontal, periapical, and other oral diseases examine and evaluate head and neck lymph nodes. enlarged, palpable, tender, and fairly immobil skin may be red and warm herpetic gingivostomatitis, necrotizing ulcerative gingivitis (NUG), and acute periodontal abscesses
  • 19. Examination of the Teeth and Implants caries poor restorations developmental defects anomalies of tooth form wasting hypersensitivity proximal contact relationships stability, position, and number of implants and their relationship to the adjacent natural dentition
  • 21. Dental Plaque & Calculus Supragingival directly observed subgingival checked to the level of gingival attachment Warm water deflect the gingiva
  • 22. Wasting Disease of the Teeth gradual loss of tooth substance formation of smooth, polished surfaces 1. Erosion 2. Abrasion 3. Attrition 4. Abfraction.
  • 23. Erosion corrosion wedge-shaped depression in the cervical area of the facial tooth surface. surfaces are smooth, hard, and polished group of teeth Decalcification by acidic beverages, or citrus fruits, combined with the effect of acid salivary secretion
  • 24. Abrasion mechanical wear other than that of mastication saucer-shaped or wedge shaped smooth, shiny surface starts on exposed cementum surfaces abrasive dentifrice Aggressive tooth brushing hard tooth brush Horizontal brushing at right angles
  • 25. Attrition occlusal wear functional contacts , occlusal, and approximal tooth surfaces physiologic Occlusal or incisal surfaces worn by attrition are called facets
  • 27. Abfraction occlusal loading tooth flexure and mechanical microfractures cervical area
  • 28. Examination of the Periodontium systematic starting in the molar region important to detect the earliest signs of gingival and periodontal disease
  • 29. Gingiva keratinized mucosa collar around each tooth coral pink Localized gingival inflammation Generalized gingival inflammation color, size, contour, consistency, surface texture, position, ease of bleeding, and pain
  • 30. Color changes in the gingiva redder
  • 31. Changes in the size of the gingiva In disease, the size is increased enlargement
  • 32. Changes in the consistency of the gingiva (edematous) and reparative (fibrotic) changes coexist
  • 33. Gingival Index (GI) (Loe, 1967) measures the degree of gingival iflammation distal facial papilla, facial margin, mesial facial papilla, lingual gingival margin
  • 34. Score of gingival index Score 0 Score 1 No bleeding on probing Score 2 Bleeding on probing Score 3 Ulceration spontaneous bleeding
  • 35. Gingival bleeding varies in severity, duration and the ease with which it is provoked Bleeding on probing early diagnosis and prevention of more advanced gingival inflammation one of the earliest visual signs of inflammation whether the lesions are in an active or inactive state
  • 36. Bleeding on probing (BOP) periodontal probe inserted to the ―bottom of the gingival/periodontal pocket moved gently along the tooth (root) surface positive inflamed
  • 37. Plaque Index Silness and Loe in 1964 all teeth selected teeth No substitution for any missing tooth all surfaces measures the thickness of plaque on the gingival one third of the teeth
  • 38. Plaque Index 0 1 can not be seen with the naked eye disclosing solution using probe 2 seen with the naked eye 3 soft matter within the gingival pocket on the tooth and gingival margin
  • 39. Calculus Index (CI) CI 0 No CI 1 Supragingival calculus not more than 1/3 CI 2 Supragingival calculus covering more than 1/3 not more than 2/3 flecks of subgingival calculus CI 3 Supragingival calculus covering more than two-thirds continuous heavy band of subgingival calculus
  • 40. Pockets Depth of sulcus: Pockets: pathologically deepened of gingival sulcus gingival pocket periodontal pocket
  • 41. Pockets generally painless localized or sometimes radiating pain or sensation of pressure after eating foul taste sensitivity to hot and cold toothache bleeding suppuration loose, extruded teeth
  • 42. Pockets Gingival pocket: pseudopocket or false pocket gingivitis gingival enlargement Periodontal pocket: periodontitis apical migration of junctional epithelium destruction to the supporting periodontal tissues Suprabony pocket: Infrabony pocket:
  • 44. Detection of Pockets careful exploration with a periodontal probe
  • 45. Assessment of probing pocket depth (PPD) examine all sites of all teeth for the presence or absence of periodontal lesions be should be inserted parallel to the vertical axis of the tooth and “walked” circumferentially around each surface of each tooth to detect the areas of deepest penetration single-rooted teeth examinated at four sites multirooted teeth at six sites distance from the gingival margin to the bottom of the gingival sulcus/pocket
  • 46. Clinical Attachment Level (CAL) more accurate indicator measured from a fixed point on the tooth that doesn’t change, the CEJ
  • 47.