0ERIODONTOLOGY

(ASSAN :IADA

#HRIS )RWIN "RIAN -ULLALLY

%DITH !LLEN AND 0ATRICK * "YRNE

0ERIODONTICS  )DENTIFICATION AND

$IAGNOSIS OF 0ERIODONTAL $ISEASES
IN 'ENERAL $ENTAL 0RACTICE
!BSTRACT 4HE DIAGNOSIS AND MANAGEMENT OF PERIODONTAL DISEASES REQUIRES A DETAILED EXAMINATION OF THE SIGNS AND SYMPTOMS ASSOCIATED
WITH PERIODONTAL DISEASE 4HIS REQUIRES A SCREENING PROCEDURE THE "0% BEING SUFFICIENT IN THE MAJORITY OF CASES $ETAILED EXAMINATION IS
HOWEVER REQUIRED IN MORE ADVANCED OR SEVERE CASES 4HE GENERAL DENTAL PRACTITIONER SHOULD FOLLOW A SYSTEMATIC AND ORGANIZED EXAMINATION
TO IDENTIFY AND DIFFERENTIATE BETWEEN INDIVIDUALS WITH GINGIVITIS AND THOSE WITH MILD MODERATE AND MORE ADVANCED FORMS OF PERIODONTITIS
4REATMENT PLANNING INCLUDING THE DECISION TO REFER TO A CONSULTANTSPECIALIST WHEN APPROPRIATE REQUIRES A CLEAR UNDERSTANDING AND
SATISFACTORY INTERPRETATION OF THE INFORMATION GATHERED FROM THE EXAMINATION 4HIS REDUCES THE RISK OF OVER OR UNDER TREATMENT HELPS IN
EVALUATING THE INDIVIDUALS RESPONSE TO THERAPY AND REDUCES THE RISK OF LITIGATION
#LINICAL 2ELEVANCE 4HE ASSESSMENT AND CLINICAL EXAMINATION OF PATIENTS WITH PERIODONTAL DISEASES AS DETAILED IN THIS PAPER ARE ESSENTIAL
FOR THE DIAGNOSIS EFFECTIVE TREATMENT PLANNING AND FUTURE MAINTENANCE CARE OF PATIENTS IN GENERAL DENTAL PRACTICE
$ENT 5PDATE    

)N  THE )NTERNATIONAL 7ORKSHOP FOR A FOR PERIODONTAL DISEASES 4HIS SYSTEM OF PERIODONTAL POCKETS TRUE POCKETING 
#LASSIFICATION OF 0ERIODONTAL $ISEASES AND SETS OUT TO CORRECT THE INADEQUACIES )N CONTRAST TO GINGIVITIS PERIODONTITIS
#ONDITIONS PRODUCED A NEW CLASSIFICATION OF PREVIOUS CLASSIFICATIONS 4HE RESULT IS IRREVERSIBLE 0ERIODONTAL TREATMENT IS
IS A DETAILED SYSTEM INCLUDING OVER AIMED AT REDUCING INFLAMMATION AND
 POSSIBLE DIAGNOSES FOR CONDITIONS POCKET DEPTH AT THE AFFECTED SITES 4RUE
(ASSAN :IADA 3ENIOR ,ECTURER#ONSULTANT AFFECTING THE PERIODONTAL TISSUES 7HILE REGENERATION OF LOST PERIODONTAL TISSUES
5NIVERSITY $ENTAL 3CHOOL AND (OSPITAL THIS CLASSIFICATION OF PERIODONTAL DISEASES IS REMAINS THE @HOLY GRAIL OF PERIODONTAL
7ILTON #ORK 2EPUBLIC OF )RELAND #HRIS USEFUL IN ALLOWING CLINICIANS TO ACCOUNT FOR THERAPY
)RWIN 2EADER#ONSULTANT $EPARTMENT OF ALL THE POSSIBLE VARIATIONS OF PERIODONTAL
2ESTORATIVE $ENTISTRY 1UEENS 5NIVERSITY OF CONDITIONS TWO BASIC DISEASE ENTITIES EXIST
"ELFAST 3CHOOL OF #LINICAL $ENTISTRY 2OYAL n GINGIVITIS AND PERIODONTITIS
6ICTORIA (OSPITAL "ELFAST "4 "0 .ORTHERN 'INGIVITIS IS A PLAQUE
)RELAND "RIAN -ULLALLY #ONSULTANT3ENIOR INDUCED GINGIVAL INFLAMMATION WITHOUT
,ECTURER $EPARTMENT OF 2ESTORATIVE INVOLVEMENT OF THE TOOTH SUPPORTING
$ENTISTRY 1UEENS 5NIVERSITY OF "ELFAST TISSUES NAMELY PERIODONTAL LIGAMENT
3CHOOL OF #LINICAL $ENTISTRY 2OYAL 6ICTORIA AND ALVEOLAR BONE 4HIS CONDITION IS FULLY
(OSPITAL "ELFAST "4 "0 .ORTHERN )RELAND REVERSIBLE n IMPROVEMENT IN ORAL HYGIENE
%DITH !LLEN ,ECTURER $EPARTMENT OF MEASURES SUPPORTED BY PROPHYLAXIS CAN
2ESTORATIVE $ENTISTRY 5NIVERSITY #OLLEGE RESULT IN THE RESTORATION OF HEALTHY GINGIVA
#ORK 5NIVERSITY $ENTAL 3CHOOL AND (OSPITAL &IGURE  
7ILTON #ORK 2EPUBLIC OF )RELAND AND 0ATRICK 0ERIODONTITIS IS CHARACTERIZED
* "YRNE ,ECTURER $UBLIN $ENTAL (OSPITAL BY CONNECTIVE TISSUE ATTACHMENT LOSS
AND 0RACTICE ,IMITED TO 0ERIODONTICS IN &IGURE  ALVEOLAR BONE LOSS AND IS &IGURE  (EALTHY GINGIVAL TISSUES
$UBLIN 2EPUBLIC OF )RELAND USUALLY ACCOMPANIED BY THE FORMATION
 $ENTAL5PDATE -AY 
 0ERIODONTOLOGY

