3. Chief Complaint
It is written in the patient own words
Examples:
1)Pain
2)Bleeding in gum
3) Enlargement of gum
4) Bad mouth odour
5) Staining
6) Calculus removal (for fabrication of RPD or FPD)
6. Bleeding
1)Character:
a) Mild, Moderate, Sever
b) spontaneous, provoked (occur during eating, brushing )
2) Onset:
Since................................
3)Duration:
Lasts
for.........................
7. Past Medical History
As some diseases need some precautions
or bring our attention to some
periodontal or gingival conditions in
the oral cavity
Past Dental History
To know
• The patient’s care for his teeth and oral
hygiene
• Cooperation of the patient
•The attributes of patient in dental clinic
8. Family History
To know the presence of any hereditary disease
ESPICIALLY
-Diabetes
-Hypertension OR heart disease
-Haemophilia
EXAMPLE: DM Type II of her father
10. Extra oral Examination
1)Eyes: Especially the color of sclera
2)Lips: If dry and incompetent mouth breather
3)Skin color: If pale OR yellowish Anemic pt
4)face symmetry:
5)Lymph nodes: (submental & submandibular):
A) Palpable OR Non-palpable
B) Tender OR Non-tender
C) Firm OR Soft
D) Mobile OR Fixed
11. Intra oral Examination
I) Hygiene
Good Fair bad
Depending on the amount of plaque and calculus in the pt mouth
12. II) Gingiva
1) COLOUR
Pale pink or Coral pink Normal OR
Reparative stage of inflammation
Bright Red Active (destructive) stage of
inflammation
Bluish Red Chronic inflammation
Physiologic Pigmentation
Smoker Melanosis
13. A) Site of Redness
B) Zone of Redness
Generalized
Localized
Related to……(location)
Marginal
Papillary
DiffuseEXAMPLE
Localized marginal redness related to lower
ant. Teeth & the rest of the mouth is pale
pink.
14. Knife-edged marginal gingiva & pointed I.D.P Normal
Rolled marginal gingiva & blunt I.D.P Inflamed
2) Shape
(Diagnostic)
IT MAY BE
Generalized
Localized
Related to……(location)
EXAMPLE:
Generalized rolling of marginal gingiva & blunt I.D.P
15. IT IS DETECTED BY
visualization after drying with a
cotton in the
presence of light
3)TEXTURE
Presence of stippling (orange peel appearance) in the attached
Gingiva Normal OR Reparative stage of inflammation
Loss of stippling Destructive stage of inflammation
17. EITHER Bleeding upon probing
Grade I: Dot of blood
Grade II: Line of blood
Grade III: Triangle of blood
Grade IV: Profuse bleeding
OR No bleeding upon probing
18. EITHER
Normal
Bulbous I.D.P As in case of mouth
breather and it is Confined to the ant. Teeth
Enlargement Generalized; as in
idiopathic & Leukemia
OR
Localized ;as in mouth breather
(usually related to the ant Teeth)
5)SIZE
19. EITHER
6)CONSISTENCY
Firm & Resilient Normal
&
Reparative stage of inflammation
Soft & Edematous Destructive stage of
inflammation
EXAMPLE: Soft & edematous related to the lower ant. teeth
&the rest of the mouth is firm & resilient
21. Determine the tooth with recession &
the location of it Labially
Buccally
Lingually
Palatally
EXAMPLE: Localized lingual recession related to 1 2 3
McCall’s festoons
Stilmann’s cleft
22. Miller’s classification :
Class I: marginal tissue
recession doesn’t extend to the
mucogingival junction.
Class II : marginal tissue
recession extend to or beyond
the mucogingival junction .no
loss of bone or soft tissues in
the interdental areas.
ClassIII : marginal tissue
recession extends beyond the
mucogingival junction.bone
and/or soft tissue loss
interdentally.
ClassIV : marginal tissue
recession extends to or beyond
the mucogingival junction with
severe bone loss and soft tissue
loss interdentally and tooth
malposition
23. Pus may present in the sulcus after pressing the
gingiva DUE TO periodontal abscess
(localized)
OR
oozing of pus from suppurate pockets
8)EXUDATES
28. ▪Grades according to the degree of penetration of
probe (Glickman’s classification)
-Grade I Only tip is entered
-Grade II cul de saac
-Grade III Through & Through
(covered with gingiva)
-Grade IV Through & Through
(with gingival recession)
32. A) Narrow zone of
attached gingival.
B) High frenal
attachment.
C) The base of the pocket
is to/beyond the
mucogingival junction.
D) Recession to/beyond
the mucogingival
junction.
10)MUCO-GINGIVAL
PROBLEMS
33. Stretch the lip & cheek to demarcate the mucogingival
line while the pocket is probed.
If stretching induce movement of free gingival margin ,
the amount of attached gingiva is considered to be
insufficient.
A]
Tension Test
Methods of Measurement
34. Done by pushing the adjacent non-attached alveolar
mucosa coronally toward the attached gingiva ,with
dull instrument.
If that induce movement of free gingival margin
coronally ,the amount of attached gingiva is
considered to be insufficient.
