Examination of Periodontium
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Pocket Depth (PD) is the distance from gingival margin to the base of the pocket
Gingival Recession (GR) is the distance from cemento-enamel junction to the gingival margin
Clinical Attachment Loss (CAL) is the distance from cemento-enamel junction to the base of the pocket
CAL= PD + GR
Guidelines that should be followed when measuring the pocket depth
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| When probing different tooth surfaces, the probe should follow the contour of the tooth |
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| Excessive force should not be used during probing |
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In interproximal areas, the pocket should be checked
at the midpoint under the contact area |
Pocket Depth
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Biologic or histologic depth: is the distance between the gingival margin and the base of the pocket |
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It can be measured only in carefully prepared and adequately oriented histologic sections |
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Probing depth: is the distance to which the probe penetrate into the pocket |
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Probing depth > Histologic depth |
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Factors Affecting Probe Penetration
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The force of introduction: 25 gm is the standard |
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The size and shape of the probe |
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The degree of gingival inflammation: more inflammation? deeper penetration |
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The probe penetrate the junctional epithelium making
the clinical pocket depth more than the histological depth |
Mucogingival Junction
The junction between the gingiva (keratinized) and the alveolar mucosa (non-keratinized)
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Mucogingival Junction
The junction between the gingiva (keratinized) and the alveolar mucosa (non-keratinized)
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Mucogingival Junction
The junction between the gingiva (keratinized) and the alveolar mucosa (non-keratinized)
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| The gingiva in picture 1 is from thin tissue biotype and is more prone to recession than the gingiva in picture 2 (medium) or 3 (thick) |
Width of Attached Gingiva
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Maxilla > Mandible |
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Incisors has the greatest width (especially lateral incisor) |
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Canines and first premolars has the least width of attached gingiva |
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The patient has mucogingival problem If the width of attached gingiva is less than 2 mm |
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There is increase in attached and keratinized gingiva in primary and permanent teeth with increase age in children |
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Factors That May Affects the Width of Attached Gingiva
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Individual variations |
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Position of the tooth in the mouth |
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Buccal-lingual tooth position |
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High frenum and muscle attachment |
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Periodontal disease |
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Brushing habit |
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| Mucogingival problems can be diagnosed by measuring the attached gingiva using periodontal probe, roll test, & Iodine test (stain the non-attached mucosa) |
Examination of the teeth
Teeth mobility
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Teeth mobility is checked by using the end of two blunt instruments, it is assed by using an ordinal score:
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horizontal displacement of 1mm |
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horizontal displacement> 1mm |
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horizontal and vertical displacement> 1mm |
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Fremitus
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| Fremitus can be checked by putting the tip of the finger on gingival margin and cervical margin of the tooth and ask the patient to tap his/her teeth. Presence of vibration indicates fremitus, presence of mobility indicates more severe form of fremitus |
Erosions
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Sharply defined wedge-shaped depression in cervical area of the facial tooth surface. |
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Suggested cause of it is decalcification by acid beverages |
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The amount of plaque not necessarily related to the severity of the disease present |
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Abrasion
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Refers to the loss of tooth substance induced by mechanical wear other than that of mastication |
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It starts on exposed cementum and extends to involve the dentin of the root |
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Attrition
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Physiologic wearing away of tooth structure as a result of contact between adjacent teeth or with the teeth in the opposing arch |
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Both deciduous and permanent teeth may exhibit significant attrition |
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Severe degrees of attrition must be considered a pathologic process |
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Abfraction
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Refers to the loss of cervical tooth structure secondary to repeated flexure of the tooth caused by occlusal stresses. |
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