BE EVALUATED QUICKLY 6ISUAL INSPECTION

WILL ALSO ALLOW THE CLINICIAN TO DETECT ANY
DEVIATION FROM THE NORMAL ANATOMICAL
FEATURES FOR EXAMPLE
„ 4OOTH MALALIGNMENTCROWDING
„ $EFECTIVE RESTORATIONS
„ &RENAL PULL AND
„ ,ACK OF KERATINIZED TISSUES
&OLLOWING VISUAL INSPECTION A
"ASIC 0ERIODONTAL %XAMINATION "0% AS
RECOMMENDED BY THE "RITISH 3OCIETY OF
&IGURE  #HRONIC PERIODONTITIS &IGURE  #0)4. PROBE TYPE #
0ERIODONTOLOGY SHOULD BE CARRIED OUT ON
ALL DENTATE PATIENTS 4HE "0% IS A MODIFIED
   AND       AND     AND  VERSION OF THE ORIGINAL #0)4. #OMMUNITY
0ERIODONTAL )NDEX FOR 4REATMENT .EEDS 
   AND       AND     AND  4HE CONCEPT WHICH IS A TIME EFFICIENT
METHOD OF SCREENING INVOLVES THE USE
4ABLE  "0% DIVIDES THE DENTITION INTO SEXTANTS OF A SPECIAL PROBE THE #0)4. OR 7(/
PROBE WHICH WAS INTRODUCED TO SCREEN
FOR PERIODONTAL DISEASES AND EVALUATE
#ODE %XAMINATION FINDINGS #LINICAL CONDITION
TREATMENT NEEDS )T IS THEREFORE A METHOD
OF IDENTIFYING THE PRESENCE OR ABSENCE
 .O POCKETS EXCEEDING  MM NO CALCULUS OR 0ERIODONTAL HEALTH
OF DISEASE AS WELL AS PROVIDING A QUICK
OVERHANGS AND NO BLEEDING ON GENTLE PROBING
PERIODONTAL TREATMENT PLANNING SCHEME
4HE PROBE USED HAS A  MM DIAMETER
 #OLOURED BAND REMAINS TOTALLY VISIBLE INDICATING NO 'INGIVITIS
BALL AT ITS TIP AND IS AVAILABLE WITH A
POCKETS EXCEEDING  MM NO CALCULUS OR OVERHANGS
SINGLE COLOUR BAND THAT EXTENDS FROM
BUT BLEEDING PRESENT ON GENTLE PROBING
 MM TO  MM KNOWN AS THE 7(/ %
EPIDEMIOLOGICAL OR WITH TWO COLOUR BANDS
 #OLOURED BAND REMAINS TOTALLY VISIBLE INDICATING NO 'INGIVITIS COMPLICATED
WITH A SECOND BAND EXTENDING FROM 
POCKETS EXCEEDING  MM BUT CALCULUS OR OTHER PLAQUE BY LOCAL RISK FACTORS
MM TO  MM ON THE 7(/ # CLINICAL
RETENTIVE FACTORS FOUND AT OR BELOW THE GINGIVAL MARGIN
TYPE &IGURE  
%ACH TOOTH SHOULD BE EXAMINED
 #OLOURED BAND ON THE PROBE REMAINS PARTIALLY VISIBLE -ILD PERIODONTITIS
AT SIX SITES DISTO BUCCAL BUCCAL MESIO
WHEN INSERTED INTO THE DEEPEST POCKET INDICATING
BUCCAL DISTO PALATAL PALATAL AND MESIO
POCKET DEPTHS GREATER THAN  MM BUT LESS THAN
PALATAL AND THE HIGHEST MEASUREMENT ON
 MM
A SEXTANT SCORED AND RECORDED IN THE CHART
CODE  TO  
 #OLOURED BAND ON THE PROBE DISAPPEARS INDICATING A -ODERATE OR ADVANCED
4HE "0% DIVIDES THE DENTITION
POCKET OF AT LEAST  MM IN DEPTH PERIODONTITIS
INTO SEXTANTS AS SHOWN IN 4ABLE  &OR A
SEXTANT TO QUALIFY FOR RECORDING IT MUST
4OTAL ATTACHMENT LOSS AT ANY SITE IS  MM OR GREATER OR !DVANCED
CONTAIN AT LEAST TWO TEETH )F ONLY ONE
IF A FURCATION DEFECT IS PROBED PERIODONTITIS
TOOTH REMAINS FOR RECORDING PURPOSES IT
4ABLE  3UMMARY OF CODES USED IN "0% IS INCLUDED IN THE ADJOINING SEXTANT 4HE
CODES USED IN THE "0% ARE SUMMARIZED IN
4ABLE  4HE HIGHEST SCORE IN EACH SEXTANT
IS RECORDED !S SOON AS A #ODE  OR IS
RECORDED THE EXAMINER CAN MOVE ON TO
2ECORD OF PERIODONTAL #LINICAL EVALUATION THE NEXT SEXTANT (OWEVER IF NEITHER OF
CONDITION 6ISUAL EXAMINATION TO THESE CODES IS RECORDED THE EXAMINER MUST
! PATIENTS INDIVIDUAL ASSESS ANY CHANGE IN COLOUR SWELLING PROBE ALL SITES TO ASCERTAIN THE HIGHEST
PERIODONTAL CHART SHOULD BE AND LOSS OF CONTOUR ANDOR RECESSION CODE FOR THAT SEXTANT 4HE "0% SHOULD
UNCOMPLICATED EASY TO READ AND CONTAIN SHOULD BE COMPLETED BEFORE MORE ALSO BE CARRIED OUT AT RECALL VISITS SINCE A
ALL THE INFORMATION REQUIRED TO DETERMINE DETAILED EXAMINATION OF THE GINGIVAL AND STUDY BY 4UGNAIT ET AL REPORTED THAT RECALL
THE DIAGNOSIS OF THE CONDITION PROGNOSIS PERIODONTAL TISSUES 7HILE THIS IS NOT A PATIENTS ARE LESS LIKELY TO BE SCREENED BY
FOR THE DENTITION AND TREATMENT PLAN FOR PRECISE METHOD OF DISEASE ASSESSMENT "0%
THE PATIENT THE PRESENCE OR ABSENCE OF DISEASE CAN 4HE CODES RECORDED FOR EACH
-AY  $ENTAL5PDATE 
 0ERIODONTOLOGY