B]
Rolling Test
38. o It is the measurement of the vibratory pattern of
teeth when placed in contact position .
o It is an early manifestation of T.F.O .
14)FREMITUS
o Way of Measurement
The patient is placed in upright position & the index finger is
placed on the cervical portion of the ant. Teeth
[Upper teeth in case of class I, Lower teeth in case of class III]
[Both Upper & Lower teeth in case of edge to edge.]
then the patient is asked to tap the teeth together in max.
Intercuspal position .
39. o Grades (classification )
Class I : Mild vibration .
Class II : Easily palpable vibration but no movement
" sense " .
Class III : Movement visible by naked eye
" see & sense " .
40. Done by tapping on the incisal 1/3 of the tooth by the
end of a blunt instrument .
15)PERCUSSION
Pain on Vertical percussion
Pain on Horizontal percussion
indicate
indicate
Periapical
problem
Periodontal
problem
41. RadiographicExamination
1] Bone loss
A] Horizontal:
B] Vertical: it means Inflammation superimposed
with T.F.O. OR Food wedging .
Treatment: 1) Remove local factors .
2) Correct T.F.O. by occlusal
adjustment
42. NOTE:
* X-Ray shows the severity of the disease
(Clinically severity can be assessed ).
- If bone loss reached ¼ of the root length Mild .
½ of the root length Moderate
>½ of the root length Severe .
43. • Appear as radiolucency in the furcation area
2] Furcation
involvement
44. It appears as white radioopaque line
surrounding the teeth roots .
3]Lamina Dura
45. A] Crestal : Below the CEJ
- Breakdown or Fuzziness or Loss of crestal Lamina
Dura .
indicate Periodontitis .
B] Overall :
- Discontinuity Periapical Lesion .
- Thickening Localized T.F.O.
Generalized Systemic Sclerosis .
- Thinning or Loss Paget`s .
Osteoporosis .
Hyperparathyroidism .
46. It appears as Radiolucent line around the roots of
the teeth .
Widening of PDL space Localized T.F.O.
Generalized Systemic
sclerosis
Narrowing of PDL space Non-Functional side .
4] PDL Space
47. o Filling .
o Crown OR Bridge .
o Caries .
o Fracture .
5] Others
48.
49. M Mobility .
P Probing depth .
AL Attachment Loss .
53. 2] P = Probing depth
It is the Distance between the gingival margin & the
base of the pocket ( i.e. Depth of probing ) .
3] AL = Attachment Loss
It is the Distance between the CEJ & the base
of the pocket ( i.e. Depth of probing ) .
71. Age: above 30 (but can affect any age group)
Amount of local factors consistent with amount of
distruction
Pattern of bone loss: mixed (horizontal + vertical)
Rate of progress: slow to moderate with periods of
remission and exacerbation
74. Age: under 30 (but can affect any age group)
Amount of local factors NOT consistent with amount
of distruction
Rapid rate of distruction (4 times more)
Pattern of bone loss : arc shape around the first molars
Severe loss around anterior teeth
76. *Phases of Treatment Plan
A-Preliminary phase [Emergency Phase].
B-Phase I Therapy [Etiotropic Phase].
C-Phase II Therapy [Surgical Phase].
D-Phase III Therapy [Restorative Phase].
E-Phase IV Therapy [Maintenance Phase].
77. B) Phase I Therapy :
*Etiotropic / Initial / Hygienic phase
1] Limited Plaque Control
2] Supragingival scaling (removal of calculus above gingival margin)
3] Recontouring of defective restorations
4] Obturation of caries
- Caries in vinicity of gingiva interfere with gingival health in absence Of calculus
AS it acts as large reservoir for microorganisms.
5] Comprehensive plaque control
6] Subgingival scaling or root treatment
- Subgingival root planning consist of removal of calculus ,
Elimination of necrotic cementum .
7] Minor occlusal adjustment.
8] Minor orthodontic treatment.
9] Tissue re-evaluation.
- After 15-30 days of following all oral hygiene instructions ,periodontal tissues are
re-examined to determine the need for further treatment
-Pockets are re-examined to decide the need for surgical treatment.
-Fate of 5mm pocket In ant. Segment Follow up (maintenance phase)
In post. segment Perio surgery (surgical phase)
78. C) Phase II Therapy :
*Surgical Phase
1-Periodontal surgery .
2-Root Canal Treatment (RCT) .
3-Placement of Implant .
Gingivectomy
Gingival Flap
Bone Graft
Tissue Graft
*Criteria for patient to undergo surgery
* O’Leary Index (Plaque Index) must be 10% .
* Bleeding Index at 0% .
* The gingival condition must be firm & resilient.
79. D) Phase III Therapy :
* Restorative Phase
1- Fixed OR Removable prosthesis .
2- Permanent restoration for the temporary
filling.
80. E) Phase IV Therapy :
* Maintenance Phase
Periodic recall visits for check up of all the
previous conditions AS;
1- plaque.
2- calculus.
3- Gingival condition.
4- Tooth mobility.
5- Other pathological conditions.
6- Periodic radiographs especially in case of
aggressive periodontitis.