Periodontal examination

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A periodontal examination is a clinical examination of the periodontium (gums). It is routinely carried out in dentistry and allied specialties. Many different techniques are used around the world.

Contents

A report by World Health Organization in 1978 led to the creation of the Community Periodontal Index of Treatment Needs (CPITN) and a periodontal probe termed WHO 621 ("Trintity"). It has a ball end of diameter 0.5 mm and a first colored band at 3.5 - 5.5 mm. Another colored band at 8.5 - 11.5 mm may be present. The CPITN was intended to provide a global standard for clinical practise and research, but several different periodontal screening tools were adapted from it. The Periodontal Screening and Recording (PSR) is increasingly used in the United States, Canada and Brazil. The Basic Periodontal Examination (BPE) is extensively used in the United Kingdom and New Zealand. The Primary Essential Periodontal Examination (PEPE) is used in Australia. All these methods use the WHO 621 probe. [1]

Basic Periodontal Examination

Division of mouth into sextants for Basic Periodontal Examination Basic periodontal examination.png
Division of mouth into sextants for Basic Periodontal Examination

This is the technique recommended by the British Society of Periodontology since its introduction in 1986. It is a screening tool which is used to quickly obtain a rough picture of the periodontal condition and treatment needs of an individual, but it does not provide an exact periodontal diagnosis. [2]

For the purposes of a BPE, all the teeth in a person's mouth are divided into sextants (i.e. 6 parts), namely the upper right second molar to the upper right first premolar, the upper right canine to the upper left canine, the upper left first premolar to the upper left second molar, the lower right second molar to the lower right first premolar, lower right canine to the lower left canine, and the lower left first premolar to the lower left second molar. Wisdom teeth are not included because pericoronitis and tooth impaction may cause isolated periodontal defects which do not represent the general periodontal condition of the rest of the mouth. At least 2 teeth must be present in a sextant for it to be scored. If only 1 tooth is present in a sextant, the tooth is included in the adjoining sextant.

The probe is "walked around" measuring the depth of the gingival crevices/periodontal pockets (the gap between the tooth and the gums, "below the gumline") with a force of approximately 20 - 25 gm (20 - 25 N) (about the force using when writing with a pencil). The worst finding in a sextant dictates the sextant's BPE score. The BPE is usually recorded in a table of six boxes (see diagram). The scoring is as follows:

CodeDescriptionTreatment
0No disease (gingival pockets < 3 mm)No action required
1Bleeding on probing, but gingival pockets < 3 mm Oral hygiene instruction because bleeding on probing usually indicates the presence of plaque induced gingivitis
2Periodontal pocketing < 3mm, but calculus (dental) present with or without plaque retentive factors such as "overhanging" restorations Oral hygiene instruction, remove plaque retentive factors (e.g. replace ledged restoration with correct use of matrix band, remove calculus with professional tooth cleaning)
3Shallow periodontal pockets 4 - 5 mm (i.e. first band on probe partially visible)More detailed examination of periodontal condition indicated
4Deep periodontal pockets > 6 mm (first band on probe disappears)More detailed examination of periodontal condition indicated
* (star added to the score, e.g. 4*)Periodontal defect furcationMore detailed examination of periodontal condition indicated

CPITN Index

CodeDescription
0No disease (gingival pockets < 3 mm)
1Bleeding on probing, but gingival pockets < 3 mm
2Periodontal pocketing < 3mm, but calculus (dental) present with or without plaque retentive factors such as "overhanging" restorations
3Shallow periodontal pockets 4 - 5.5 mm (i.e. first band on probe partially visible)
4Deep periodontal pockets > 6 mm (first band on probe disappears)

PSR Index

The PSR (Periodontal Screening and Recording) system was first introduced to the United States in 1992. It is based on the CPITN index.[ citation needed ]

