بسم الله الرحمن الرحيم

وسع ربنا كل شئ علما على الله توكلنا ربنا افتح بيننا وبين لومنا بالحك

وانت خير الفاتحين“ 89األعراف ” صدق الله العظيم

Prof Dr.Eman Abd El -Sattar Tella

1) To record the patient's periodontal condition atbaseline

2) To establish effective patient communication aboutperiodontal disease and its prevention and treatment.

3) To establish proper diagnosis and treatment planning.

4) To evaluate the response to therapy.

5) To serve as a baseline for future comparison at recallvisits during maintenance phase

Importance of dental Charting

Involves entire mouthGeneralized

LocationConfined to a single tooth or group of teethLocalized

Involves gingival margin including papillaeMarginal

DistributionInvolves interdental papilla(e) onlyPapillary

Involves gingival margin including papillae and attached gingiva

Diffuse

Slight, Moderate, SevereSeverity

Clinical evaluation of the gingiva

Describe observation using the evaluation

DISTRIBUTION

• Localized gingivitis is confined to the gingiva of a single tooth or group of teeth while generalized gingivitis involves the entire mouth.

DISTRIBUTION

• Marginal gingivitis involves the gingival margin and may include a portion of the contiguous attached gingiva.

• Papillary gingivitis involves the interdental papillae and often extends into the adjacent portion of the gingival margin.

DISTRIBUTION

• Diffuse gingivitis affects the gingival margin, the attached gingiva, and the interdental papille.

Record color, size, shape, consistency and

surface texture of the gingiva :

Red, bright red, bluish red, grayQualityGingival

color Generalized moderate marginal redness with localized bright red gingiva at # 46,45 & 34

Example

EnlargedQualityGingival size Generalized slight to moderate marginal enlargement with

localized severe enlargement about facial of # 47-45 & #23-34 Example

Bulbous, flattened, punched-out, cratered, rolledQualityGingival shape Localized, moderately punched-out papillary gingiva at # 24Example

Firm; spongyQualityConsistency of gingiva Generalized moderate marginal sponginess more severe about

#34-37Example

Smooth, shiny, loss of stippling; or heavy deep stippling may occur with fibrotic firm tissue

QualitySurface Texture of

gingiva Localized smooth gingiva facial # 13-15Example

Healthy gingivaPale pink & stippled. Narrow

distinguishable free gingival margin. No bleeding on probing

Mild gingivitisLocalized mild erythema & slight

edema. Some stippling is lost. Minimal bleeding after probing.

Moderate gingivitis

Obvious erythema & edema. No stippling, bleeding on probing

Severe gingivitisFiery redness, edematous &

hyperplastic swelling, complete absence of stippling, bleeding on probing & spontaneous hemorrhage.

Mild gingivitis in anterior area:

Mild erythema in maxilla. Slight

edematous swelling & erythema.

In mandible, slight edematous

swelling & erythema.

Papilla Bleeding Index: Grade 1

& 2

Stained plaque: Small plaque

accumulations arounds the necks

of the teeth & in interdental areas.

Moderate gingivitis in

anterior teeth :Erythema

& enlargement of gingiva

pronounced in mand than

in maxilla.

Papilla Bleeding Index :

grade 3 & 4

Stained plaque : Moderate plaque

accumulation in maxilla. Heavier plaque in mandible.

Radiographically, no destruction of interdental bony septa.

Gingival

Recession

Draw lines facial, lingual and palatal to represent the

position of the gingival margin in relation to the tooth

crown and the cementoenamel junction (CEJ) on the

dental chart. On diagram record accurately the position of

the free margin to show recession.

Generalized or Localized

Location

Gingival Recession

May be measured with probe from CEJ

Severity

Generalized slight (see chart) Localized 4mm#28 (Stillman's Cleft)

Example

Pocket Depth “Probed Pocket Depth”

The probing depth is the distance from gingival margin to

which the probe penetrates into the pocket

Proceed from posterior teeth to midline for each quadrant,

all teeth from facial approach, then lingual for the entire

quadrant.

Insert probe at the distal line angle and "walk" distally

along the proximal surface; slant to accomodate the

contact area.

Return, the probe to the distal line angle; proceed around

the mesial line angle and into the mesial proximal.

Carefully diagonal probe to complete the proximal

examination.

Rationale

Attachment level

“Probed Attachment level”

1) Inflammation in the gingiva fluctuates

and pocket depth varies.

2) Measuring attachment level from a

fixed point (CEJ) provides a more

accurate evaluation for comparison.

Gingival Bleeding

Bleeding on probing is a significant sign of inflammation

that appears early before tissue color changes.

