2. In general, they fall into
the following three broad categories:
1. The gingival diseases
2. The various types of periodontitis
3. The periodontal manifestations of systemic diseases
first determine whether disease is present?
disease’s type, extent, distribution, and
severity
probing,
mobility assessment, radiographs, blood tests, and biopsies
3.
4.
5. • First Visit
• Second Visit
• Laboratory Aids to Clinical Diagnosis
6. First Visit
• Overall Appraisal of the Patient
• Medical History
• Dental History
• Intraoral Radiographic Survey
• Casts
• Clinical Photographs
• Review of the Initial Examination
7. Second Visit
• Oral Examination
• Examination of the Teeth and Implants
• Examination of the Periodontium
8. • Overall Appraisal of the Patient
consideration of the
patient’s mental and emotional status, temperament,
attitude, and
physiologic age
• Medical History
1) patient is under the care of a physician, the nature and
duration of the problem
2) Details regarding hospitalizations and operations
anesthetic, hemorrhagic, or infectious complications
3) A list of all medications being taken Special inquiry
Patients who are taking the family of drugs
called bisphosphonates (e.g., Actonel, Fosamax, Boniva, Aredia,
Zometa)
9. • Medical History
4) All medical problems cardiovascular, hematologic, endocrine
infectious diseases, sexually transmitted diseases,
and high-risk behavior for human immunodeficiency
virus infection
5) Any possibility of occupational disease
6) Abnormal bleeding tendencies
7) allergy history
hay fever, asthma, sensitivity to foods, sensitivity to
drugs
aspirin, codeine, barbiturates, sulfonamides,
antibiotics,
procaine, laxatives
sensitivity to dental materials
eugenol, acrylic resins
10. 8) onset of puberty and for
females, menopause, menstrual disorders, hysterectomy, pregnancies,
and miscarriages
• Medical History
9) A family medical history
bleeding disorders and diabetes
11. • Dental History
• Current Illness. Unaware / report
1. Visits to the dentist
2. The patient’s oral hygiene regimen
3. orthodontic treatment
4. patient is experiencing pain in the teeth or in the gingiva
5. presence of any gingival bleeding,
6. bad taste in the mouth and areas of food impaction
12. 7. the patient’s teeth feel “loose” or insecure, difficulty chewing,
tooth mobility.
• Dental History
8. patient’s general dental habits, grinding or
clenching of the teeth during the day or at night.
9. patient’s history of previous periodontal problems
10. wear removable prosthesis.
11. patient have implants
13. Intraoral Radiographic Survey
consist of a minimum of 14 intraoral
films and 4 posterior bite-wing films
• Panoramic radiographs
detection of
developmental anomalies, pathologic lesions of the teeth
and jaws
14.
15. • Casts view of the lingual–cuspal relationships
helpful to determine the position of implant placement
• Clinical Photographs mucogingival
problems
areas of gingival recession, frenum involvement,
papilla loss
• Review of the Initial Examination
16. Second Visit
• Oral Examination Oral Hygiene
Oral Malodor
Examination of the Oral Cavity
Examination of the Lymph Nodes
aware of the presence of “swollen glands.”
Primary herpetic
gingivostomatitis, necrotizing ulcerative gingivitis, and
acute
periodontal abscesses
17. Examination of the Teeth and Implants
Wasting Disease of the Teeth
Dental Stains
Hypersensitivity
Proximal Contact Relations
Tooth Mobility
Trauma from Occlusion
Pathologic Migration of the Teeth
Sensitivity to Percussion
Dentition With the Jaws Closed
Functional Occlusal Relationships
18. Wasting Disease of the Teeth
Erosion
Sognnaes refers to these
lesions as dentoalveolar ablations
corrosion
long axis of the eroded area is perpendicular to the
vertical axis of the tooth
Decalcification by acidic
Beverages or citrus fruits in combination with the effect of
acid
salivary secretion
the salivary pH, the buffering
capacity, and the calcium and phosphorus content have
been
reported as normal, and the mucin level is elevated
19. Abrasion saucer-shaped or wedge-shaped indentations with a smooth, shiny
surface.
A sharp “ditching” around the cementoenamel junction
Toothbrushing with an abrasive dentifrice and
the action of clasps
20. Attrition
results from functional contacts
with opposing teeth.
Occlusal or incisal surfaces worn by attrition are called facets
abfraction
occlusal loading surfaces
causing tooth flexure and mechanical
microfractures and tooth
substance loss in the cervical area
These four mechanisms of tooth wear
(corrosion, abrasion,
attrition, and abfraction) can combine with
each other to result in
an increased degree of tooth wear.
21. Dental Stains. Dental stains are pigmented deposits on the
teeth. They should be carefully examined to determine their origin
Hypersensitivity. Root surfaces exposed by gingival recession
Proximal Contact Relations food
impaction
shift in the median line between the central incisors with labial
flaring of
the maxillary canine; buccal or lingual displacement of the
posterior
teeth; and an uneven relationship of the marginal ridges.
22. Tooth Mobility
Tooth mobility occurs in the following two stages
1. The initial or intrasocket stage
2. The secondary stage
100 μm to 200 μm for incisors,
50 μm to 90 μm for canines, 8
μm to 10 μm for premolars,
and 40 μm to 80 μm for molars
23. Tooth Mobility
Mobility is graded according to the ease and extent of tooth
movement as follows:
• Normal mobility
• Grade I:
• Grade II:
• Grade III:
Increased mobility is caused by one or more of the following
factors:
1. Loss of tooth support
2. Trauma from occlusion
3. Extension of inflammation
from the gingiva or from the
periapex
into the periodontal ligament
4. Periodontal surgery
5. during pregnancy
6. Pathologic processes of the
jaws that destroy the alveolar
bone
or the roots of the teeth
24. • higher proportions of Campylobacter rectus and
Peptostreptococcus
• micros and possibly of Porphyromonas gingivalis as
• compared with nonmobile teeth
Tooth Mobility
25. Trauma from Occlusion radiographic evidence of a widened periodontal space;
vertical or angular bone destruction; infrabony pockets;
and pathologic
migration, especially of the anterior teeth
Pathologic Migration of the Teeth.
26. • Sensitivity to Percussion
• Dentition With the Jaws Closed overbite open-bite crossbite
Functional Occlusal Relationships.
27. Examination of the Periodontium
• Plaque and Calculus
• Gingiva
• Use of Clinical Indices in Dental Practice.
• Periodontal Pockets
Signs and Symptoms
Detection of Pockets
Pocket Probing
