Initial phase

CLINICAL PERIODONTOLOGY

INITIAL PHASE OF TREATMENT INCLUDING EXAMINATION AND THE DIAGNOSIS DETERMINED BY HISTORY, SIGNS & SYMPTOMS, TESTS

The diagnosis include history

MedicalDental ( chief complain )Past dental historyAsk about tooth brushingOthers like mouth wash & I.D. AidsAreas of food impactionTeeth feel loose? Difficulty in chewing ?Habits (smoking, nail biting….etc)

Clinical Examination

1st dryness of the gingiva Inspect the color of gingiva,(red spongy texture smooth,glossy)or pale & firm or bluish gray Bleeding on probing (only 30% of sites with bleed will go on to lose attachment ) Pressure by index finger Localized or generalized , marginal or diffused , edematous or fibrotic

Probing Pocket Depth

Distance to which the probe penetrate into the pocket Dependent on the position of the G.M. Differ from actual biological depth as it depend on : size or type , force , direction , resistance , convexity Others signs of pocket as rolled margen that separate from tooth sur.,pus discharge,extrusion of tooth with diastema


Over & under estimation; as in healthy g.2/3 penetration of epith.in gingivitis its stopped o.1mm short of its apical end,in p.d.it past most apical cells of J.E.about 0.3mm 0.75 N force, accurate Interexaminer error---2.1 mm ( average 1.5 mm )

Probing Attachment Level

Measured from a fixed reference point ; the CEJ or margin of restoration to the base of the pocket Detected in exposed & unexposed CEJ

Furcation Involvment

Classification Special probe : Nebers 2 , Za 3 Radiograph can detect D.2 & 3


Tooth mobility
Causes Classification technique

Detection of

T.O. ? Pathological tooth migration due to tongue thrust,premature contact post.?,ant. Caused by agg.p.dontitis in young Bite(open,over,cross) Examine dentition when Jaws closed to detect malaligned,extruded teeth,improper proximal contact,FI DENTAL PLAQUE by ?

Halitosis (fetor ex ore, fetor oris, malodor)

Foul or offensive odor emerge from O.C.by (H2sulfyde,methyl mercaptan) Intra oral causes ; retention of food ,NUG ,dehydration ,caries,denture,smoking,healing surgical or exo.wound, coated tongue ,pocket(accumulated debris), putrefaction of saliva Extra oral causes; lung dis. ,metabolites excreted through lung from onion, alcoholic ,acetone,uremic,

WASTING disease of teeth

Gradual loss of tooth substance By formation of smooth, polished surface Erosion; wedge shaped depression in cervical area of F.tooth sur.1st in E.caused by acidic food, acidic S.secresion,frectional action b/w soft & hard t. Abrasion; caused by mechanical wear other than that of mastication started in C. due to clasp,toothbrushing Attrition;occlusal wear due to functional contact with opposing teeth

Radiographical examination

Bitewing post,paralleling ant. Adjunct not substitude Detect bone loss not pocket which is soft tissue changes Measure from CEJ to alv.crest(2mm), A.crest;most coronal level where p.d.l.space retained its normal width Bone loss recorded when widening of p.d.l.accompanied by evidence of oblique resorption Infrabony crater record to apical border of radiolucency


Standardized reproducible technique for pre & post treatment comparison Bisecting technique Increase projection & make bone margin appear closer to crown while long cone paralleling technique projects most realistic image of level of A.bone


Criteria to determine adequate angulation of p.A .R
Tips of molars cusp Destinct E.cup&pulp chamber I .proximal space sh .be open Prox. Contact sh. Not overlap

Pattern of bone loss

I.D. Crater seen as irregular areas of reduced radiopacity on bone crest that not sharply demarcated from rest of bone with which they blend gradually Wedge-shaped radiolucent area (infra bony defect) at M.& D.aspect of crest due to bone resorption at lateral aspect of septum associated with p.d.space widening Supra bony defect finger like radiolucent projection extend from crest into septum as destructive process extend across crest & height reduced

PROBING TO

Determine H.&C. Of F. & L. Bone Architecture of I. D. bone Technique; transg.probing performed after anesthetize the area---accurate method


Horizontal bitewings useful for minor bone loss & detect ca. Depositsvertical bitewings for deep pocket

Assessment of

Plaque retentive factor like; ca. ,overhang restoration ,ill-fitting crown & bridge