CodeDescription
0No disease (gingival pockets < 3 mm)
1Bleeding on probing, but gingival pockets < 3 mm
2Periodontal pocketing < 3mm, but calculus (dental) present with or without plaque retentive factors such as "overhanging" restorations
3Shallow periodontal pockets (i.e. first band on probe partially visible)
4Deep periodontal pockets > 5.5 mm (first band on probe disappears)
* (star added to the score, e.g. 4*)Indicates an additional issue that must be considered e.g furcation, substantial gingival recession, mobility

Spanish Periodontal Examination

In teeth 16, 11, 25, 32, 36 and 45, the following is assessed:

• Probing depth (PS - profundidad de sondaje)

• Bleeding on probing (BOP: +/-)

• Loss of attachment with bitewings (Horizontal bone loss/ Vertical defects)

(If said teeth are absent, the immediately adjacent teeth are taken as a reference or failing that, whichever is closest clinically affected.)

Related Research Articles

Human tooth Calcified whitish structure in humans mouths used to break down food

The human teeth function to mechanically break down items of food by cutting and crushing them in preparation for swallowing and digesting. Humans have four types of teeth: incisors, canines, premolars, and molars, which each have a specific function. The incisors cut the food, the canines tear the food and the molars and premolars crush the food. The roots of teeth are embedded in the maxilla or the mandible and are covered by gums. Teeth are made of multiple tissues of varying density and hardness.

Periodontal disease Medical condition

Periodontal disease, also known as gum disease, is a set of inflammatory conditions affecting the tissues surrounding the teeth. In its early stage, called gingivitis, the gums become swollen and red and may bleed. It is considered the main cause of tooth loss for adults worldwide. In its more serious form, called periodontitis, the gums can pull away from the tooth, bone can be lost, and the teeth may loosen or fall out. Bad breath may also occur.

Gums Human mouth anatomy

The gums or gingiva consist of the mucosal tissue that lies over the mandible and maxilla inside the mouth. Gum health and disease can have an effect on general health.

Periodontology or periodontics is the specialty of dentistry that studies supporting structures of teeth, as well as diseases and conditions that affect them. The supporting tissues are known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum, and the periodontal ligament. A periodontist is a dentist that specializes in the prevention, diagnosis and treatment of periodontal disease and in the placement of dental implants.

Veterinary dentistry

Veterinary dentistry is the field of dentistry applied to the care of animals. It is the art and science of prevention, diagnosis, and treatment of conditions, diseases, and disorders of the oral cavity, the maxillofacial region, and its associated structures as it relates to animals.

Universal Numbering System

The Universal Numbering System, sometimes called the "American System", is a dental notation system commonly used in the United States.

Gingival sulcus Space between tooth and gums

The gingival sulcus is an area of potential space between a tooth and the surrounding gingival tissue and is lined by sulcular epithelium. The depth of the sulcus is bounded by two entities: apically by the gingival fibers of the connective tissue attachment and coronally by the free gingival margin. A healthy sulcular depth is three millimeters or less, which is readily self-cleansable with a properly used toothbrush or the supplemental use of other oral hygiene aids.

Tooth eruption

Tooth eruption is a process in tooth development in which the teeth enter the mouth and become visible. It is currently believed that the periodontal ligament plays an important role in tooth eruption. The first human teeth to appear, the deciduous (primary) teeth, erupt into the mouth from around 6 months until 2 years of age, in a process known as "teething". These teeth are the only ones in the mouth until a person is about 6 years old creating the primary dentition stage. At that time, the first permanent tooth erupts and begins a time in which there is a combination of primary and permanent teeth, known as the mixed dentition stage, which lasts until the last primary tooth is lost. Then, the remaining permanent teeth erupt into the mouth during the permanent dentition stage.

Dental anatomy is a field of anatomy dedicated to the study of human tooth structures. The development, appearance, and classification of teeth fall within its purview. Tooth formation begins before birth, and the teeth's eventual morphology is dictated during this time. Dental anatomy is also a taxonomical science: it is concerned with the naming of teeth and the structures of which they are made, this information serving a practical purpose in dental treatment.