• Spontaneous, upon provocation, acute, chronic,

recurrentNature

• Generalized moderate marginal bleeding on

probing; profuse lingual # 32-29 & # 21Example

Exudate

The index finger is placed along the lateral aspect of

marginal gingiva and pressure is applied in a rolling

motion toward the crown

• Visible or upon

palpation (linger

pressure)

Nature

• Localized severe

exudate on pressure

at # 13, 47-45 &# 34-

32

Example

Probe Furcation

Area

Location

• Furcation is accessible for probing from the facial and lingual

• Mandibular molars

Bifurcation•Furcation is accessible for probing

from the mesial and distal•Maxillary first

pre molars

•Furcation iis accessible for probing fnbm the mesial and distal and the facial

• Maxillary molarsTrifurcation

Classification of furcation

involvement

Incipient bone lessClass I

Partial bone loss (cul-de-

sac)Class II

Classification of furcation

involvement

Total bone loss withthrough and throughopening of the furcation

Class III

Total bone loss withthrough-and-throughopening ot the furcationwith gingival recessionexposing the furcation toview

Class IV

Mucogingival areas

The width of the attached gingiva

When a pocket extends to or beyond the mucogingival

junction, the probe may pass through the pocket directly

into the alveolar mucosa.

1) On the external surface of the gingiva, measure from the margin of the

gingiva to the mucogingival junction (total width of the gingiva).

2) Insert the probe into the sulcus or pocket and measure from the gingival

margin to the junctional epithelium (probing depth).

3) The width of the attached gingiva = total width of gingiva - probing depth

Bacterial

plaque

Observe thin plaque by running an explorer5 over

the tooth surface at cervical third and thick

plaque by direct observation.

Write: light, medium, heavy.

Calculus

Supragingival

Subgingival

Dental stains`

Write: color, source when known, distribution;

localized, generalized, cervical third or surface;

intrinsic or extrinsic

Functional

relations

• Pathologic migration occurs most frequently inanterior teeth. Distinguish from "mesial drift” whichoccurs in posterior teeth with healthy gingival

Pathologic Migration

• Test for open contacts where food impaction can occurby using dental floss.

• Record on the tooth chart by parallel lines.

Open Contacts

•Record any symptoms such as pain, tenderness sounds(crepitation) or limitation of movement.

Temporomandibular Joint Disorder

Parafunctional

Note tooth wear facets and occlusal and incisal

wear.

Question patient concerning habits such as

bruxing, clenching, or tapping

o Bruxism = grinding of teeth in directions different from normal

chewing at night

o Clenching = closing of teeth in the chewing position at day &

night

o Tapping = grading of an isolated tooth

Fremitus

Fremitus is palpable_vibration (or) movement, It is an

important sign during examination % of the occlusion,

and is commonly used as an indicator of the need for

further analysis

NOMINAL SCALE

o N normal

o + vibration felt

o 1 slight movement felt against finger

o 2 clearly palpable, movement visible

o 3 movement very apparent

Percussion

Percussion is the act of tapping a surface of a tooth

with an instrument. Sensitivity to percussion is a

manifestation of inflammation in the periodontal

ligament.

Mobility

Position the patient in supine for clear visibility.

Stabilize the head. Motion of head can interfere with a

true evaluation of tooth movement.

Begin with most posterior tooth and move

systematically around each arch.

Use two single-ended metal instruments. Hold in

modified pen grasp. Using wooden tongue depressors

or plastic mirror handles is not good, because of their

flexibility. Testing with fingers without the metal

instruments can be misleading since the soft tissue

moves.

Normal Mobility

Grade I: Slightly more than normal.

Grade II: Moderately more than normal.

Grade III: Severe mobility faciolingually and/or mesiodistally

combined with vartical displacement.

Radiographic

Examination

• Horizontal

• AngularBone loss

Write tooth numbers.

Place a black dot in furcation on the dental charting (See Key for Chart)

Furcation Involvement (radiolucency between

roots)

Lamina Dura

Use of clinical photographs and study casts

1. Clinical Photographs

Color photographs are useful for recording the

appearance of the tissue before, and after treatment.

2. Casts

position of the gjngival margins

position and inclination of the teeth

proximal contact relationships

Food impactions areas.

Finally casts also serve as visual aids in discussions with the

patient and are useful for pre and post-treatment comparisons, as

well as for reference at check-up visits.

References

-Caranza’s Clinical Periodontology, 10th ed.

WB Saunders, 2006.

-Color Atlas of Dental Medicine:

Periodontology By Klaus H. Rateitschak,

Edith M.