 .O TREATMENT IS REQUIRED INFORMATION RELATING TO THE INFLAMMATORY

STATUS OF THE POCKET AND IS USED AS AN
 /RAL HYGIENE INSTRUCTION AND PROPHYLAXIS INDICATOR OF DISEASE ACTIVITY 0URULENT
DISCHARGE FROM A PERIODONTAL POCKET ON
 /RAL HYGIENE INSTRUCTION SCALING AND CORRECTION OF ANY PLAQUE RETENTIVE FACTORS THE OTHER HAND IS A MORE SIGNIFICANT SIGN OF
PRESENT SURROUNDING TISSUES DESTRUCTION
%VALUATING AND DOCUMENTING
 /RAL HYGIENE INSTRUCTION SCALING AND ROOT PLANING WITH CORRECTION OF ANY BLEEDING ON PROBING IS IMPORTANT !
PLAQUE RETENTIVE FACTORS ! FULL PERIODONTAL POCKET CHARTING PLAQUE AND BLEEDING CHART SIMILAR TO THE PLAQUE SCORE CHART
SCORES SHOULD BE RECORDED IN SEXTANTS SCORING #ODE  CAN BE USED TO MARK THE SITES OF "/0 AND
RECORD THESE ON THE PATIENTS CHART 4HIS
 OR /RAL HYGIENE INSTRUCTION SCALING AND ROOT PLANING AND CORRECTION OF ANY PLAQUE INFORMATION IS ALSO USED AS A BASELINE AND
RETENTIVE FACTORS 4HE SCORE INDICATES SIGNIFICANT LOSS OF ATTACHMENT AND FOR CONTINUOUS ASSESSMENT OF PROGRESS
ACCORDINGLY FULL PERIODONTAL POCKET CHARTING INCLUDING GINGIVAL RECESSION FOLLOWING THERAPY AND AS A VERIFICATION
MEASUREMENT PLAQUE AND BLEEDING SCORES AND THE EXTENT OF FURCATION OF THE EFFECTIVENESS OF THERAPY AS WELL
INVOLVEMENT SHOULD BE RECORDED 4HIS CODE ALSO INDICATES COMPLEX TREATMENT AS COMPLIANCE !LTHOUGH BLEEDING ON
MAY BE REQUIRED INCLUDING SURGICAL PERIODONTAL THERAPY AND REFERRAL TO A PROBING HAS SHOWN WEAK CORRELATION TO THE
SPECIALIST OR CONSULTANT SHOULD BE CONSIDERED IN THIS CASE 4HE CASE COMPLEXITY PROGRESSION OF PERIODONTAL DESTRUCTION IT IS
CRITERIA SUGGESTED IN THE "RITISH 3OCIETY OF 0ERIODONTOLOGY GUIDELINES FOR REFERRAL STILL WIDELY USED AS AN INDICATOR OF DISEASE
POLICY AND PARAMETERS OF CARE IS AN IDEAL GUIDELINE FOR GENERAL PRACTICE AND INFLAMMATION IN CLINICAL PRACTICE 0ART
  )T HAS BEEN SUGGESTED THAT THE ABSENCE
4ABLE  #ODES RECORDED FOR EACH SEXTANT USED TO DETERMINE THE PATIENTS TREATMENT NEEDS
OF BLEEDING IS A MORE IMPORTANT INDICATOR
OF PERIODONTAL HEALTH AND CAN BE USED
AS A MEASURE OF STABILITY 2EDUCTION IN
THE BLEEDING SCORE IS A POSITIVE OUTCOME
AETIOLOGICAL AGENT IN THE DEVELOPMENT AND SHOULD BE COMMUNICATED TO THE
