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.
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]
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:
Code | Description | Treatment |
---|---|---|
0 | No disease (gingival pockets < 3 mm) | No action required |
1 | Bleeding on probing, but gingival pockets < 3 mm | Oral hygiene instruction because bleeding on probing usually indicates the presence of plaque induced gingivitis |
2 | Periodontal 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) |
3 | Shallow periodontal pockets 4 – 5 mm (i.e. first band on probe partially visible) | More detailed examination of periodontal condition indicated |
4 | Deep 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 furcation | More detailed examination of periodontal condition indicated |
Code | Description |
---|---|
0 | No disease (gingival pockets < 3 mm) |
1 | Bleeding on probing, but gingival pockets < 3 mm |
2 | Periodontal pocketing < 3mm, but calculus (dental) present with or without plaque retentive factors such as "overhanging" restorations |
3 | Shallow periodontal pockets 4 - 5.5 mm (i.e. first band on probe partially visible) |
4 | Deep periodontal pockets > 6 mm (first band on probe disappears) |
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 ]
Code | Description |
---|---|
0 | No disease (gingival pockets < 3 mm) |
1 | Bleeding on probing, but gingival pockets < 3 mm |
2 | Periodontal pocketing < 3mm, but calculus (dental) present with or without plaque retentive factors such as "overhanging" restorations |
3 | Shallow periodontal pockets (i.e. first band on probe partially visible) |
4 | Deep 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 |
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.)
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. Halitosis may also occur.
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.
The Universal Numbering System, sometimes called the "American System", is a dental notation system commonly used in the United States.
FDI World Dental Federation notation is the world's most commonly used dental notation. It is designated by the International Organization for Standardization as standard ISO 3950 "Dentistry — Designation system for teeth and areas of the oral cavity".
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 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.
Crown lengthening is a surgical procedure performed by a dentist, or more frequently a periodontist, where more tooth is exposed by removing some of the gingival margin (gum) and supporting bone. Crown lengthening can also be achieved orthodontically by extruding the tooth.
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.
Bleeding on probing (BoP) which is also known as bleeding gums or gingival bleeding is a term used by dentists and dental hygienists when referring to bleeding that is induced by gentle manipulation of the tissue at the depth of the gingival sulcus, or interface between the gingiva and a tooth. BoP is a sign of periodontal inflammation and indicates some sort of destruction and erosion to the lining of the sulcus or the ulceration of sulcular epithelium. The blood comes from lamina propria after the ulceration of the lining. BoP seems to be correlated with Periodontal Inflamed Surface Area (PISA).
Dental pertains to the teeth, including dentistry. Topics related to the dentistry, the human mouth and teeth include:
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.
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:
Hipposideros besaoka is an extinct bat from Madagascar in the genus Hipposideros. It is known from numerous jaws and teeth, which were collected in a cave at Anjohibe in 1996 and described as a new species in 2007. The site where H. besaoka was found is at most 10,000 years old; other parts of the cave have yielded H. commersoni, a living species of Hipposideros from Madagascar, and some material that is distinct from both species. H. besaoka was larger than H. commersoni, making it the largest insectivorous bat of Madagascar, and had broader molars and a more robust lower jaw. As usual in Hipposideros, the second upper premolar is small and displaced from the toothrow, and the second lower premolar is large.
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 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 or wisdom teeth that are not erupted but are exposed to oral bacteria through deep periodontal pocket, can develop cavities or pericoronitis. Removal of impacted wisdom teeth is advised for the future prevention of or in the current presence of certain pathologies, such as caries, periodontal disease or cysts. Prophylactic (preventative) extraction of wisdom teeth is preferred to be done at a younger age to take advantage of incomplete root development, which is associated with an easier surgical procedure and less probability of complications.
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.