Periodontal Chart presentation

description how to write the periodontal chart.

2. PERSONAL DATA
Name
Sex
Age
Marital status
occupation
I-History

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)

4. Present illness
It is the analysis of the
chief complain

5. Pain
1)Character, mild, moderate, sever/
intermittent, continous, itching, throbbing pain,
sensitivity.
2)Onset Since..........................
3)Duration Lasts for...................
4)Aggrevating Factors
Increased with........
(e.g.. Eating, Brushing ,Cold or Hot drinks )
5)Reliefing Factors
Decreased with......... (e.g.. Brushing, using
wooden sticks to stimulate bleeding)

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

9. Habits
Occupational
Parafunctional
Smoking
Tooth brushing

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
Diffuse
EXAMPLE
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

16. 4)BLEEDING

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

20. 7)RECESSION
It is exposure of the root
surface due to apical shift in
the position of gingiva

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

24. 9)FURCATION

25. Naber’sprobe

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)

30. Mucogingival problems

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

35. Include;
-Attrition. -Abrasion.
-Staining. -Crowding.
-Enamel hypoplasia .
-Supernumerary teeth.
11)TEETH

36. Includes
1)Maxillo-mandibular relation.
-class I -class II -class III
2)Open bite.
3)Cross bite.
4)Deep bite.
5)Non-functional side.
6)Unreplaced missing teeth sequelae.
7)Pathological migration.
8)T.M.J disorders.
12)FUNCTIONAL RELATION

37. Includes
1)Bruxism.
2)Clenching.
3)Tapping.
13)PARA-FUNCTIONAL

38. oIt is the measurement of the vibratory pattern of
teeth when placed in contact position .
oIt is an early manifestation of T.F.O.
14)FREMITUS
oWay 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.
Intercuspalposition .

39. oGrades (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 meansInflammation superimposed
with T.F.O. OR Food wedging .
Treatment:1)Remove local factors .
2)Correct T.F.O. by occlusal
adjustment

42. NOTE:
* X-Rayshows the severity of the disease
(Clinicallyseverity can be assessed ).
-If bone loss reached ¼of the root lengthMild .
½of the root lengthModerate
>½of 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 spaceLocalized T.F.O.
Generalized Systemic
sclerosis
Narrowing of PDL spaceNon-Functional side .
4] PDL Space

47. oFilling .
oCrown ORBridge .
oCaries .
oFracture .
5] Others

49. MMobility .
PProbing depth .
ALAttachment Loss .

50. 1] M = Mobility

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 ) .

60. Wrong application

67. Diagnosis
1]Gingival DiseaseChronic gingivitis.
Gingival enlargement.
Acute gingival diseases.
2]Periodontal DiseaseChronic periodontitis
Aggressive periodontitis
3]Caries.
4]Abrasion.
5]Attrition.
6]Erosion.
7]Non-Functional Side.

68. 1] Gingival Diseases
Changes in the normal criteria of gingiva ONLY
A]Localized Marginal .
Papillary .
Generalized Diffuse .
B]ANUG .
C]Acute herpetic gingivostomatitis .
D]Acute allergic stomatitis .
E]Acute gingival abscess . {Rare}
Chronic
Gingivitis
OR
Gingival Enlargement

69. 2] Periodontal Diseases
Changes in the normal criteria of gingiva ( gingivitis )
+Periodontal pocket (AL)
+Tooth mobility
+Recession
+Bone loss
+Pathological migration .

70. Chronic periodntitis

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

72. Aggressive periodontitis

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

75. Prognosis
After clinical examination & diagnosis will the
patient respond to Treatment .
A]Overall prognosis B]Individual prognosis

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 Indexat 0%.
* The gingival conditionmust 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.

81. Thank You