OF GINGIVITIS AND PERIODONTITIS AND PATIENT AS IT REINFORCES AN IMPROVEMENT
THE MAINTENANCE OF PLAQUE AT A LEVEL IN PERIODONTAL HEALTH AND THE NEED TO
COMPATIBLE WITH HEALTH IS ESSENTIAL IN THE MAINTAIN A POSITIVE OUTCOME
MANAGEMENT OF PERIODONTAL DISEASES
!N ASSESSMENT OF PLAQUE LEVELS SHOULD
BE MADE AT THE INITIAL PRESENTATION AND 0ERIODONTAL POCKET DEPTH
MONITORED DURING THE TREATMENT PHASE 0ERIODONTAL POCKET PROBING
&IGURE  $ISCLOSING FOR PLAQUE DETECTION 4HE PATIENTS TEETH ARE DISCLOSED &IGURE  DEPTH MEASUREMENTS ARE ONLY REQUIRED
AND THE PRESENCE OF PLAQUE RECORDED ON IN SEXTANTS WITH "0% SCORE OF CODE 
FOUR SITES PER TOOTH 4HE PERCENTAGE OF SITES  OR  4HE PROBING POCKET DEPTH IS
EXHIBITING PLAQUE  PLAQUE SCORE SHOULD MEASURED FROM THE GINGIVAL MARGIN TO
BE RECORDED IN THE PATIENTS CHART AND USED THE MOST APICAL PART OF THE POCKET &IGURE
AS A BASELINE FOR FUTURE EVALUATION 4HIS   0ERIODONTAL POCKET DEPTH SHOULD BE
IS A SIMPLE METHOD FOR RECORDING PLAQUE RECORDED AT THE FOLLOWING SIX SITES PER
LEVELS WHILE THE USE OF DISCLOSING AGENTS TOOTH
CAN ALSO BE AN EXCELLENT EDUCATIONAL AND „ $ISTO BUCCAL
MOTIVATIONAL TOOL DURING ORAL HYGIENE „ "UCCAL
INSTRUCTION „ -ESIO BUCCAL
4HE PLAQUE SCORE ON ITS OWN „ -ESIO PALATAL
DOES NOT PROVIDE A TRUE PICTURE OF THE „ 0ALATAL AND
ORAL HOME CARE SINCE PATIENTS MAY BRUSH „ $ISTO PALATAL
&IGURE  ! GRADUATED PROBE FOR MEASURING THE THEIR TEETH AND REMOVE MOST OF THE 0OCKET DEPTHS IN GROSSLY INFLAMED TISSUES
PROBING POCKET DEPTH PLAQUE BEFORE ATTENDING FOR THEIR VISIT CAN BE DIFFICULT TO RECORD ACCURATELY )N
0LAQUE SCORE SHOULD THUS BE ASSESSED SUCH CASES SUPRAGINGIVAL SCALING SHOULD BE
AND CORRELATED WITH RECORDS OF BLEEDING CARRIED OUT BEFORE DEPTHS ARE RECORDED
SEXTANT CAN THEN BE USED TO DETERMINE THE ON PROBING SCORE AND THE PRESENCE ! GENTLE FORCE OF APPROXIMATELY
PATIENTS TREATMENT NEEDS 4ABLE   PERSISTENCE OR ABSENCE OF INFLAMMATION n G SHOULD BE EMPLOYED DURING
PERIODONTAL POCKET PROBING 4HIS IS
CLEARLY DIFFICULT TO GAUGE CLINICALLY BUT IS
0LAQUE "LEEDING ON PROBING APPROXIMATELY EQUIVALENT TO THE WEIGHT
$ENTAL PLAQUE IS THE PRIMARY "LEEDING ON PROBING PROVIDES OF THE PERIODONTAL PROBE %XCESS FORCE
 $ENTAL5PDATE -AY 
 0ERIODONTOLOGY

