Dr.

Wael Abd al-Azeez

Diagnosis and examination of patients with periodontal disease

Why we do diagnosis?

1. To determine whether the disease is present or not.

2. Identify its types.

3. Extent

4. Severity

5. Distribution

6. Underlying pathological process and their causes.

First visit

 Overall appraisal of the patient.

 Medical history.

 Dental history.

 intraoral radiographic survey

 Cast

 Clinical photograph

The medical history should include reference to the following:

1. If the patient is under the care of a physician, the nature and duration of the problem and its

therapy should be discussed.

2. Details regarding hospitalizations and operations, including the diagnosis, the type of

operation, and any untoward events (e.g.,anesthetic, hemorrhagic, or infectious complications)

should be provided.

3. A list of all medications being taken.

4. All medical problems (e.g., cardiovascular, hematologic, endocrine), including infectious

diseases, sexually transmitted diseasess should be listed.

5. Abnormal bleeding tendencies, such as nosebleeds, prolonged bleeding from minor cuts,

spontaneous ecchymoses, a tendency toward excessive bruising, and excessive menstrual

bleeding, should be cited. These symptoms should be correlated with the medications that the

patient is taking..

6. The patient’s allergy history should be taken

What is the relevance of a patient's medical history to his or her periodontal

care?

1. Medical problems can increase susceptibility to periodontal diseases (e.g diabetes and HIV)

2.Medical problems can have periodontal and other oral manifestations (e g., leukaemia and

subcutaneous disorders).
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3• Prescribed and nonprescribed medications can have oral and periodontal side effects (e.g.,

calcium channel blocker or phenytoin).

4.Precautions to be taken to avoid complications during or after treatment (e.g., antibiotic

prophylaxis and patients on certain medications such as anticoagulants).

5. Treating certain conditions may present additional risk to the dental team (e.g., communicable

diseases) and may alter the way treatment is provided (e.g., not using ultrasonic instrumentation

to avoid producing aerosol).

2)Dental History

1. Visits to the dentist should be listed, including their frequency, the date of the most recent

visit, the nature of the treatment, and oral prophylaxis or cleaning by a dentist or hygienist,

including the frequency and date of most recent cleaning.

2. The patient's oral hygiene regimen should be described, including tooth brushing frequency,

time of day, method, type of toothbrush and dentifrice, and interval at which brushes are

replaced. Other methods for mouth care, such as mouthwashes, interdental brushes, other

devices, water irrigation, and dental floss, should also be listed.

3. Any orthodontic treatment, including its duration and the approximate date of termination,

should be noted.

4. If the patient is experiencing pain in the teeth or in the gingiva, the manner in which the pain is

provoked, its nature and duration, and the manner in which it is relieved should be described.

5. Note the presence of any gingival bleeding, including when it first occurred; whether it occurs

spontaneously, on brushing or eating, at night, or with regular periodicity; whether it is

associated with the menstrual period or other specific factors; and the duration of the bleeding

and the manner in which it is stopped.

6. A bad taste in the mouth and areas of food impaction should be mentioned.

7. If the patient has any difficulty chewing, and whether there is any tooth mobility.

8. Note the patient’s general dental habits, such as grinding or clenching of the teeth during the

day or at night ,tobacco smoking or chewing, nail biting, or biting on foreign objects?

9. Discuss the patient’s history of previous periodontal problems, including the nature of the

condition, and, if it was previously treated, the type of treatment received (surgical or

nonsurgical) and the approximate period of termination of the previous treatment. If, in the

opinion of the patient, the present problem is a recurrence of previous disease, what does he or

she think caused it?

10. Note whether the patient wears any removable prosthesis.

11. Does the patient have implants to replace any of the missing teeth?

Intraoral Radiographic Survey

The radiographic survey

should consist of a minimum of 14 intraoral films and 4 posterior bite-wing films Panoramic

radiographs are a simple and convenient method of obtaining a survey view of the dental arch

and the surrounding Structures. They are helpful for the detection of developmental

anomalies, pathologic lesions of the teeth and jaws, and fractures as well as for the dental

screening examinations of large groups. They provide an informative overall radiographic

picture of the distribution and severity of bone destruction with periodontal disease.

Gingiva :-

*Features of the gingiva to consider include color, size, contour, consistency,

position, ease of bleeding, and pain

*Clinically, gingival inflammation can produce two basic types of tissue response:

edematous and fibrotic. Edematous tissue response is characterized by a smooth,

glossy, soft, red gingiva. With the fibrotic tissue response, some of the

characteristics of normally persist; the gingiva is more firm, stippled, and opaque;

it is usually thicker, and the margin appears rounded.

Bleeding on Probing.

The insertion of a probe to the bottom of the pocket elicits bleeding if the gingiva

is inflamed and if the pocket epithelium is atrophic or ulcerated. Noninflamed sites

rarely bleed. In most cases, bleeding on probing is an earlier sign of inflammation

than gingival color changes

*Depending on the severity of inflammation, bleeding can vary from a tenuous red

line along the gingival sulcus to profuse bleeding.

*If periodontal treatment is successful, bleeding on probing will cease.

To test for bleeding after probing, the probe is carefully introduced to the bottom

of the pocket and gently moved laterally along the pocket wall. Sometimes

bleeding appears immediately after the removal of the probe; other times, it may be

delayed for a few seconds. Therefore, the clinician should recheck for bleeding 30

to60 seconds after probing.

Level of Attachment Versus Pocket Depth.

Pocket depth is the distance between the base of the pocket and the gingival

margin. It may change from time to time, even in patients with untreated

periodontal disease, as a result of changes in the position of the gingival margin.

Therefore, it may be unrelated to the existing attachment of the tooth.

The level of attachment is the distance between the base of the pocket and a fixed

point on the crown, such as the cementoenamel junction (CEJ). Changes in the
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level of attachment can be the result of a gain or loss of attachment, and they can

afford a better indication of the degree of periodontal destruction or gain.