This is a list of definitions of commonly used terms of location and direction in dentistry. This set of terms provides orientation within the oral cavity, much as anatomical terms of location provide orientation throughout the body.

Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:

Guided bone regeneration (GBR) and guided tissue regeneration (GTR) are dental surgical procedures that use barrier membranes to direct the growth of new bone and gingival tissue at sites with insufficient volumes or dimensions of bone or gingiva for proper function, esthetics or prosthetic restoration. Guided bone regeneration typically refers to ridge augmentation or bone regenerative procedures; guided tissue regeneration typically refers to regeneration of periodontal attachment.

Furcation defect

In dentistry, a furcation defect is bone loss, usually a result of periodontal disease, affecting the base of the root trunk of a tooth where two or more roots meet. The extent and configuration of the defect are factors in both diagnosis and treatment planning.

Epidemiology of periodontal disease is the study of patterns, causes, and effects of periodontal diseases. Periodontal disease is a disease affecting the tissue surrounding the teeth. This causes the gums and the teeth to separate making spaces that become infected. The immune system tries to fight the toxins breaking down the bone and tissue connecting to the teeth to the gums. The teeth will have to be removed. This is an advance stage of gum disease that has multiple definitions. Adult periodontitis affects less than 10 to 15% of the population in industrialized countries, mainly adults around the ages of 50 to 60. The disease is now declining world-wide.

Equine malocclusion

An equine malocclusion is a misalignment between the upper and lower jaws of a horse or other equine. It results in a faulty bite with the upper and lower teeth failing to meet correctly. Malocclusions can cause pain to the horse and may also lead to weight loss and other eating problems related to poor chewing or loss of appetite. In addition, discomfort can lead to poor behavior when the animal is ridden or driven, particularly if a bit is used in the horse's mouth.

Chronic periodontitis is one of the seven categories of periodontitis as defined by the American Academy of Periodontology 1999 classification system. Chronic periodontitis is a common disease of the oral cavity consisting of chronic inflammation of the periodontal tissues that is caused by the accumulation of profuse amounts of dental plaque. Periodontitis initially begins as gingivitis and can progress onto chronic and subsequent aggressive periodontitis according to the 1999 classification.

Aggressive periodontitis describes a type of periodontal disease and includes two of the seven classifications of periodontitis as defined by the 1999 classification system:

  1. Localized aggressive periodontitis (LAP)
  2. Generalized aggressive periodontitis (GAP)

In dentistry, numerous types of classification schemes have been developed to describe the teeth and gum tissue in a way that categorizes various defects. All of these classification schemes combine to provide the periodontal diagnosis of the aforementioned tissues in their various states of health and disease.

Impacted wisdom teeth Teeth that do not fully grow out of the gums due to being blocked by other teeth

Impacted wisdom teeth is a condition where the third molars are prevented from erupting into the mouth. This can be caused by a physical barrier, such as other teeth, or when the tooth is angled away from a vertical position. Completely unerupted wisdom teeth usually result in no symptoms, although they can sometimes develop cysts or neoplasms. Partially erupted wisdom teeth can develop cavities or pericoronitis. Removal of impacted wisdom teeth is advised in the case of certain pathologies, such as nonrestorable caries or cysts.

Periodontal surgery is a form of dental surgery that prevents or corrects anatomical, traumatic, developmental, or plaque-induced defects in the bone, gingiva, or alveolar mucosa. The objectives of this surgery include accessibility of instruments to root surface, elimination of inflammation, creation of an oral environment for plaque control, periodontal diseases control, oral hygiene maintenance, maintain proper embrasure space, address gingiva-alveolar mucosa problems, and esthetic improvement. The surgical procedures include crown lengthening, frenectomy, and mucogingival flap surgery.

References

  1. RAPP GE; et al. "Technical Assessment of WHO-621 Periodontal Probe made in Brazil, Braz Dent J (2002) 13(1): 61-65 ISSN 0103-6440".
  2. BASIC PERIODONTAL EXAMINATION (BPE) British Society of Periodontology, 2011