#ORPORATION 'AINESVILLE  4HIS ALLOWS THE

'RADE #LINICAL &INDING
RELATIVE ATTACHMENT LEVEL TO BE MEASURED
USING THE OCCLUSAL SURFACES OF THE TEETH
 0ROBE PASSES INTO THE FURCATION AREA BUT DOES NOT GO BEYOND MORE THAN ONE
RATHER THAN THE #%* AS REFERENCE LANDMARK
THIRD OF THE BUCCO LINGUAL WIDTH OF THE TOOTH
)T ALSO ALLOWS A CONTROLLED INSERTION FORCE
AUTOMATIC GENERATION AND RECORDING OF
 0ROBE PASSES MORE THAN ONE THIRD OF THE TOOTH BUT DOES NOT EXTEND TO THE OTHER
INFORMATION 4HE DIFFERENCES IN CONSEQUENT
SIDE OF THE FURCATION AREA
COLLECTED DATA AND MEASUREMENTS BETWEEN
VISITS CAN ALSO BE MADE
 0ROBE PASSES FULLY THROUGH THE FURCATION &IGURE  
4ABLE  #LASSIFICATION OF FURCATION INVOLVEMENT TO IDENTIFY THE SEVERITY OF BONE LOSS SECONDARY TO PERI
ODONTAL DISEASE IN THE HORIZONTAL DIMENSION &URCATION DEFECTS
)N ADDITION TO VERTICAL
MEASUREMENT OF PROBING POCKET DEPTH
HORIZONTAL MEASUREMENT IN THE FURCATION
PENETRATION OF THE PROBE THROUGH THE SOFT AREAS SHOULD BE CARRIED OUT #URVED
TISSUE BASE OF THE POCKET PARTICULARLY AT FURCATION PROBES EG .ABERS PROBE ARE
INFLAMED SITES "LANCHING OF THE TISSUES USED &URCATION INVOLVEMENT IS CLASSIFIED
PARTICULARLY IN SHALLOW POCKETS INDICATES INTO GRADES OR DEGREES THAT ARE INTENDED
THAT THE DEEPEST PART OF THE POCKET HAS TO IDENTIFY THE SEVERITY OF BONE LOSS
BEEN REACHED AND FURTHER PRESSURE WOULD SECONDARY TO PERIODONTAL DISEASE IN THE
BE UNCOMFORTABLE TO THE PATIENT )N MOVING HORIZONTAL DIMENSION 4ABLE  
THE PROBE APICALLY INTO THE POCKET ALONG 4HE PRESENCE OF FURCATION
&IGURE  &URCATION MEASUREMENT THROUGH AND THE ROOT SURFACE DEPOSITS OF SUBGINGIVAL INVOLVEMENT IS REGARDED AS A RISK FACTOR
THROUGH  CALCULUS MAY BE ENCOUNTERED RESULTING IN FOR THE INVOLVED SITE AND THE ADJACENT
AN UNDERESTIMATION OF POCKET DEPTH 4HE TEETH IN CASES OF PROXIMAL FURCATION
PROBE SHOULD BE TEASED PAST THE CALCULUS INVOLVEMENT 2ECORDING INFORMATION
UNTIL THE SOFT TISSUE BASE OF THE POCKET IS REGARDING THE PRESENCE AND DEGREE OF
REACHED FURCATION DEFECTS IS IMPORTANT AS THIS
4HE PROBE WHERE POSSIBLE AFFECTS BOTH THE PROGNOSIS FOR THE TOOTH
SHOULD REMAIN PARALLEL TO THE LONG INVOLVED AND INFLUENCES TREATMENT
AXIS OF THE TOOTH DURING POCKET DEPTH PLANNING &URCATION INVOLVED TEETH PROVIDE
DETERMINATION !NGULATION OF THE PROBE DIFFICULTIES WITH THOROUGH DEBRIDEMENT
WILL RESULT IN OVERESTIMATION OF THE POCKET AND ARE ALSO DIFFICULT FOR PATIENTS TO CLEAN
DEPTH ! NOTABLE EXCEPTION IS WHEN AND MAINTAIN (OWEVER METICULOUS HOME
PROBING INTERPROXIMAL AREAS WHERE THE CARE FOLLOWING THERAPY CAN RESULT IN A
PROBE MAY NEED TO BE ANGLED TO REACH THE SUCCESSFUL OUTCOME FOR A CONSIDERABLE
&IGURE  'INGIVAL MARGIN LEVEL MEASUREMENT BASE OF THE POCKET DIRECTLY BENEATH THE TIME 4HE PROGNOSIS OF FURCATION INVOLVED
RECESSION  CONTACT POINT TEETH CAN BE IMPROVED USING SEVERAL
)N CLINICAL PRACTICE POCKET PROCEDURES WHICH WILL BE PRESENTED LATER
DEPTH MEASUREMENTS RATHER THAN CLINICAL IN THIS SERIES
ATTACHMENT LOSS ARE RECORDED 4HIS REFLECTS
THAT PERIODONTAL THERAPY IS AIMED AT
RESOLVING INFLAMMATION AND INDUCING A 'INGIVAL RECESSION
REPAIR PROCESS THUS REDUCING POCKET DEPTH 4HE PRESENCE OF GINGIVAL
)T SHOULD BE REMEMBERED HOWEVER THAT RECESSION SHOULD BE RECORDED AS PART OF A
ATTACHMENT LOSS MEASUREMENTS GIVE A COMPREHENSIVE PERIODONTAL EXAMINATION
TRUE RECORD OF THE DEGREE OF PERIODONTAL &IGURE   2ECESSION CAN BE A RESULT
DESTRUCTION THAT HAS OCCURRED AT A SPECIFIC OF PERIODONTAL DISEASE AGGRESSIVE
SITE 7HEN MONITORING DISEASE PROGRESSION TOOTH BRUSHING PERIODONTAL TREATMENT
FOR EXAMPLE IN CLINICAL RESEARCH THE TOOTH POSITION OR AN UNDERLYING BONY
&IGURE  4OOTH MOBILITY MEASUREMENT  ATTACHMENT LOSS MEASUREMENTS MUST BE DEHISCENCE OR A COMBINATION OF ANY OF
USED THESE FACTORS )N AFFECTED AREAS PATIENTS
! MORE DEPENDABLE METHOD ARE SUSCEPTIBLE TO SENSITIVITY ROOT CARIES
OF MEASUREMENT IS THE COMPUTERIZED DATA AND POOR AESTHETICS 4HE MANAGEMENT
MAY CAUSE DISCOMFORT TO THE PATIENT AND COLLECTION AND MEASUREMENTS USING FOR OF GINGIVAL RECESSION WILL BE DISCUSSED IN
ALSO OVERESTIMATE POCKET DEPTH DUE TO EXAMPLE THE &LORIDA 0ROBE &LORIDA 0ROBE DETAIL LATER IN THIS SERIES

