PowerPoint Handout       

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*Note: test questions may come from the Journal Article: The Complete Periodontal Exam

Module
: Comprehensive Periodontal Examination
(rev 11/13)
Competency II-7:  Assess a patient's periodontium accurately with an understanding of normal function and appearance
Facilitator: Boyd
Primary Resources: Mosby's Dental Hygiene 2nd Ed.- Chapter 16: pp. 313-322; Nield-Willmann (perio book) 3rd Ed.- Ch 13, 19;  Nield (spiral book) 7th Ed. - Module 18

Supplemental Resources:

Wilkins 11th Ed. Ch15 -skim chapter
Journal Article: The Complete Periodontal Exam**
Journal Article: The Challenge of Furcations



Key Terms:
clinical periodontal assessment comprehensive periodontal examination (CPE)
baseline data mobility rating scales (1-3)
recession of gingival margin mobility
physiologic tooth mobility pathologic tooth mobility
vertical tooth mobility horizontal tooth mobility
primary occlusal trauma secondary occlusal trauma
attached gingiva, width and measurement fremitus
mucogingival defect (MGD) Clinical attachment level (CAL)
tension test junctional epithelium
inflammation bleeding on probing (BOP)
sulcus periodontal pocket
pseudopocket exudate/suppuration/pus
probing depth stippling
gingivitis periodontitis
bulbous papilla blunted papilla
cratered papilla extent of inflammation
distribution of inflammation localized inflammation
generalized inflammation papillary inflammation
marginal inflammation diffuse inflammation
gingival fibers PDL fibers
furcation bifurcation
trifurcation furcation involvement
furcation grades (I-IV) severity
periodontal attachment system loss of attachment
frenum frenum pull
edematous erythematous
cyanotic pigmentation
festooned gingiva Stillman's Cleft (Wilkins)
McCall's Festoons (Wilkins) gingival enlargement - hyperplasia
acute infection chronic infection
Severity - slight, moderate, severe tooth migration
PSR and WHO probe - Nield-Willmann p.324-325 (independent study)

Learning Objectives:

  1. Define each of the key terms,

  2. Compare the normal clinical  gingiva to that of inflamed gingiva with regard to color, size, contour, shape, position, surface texture, bleeding and exudate,  study aid

  3. Compare the following gingival descriptors (characteristics): localized and generalized, marginal and papillary, slight, moderate and severe,  study aid

  4. Identify the items involved in the indication of the periodontal disease process,

  5. Explain the components of a gingival examination, including the gingival tissue examination, mucogingival defect identification (tension test), the attached gingiva measurement, and the loss of attachment,  

  6. Discuss the purpose of taking probe measurements during a comprehensive periodontal examination,  

  7. Explain why the CAL measurement is a more definitive measurement of periodontal disease progression than probing depth measurement.

  8. Describe the methods for measuring  sulcus/pocket depths, clinical attachment, gingival recession, furcation involvement and attached gingiva with a calibrated periodontal probe,  

  9. Identify the clinical differences between the 4 grades of furcation involvement, as well as how and where to record this data on a patient chart (Mosby's p. 321 Table 16-1)

  10. Differentiate between pathologic and physiologic tooth mobility,               

  11. Identify causative factors for tooth mobility,

  12. Identify the differences between grade I, II, and III mobility, as well as how and where to record this data on a patient chart

  13. Differentiate between primary occlusal trauma and secondary occlusal trauma, 

  14. Compare the technique for the assessment and recording of tooth mobility and fremitus,

  15. Describe the possible causes of abnormal tooth mobility,

  16. Relate radiographic interpretation to the role it plays in the comprehensive periodontal examination (Wilkins 11th Ed. p. 240-242)

  17. Compare horizontal bone loss to vertical bone loss with regards to radiographic appearance, probe measurements, and etiology,

  18. Explain radiographic changes to the crestal lamina dura, bone level, furcations and periodontal ligament space, that would reflect occurrence of periodontal infections,

  19. Describe the method of documentation of tooth mobility and/or fremitus,

  20. Explain  the purposes and uses of the air syringe during the oral examination process to determine calculus deposits, etc.,  

  21. List the terms that are used to describe supragingival and subgingival calculus according to the location, distribution, and amount

  22. Identify the spatial relationship between the cementoenamel junction, the alveolar crest, the junctional epithelium and the gingival margin in health versus disease   

  23. Review the PSR - Periodontal Screening Report (Nield Willman p. 324-325 independent study) and compare it to the CPE - Comprehensive Periodontal Exam

Learning Activities:

  1. Obtain patient charts that indicate periodontal involvement and identify what is not within the normal range,

  2. Practice reading aloud the periodontal charting including probing depths, furcation, mobility, mucogingival defects, recession, etc. that may be indicated,

  3. Create a chart of  hypothetical periodontal pathological findings including: gingival recession, probing depths, bleeding on probing, mucogingival defects, attachment level, tooth mobility, tooth migration and furcation involvements that can be used as a check sheet during beginning patient care. ( A "cheat sheet" of documentations)  

  4. Practice looking at radiographs for evidence of horizontal bone loss and vertical bone loss indicating periodontal involvement,

Problem Solving:

  1. A patient presents with a recession measurement of 4 mm and a sulcus depth of 5 mm on tooth #30. What is the measurement for the attachment loss?

  2. A patient presents with edematous tissue and a probing depth of 6mm on tooth # 3. How would you determine the attachment level?

  3. A patient's radiographs indicate slight vertical bone loss. What does this indication mean and what would you use to verify the appearance on the radiographs? What information would you give to the patient?