-AY  $ENTAL5PDATE 

 0ERIODONTOLOGY

3CORE #LINICAL FINDINGS ASSESSING THE LEVEL OF BONE SUPPORTING

THE TOOTH AND ALSO AID IN THE DETECTION OF
 4HERE IS A DETECTABLE MOBILITY OF UP TO  MM PHYSIOLOGICAL MOBILITY  OSSEOUS LESIONS 0ATIENTS WITH NO CLINICAL
EVIDENCE OF TRUE POCKETING OR ATTACHMENT
 4HE CROWN OF THE TOOTH MOVES IN A HORIZONTAL DIRECTION BETWEEN n MM LOSS DO NOT REQUIRE RADIOGRAPHS FOR
PERIODONTAL ASSESSMENT
 4HE CROWN OF THE TOOTH MOVES IN A HORIZONTAL DIRECTION BY MORE THAN  MM 4HE ORTHOPANTOMOGRAPH /04
PROVIDES AN EXCELLENT OVERVIEW OF THE ORAL
 4HE TOOTH MOVES IN BOTH A HORIZONTAL AND A VERTICAL DIRECTION STRUCTURES (OWEVER WHILE PROVIDING A
VIEW OF THE OVERALL PATTERN OF BONE LOSS
4ABLE  'RADING OF TOOTH MOBILITY AN /04 LACKS THE RESOLUTION AND DETAIL OF
INDIVIDUAL TEETH PARTICULARLY IN THE ANTERIOR
REGION OF THE MOUTH 4HE /04 HAS BEEN
ADVOCATED AS AN ALTERNATIVE TO FULL MOUTH
ASSESSMENT OF MOBILITY POST TREATMENT
PERIAPICAL RADIOGRAPHS ON THE BASIS THAT AN
5NLIKE A REDUCTION IN BLEEDING
UNSUSPECTED PATHOLOGY MAY BE PICKED UP
ON PROBING AND POCKET PROBING DEPTH
4HIS MAY NOT BE JUSTIFIABLE IN THE ABSENCE
TOOTH MOBILITY IS NOT A RELIABLE INDICATOR OF
OF SIGNS OR SYMPTOMS THAT REQUIRE AN
THE SUCCESS OF TREATMENT OUTCOME BUT IT IS
OVERALL RADIOGRAPH OF THE MOUTH
AN IMPORTANT CONSIDERATION IN TREATMENT
7HEN PERIODONTAL DISEASE
PLANNING SINCE IT MAY INDICATE THE
IS PRESENT PERIAPICAL RADIOGRAPHS OF
INVOLVEMENT OF FACTORS THAT MAY EXACERBATE
THE ANTERIOR AND HORIZONTAL OR VERTICAL
PERIODONTAL DISEASE IE OCCLUSAL TRAUMA
BITEWINGS DEPENDING ON THE DEPTH OF
THE POCKET OF THE POSTERIOR TEETH ARE THE
/CCLUSION APPROPRIATE RADIOGRAPHS TO TAKE 6ERTICAL
BITEWINGS PROVIDE A RELATIVELY NON
4HE OCCLUSION NEEDS TO BE
DISTORTED IMAGE OF THE INTERDENTAL BONE
EXAMINED CLOSELY AND ANY ABNORMALITIES
OF BOTH MAXILLARY AND MANDIBULAR TEETH
NOTED AND CORRECTED
ON THE SAME FILM &IGURE   )F THE PATIENT
%XAMINATION OF THE OCCLUSION
PRESENTS WITH GENERALIZED DISEASE FULL
SHOULD INCLUDE EVALUATION OF ANY HISTORY
MOUTH INTRA ORAL PERIAPICAL RADIOGRAPHS ARE
&IGURE  6ERTICAL BITEWING RADIOGRAPH OF TEMPOROMANDIBULAR JOINT PROBLEMS
MORE APPROPRIATE 0ERIAPICAL RADIOGRAPHS
PARAFUNCTION SUCH AS NOCTURNAL BRUXISM
OR CLENCHING OF TEETH )N ADDITION ANY
INTERFERENCE IN CENTRIC LATERAL AND ANTERIOR
4OOTH MOBILITY GUIDANCE SHOULD BE EVALUATED AND
4HE PRESENCE DEGREE OR RECORDED !NY SIGNS OF TOOTHWEAR SHOULD
GRADE AND THE CAUSE OF MOBILITY SHOULD BE NOTED &REMITUS THE SITUATION WHERE
BE ESTABLISHED AND RECORDED 4ABLE   CLOSURE INTO CENTRIC OCCLUSION CAUSES
4OOTH MOBILITY IS A COMMON RESULT OF TOOTH MOVEMENT SHOULD ALSO BE NOTED
SIGNIFICANT BONE LOSS (OWEVER INCREASED AND APPROPRIATE OCCLUSAL ADJUSTMENTS
OCCLUSAL LOADING MAY ALSO PLAY A ROLE IN THE MADE &REMITUS IS COMMONLY SEEN IN THE
AETIOLOGY OF A MOBILE TOOTH AND SHOULD BE UPPER ANTERIOR TEETH OF PATIENTS WITH
ASSESSED -OBILITY IS EVALUATED BY LIGHTLY PERIODONTITIS AND A REDUCED POSTERIOR
PRESSING ON THE CROWN OF THE TOOTH USING SUPPORT 4HE AFFECTED TEETH ARE UNABLE TO
THE NON WORKING ENDS OF TWO INSTRUMENT WITHSTAND THE TRANSFER OF THE OCCLUSAL FORCE
HANDLES &IGURE   TO THE ANTERIOR SEGMENT /CCLUSAL PROBLEMS
-EASUREMENTS OF MOBILITY COMPLICATE EXISTING PERIODONTAL DISEASE
TEND TO BE SUBJECTIVE AND TO OVERCOME AND THE POTENTIAL SUCCESS OF THERAPY THEY
THIS SUBJECTIVE EVALUATION THE 0ERIOTEST SHOULD EITHER BE MANAGED OR APPROPRIATE
FORMERLY MANUFACTURED BY 3IEMENS $ENTAL REFERRAL MADE
NOW BY 'ULDEN -EDIZINTECHNIK BOTH
$  "ENSHEIM AND DER "ERGSTRASSE
'ERMANY HAS BEEN INTRODUCED 4HIS IS 2ADIOGRAPHS
AN ELECTRONIC MEASUREMENT OF TOOTH AND 2ADIOGRAPHS ARE USED TO
IMPLANT MOBILITY AND MAY BE OF VALUE IN CONFIRM AND VERIFY FINDINGS FROM THE
&IGURE  0ERIAPICAL RADIOGRAPH
RECORDING PROGRESSIVE MOBILITY AND IN THE CLINICAL EXAMINATION 4HEY ASSIST IN

 $ENTAL5PDATE -AY 

 0ERIODONTOLOGY

&IGURE  SHOULD BE EXPOSED USING THE ! COMMERCIALLY AVAILABLE GENERAL DENTAL PRACTICE * $ENT 
LONG CONE PARALLELING TECHNIQUE WITH THE KIT DESIGNED TO DETECT THE PRESENCE  ´
APPROPRIATE RADIOGRAPH HOLDERS SINCE OF THREE PERIODONTAL PATHOGENS USING  HTTPWWWBSPERIOORGUK
BISECTING ANGLE PERIAPICAL RADIOGRAPHS %,)3! TECHNOLOGY IS NOT ROUTINELY USED IN MEMBERSREFERRALHTM
MAY DISTORT THE RELATIONSHIP BETWEEN THE PERIODONTAL PRACTICE  ,ANG .0 *OSS ! /RSANIC 4 'USBERTI &!
ALVEOLAR CREST AND TOOTH 4HE "ENZYL !RGININE 3IEGRIST "% "LEEDING ON PROBING
(IRSCHMANN ET AL HAVE .APTHYLAMIDE OR "!.! TEST OFFERS A ! PREDICTOR FOR THE PROGRESSION OF
MADE USEFUL SUGGESTIONS REGARDING THE RELATIVELY RAPID AND INEXPENSIVE METHOD PERIODONTAL DISEASE * #LIN 0ERIODONTOL
APPROPRIATE RADIOGRAPHS TO BE TAKEN OF SCREENING POCKETS FOR THE PRESENCE OF   ´
AS AN AID IN DIAGNOSIS 4HE RADIOGRAPH BACTERIA PRODUCING TRYPSIN LIKE PROTEASES  'IBBS #( (IRSCHFELD *7 ,EE *'
CHOSEN IS BASED ON THE FINDINGS IN THE SUCH AS 0ORPHYROMONAS GINGIVALIS AND TO ,OW 3" -AGNUSSON ) 4HOUSAND 22
CLINICAL EXAMINATION )T MUST BE BORNE IN A LESSER DEGREE 4ANERELLA FORSYTHENSIS AND 9ERNENI 0 #LARK 7" $ESCRIPTION
MIND THAT WHILE THERE IS A NEED TO OBTAIN 4REPONEMA DENTICOLA AND CLINICAL EVALUATION OF A NEW
INFORMATION ESSENTIAL IN DIAGNOSIS OF 'ENETIC TESTING HAS RECENTLY COMPUTERIZED PERIODONTAL PROBE ´ THE
PERIODONTAL DISEASE AND IN THE ASSESSMENT BECOME AVAILABLE AND MAY OFFER SOME &LORIDA PROBE * #LIN 0ERIODONTOL 
OF THE RESPONSE TO THERAPY IT IS IMPERATIVE ADDITIONAL INFORMATION REGARDING GENETIC  ´
TO KEEP THE PATIENTS RADIATION EXPOSURE SUSCEPTIBILITY TO PERIODONTAL DISEASE 4HIS  &LESZAR 4* +NOWLES *7 -ORRISON %#
TO THE MINIMUM ! TWO YEARLY REPEAT OF INFORMATION WOULD HAVE RELEVANCE IN THE "URGETT &' .ISSLE 22 2AMFJORD 30
RADIOGRAPHS FOR PATIENTS WITH PERIODONTAL EARLY TREATMENT OF PERIODONTAL DISEASES 4OOTH MOBILITY AND PERIODONTAL
DISEASE IS CONSIDERED APPROPRIATE FOR IF A GENETIC SUSCEPTIBILITY WAS IDENTIFIED THERAPY * #LIN 0ERIODONTOL  
FOLLOW UP UNLESS A SPECIFIC PROBLEM TOGETHER WITH FURTHER INFORMATION WITH ´
NECESSITATES A SHORTER TIME FRAME WHICH THE CLINICIAN CAN DECIDE ON THE  (IRSCHMANN 0. (ORNER + 2USHTON 6%
FUTURE RISK OF DISEASE WHICH IS ESSENTIAL IN 3ELECTION CRITERIA FOR PERIODONTAL
TREATMENT PLANNING RADIOGRAPHY "R $ENT *  
$IAGNOSTIC ADVANCES ´
4HE SYSTEM OF CLINICAL  *EFFCOAT -+ 7ANT )# 2EDDY -3
EXAMINATION AND DATA COLLECTION DESCRIBED
#ONCLUSION 2ADIOGRAPHIC DIAGNOSIS IN
IN THIS PAPER CAN DETECT LOCAL RISK FACTORS 4O IMPROVE THE ACCURACY OF PERIODONTICS 0ERIODONTOLOGY 
SITES OF INFLAMMATION PERIODONTAL DIAGNOSIS THE DENTAL PRACTITIONER SHOULD   ´
POCKETING AND LOSS OF CLINICAL ATTACHMENT ADOPT A CONSISTENT AND SYSTEMATIC  %LEY "- #OX 37 !DVANCES IN
3UCH MEASURES HOWEVER ARE RELATIVELY APPROACH TO RECORDING AND DOCUMENTING PERIODONTAL DIAGNOSIS  0OTENTIAL
CRUDE AND ARE A RECORD OF HISTORIC DISEASE THE FINDINGS FROM THE PERIODONTAL MICROBIOLOGICAL MARKERS "R $ENT *
4HEY OFFER LITTLE INFORMATION IN PREDICTING EXAMINATION 4HIS REDUCES THE RISK OF OVER   ´
THE LIKELIHOOD OF DISEASE PROGRESSION OR UNDER TREATMENT HELPS IN EVALUATING  %LEY "- #OX 37 !DVANCES IN
0ERIODONTAL DISEASE PROGRESSION IS NOW THE INDIVIDUALS RESPONSE TO THERAPY AND PERIODONTAL DIAGNOSIS  0OTENTIAL
CONSIDERED TO BE SITE SPECIFIC AND OCCURS REDUCES THE RISK OF LITIGATION INFLAMMATORY AND IMMUNE MARKERS
IN AN EPISODIC FASHION WITH SHORT BURSTS "R $ENT *   ´
OF DISEASE ACTIVITY ALTERNATING WITH MUCH  'REENSTEIN ' (ART 4# #LINICAL UTILITY
LONGER PERIODS OF QUIESCENCE 7HILE THE 2EFERENCES OF A GENETIC SUSCEPTIBILITY TEST FOR
DEGREE OF PERIODONTAL DESTRUCTION MAY TO  !RMITAGE '# $EVELOPMENT OF A SEVERE CHRONIC PERIODONTITIS A CRITICAL
SOME EXTENT PREDICT FUTURE PROGRESSION AS CLASSIFICATION SYSTEM FOR PERIODONTAL EVALUATION * !M $ENT !SSOC  
CLINICIANS WE LACK DEFINITIVE PREDICTORS OF DISEASES AND CONDITIONS !NNLS ´
ONGOING OR FUTURE DISEASE ACTIVITY 0ERIODONT   ´
"ACTERIOLOGICAL AND BIOCHEMICAL  "RITISH 3OCIETY OF 0ERIODONTOLOGY
ANALYSIS MAY OFFER THE POTENTIAL FOR THE 0ERIODONTOLOGY IN 'ENERAL $ENTAL
PREDICTION OF FUTURE TISSUE DESTRUCTION 0RACTICE IN THE 5+ ! FIRST POLICY &3'$16:(56
AND DISEASE PROGRESSION AT A PARTICULAR STATEMENT  $35,/
SITE "ACTERIOLOGICAL $.! ANALYSIS IS WIDELY  !IMAMO * "ARMES $ "EAGRIE '
USED FOR RESEARCH PURPOSES TO DETECT #UTRESS 4 -ARTIN * 3ARDO )NFIRRI *
PUTATIVE PATHOGENS AND COULD HOLD $EVELOPMENT OF THE 7ORLD (EALTH  ! " #  ! " $
PROMISE AS A QUICK SCREENING METHOD TO /RGANIZATION 7(/ #OMMUNITY
DETECT THE COLONIZATION OF POCKETS WITH 0ERIODONTAL )NDEX OF 4REATMENT .EEDS  ! " #  #
PATHOGENS ! SPECIFIC COMBINATION OF FLORA #0)4.  )NT $ENT *   ´  ! " #  ! " $
COULD REPRESENT AN INCREASED LIKELIHOOD  4UGNAIT ! #LEREHUGH 6 (IRSCHMANN
OF DISEASE PROGRESSION AT THE SITE TESTED 0. 5SE OF THE BASIC PERIODONTAL  ! $  " $
(OWEVER ITS VALIDATION FOR DAILY USE IN EXAMINATION AND RADIOGRAPHS IN THE
 " #  ! " $
GENERAL PRACTICE IS YET TO BE DEMONSTRATED ASSESSMENT OF PERIODONTAL DISEASES IN
-AY  $ENTAL5PDATE