Examination, Diagnosis Treatment Planning

Data Collection
Accurate
Full Periodontal Examination
Recorded

Data Collection
History
Chief complaint
History of C/C
Medical history
Dental history

Clinical examination
Extraoral examination
Intraoral examination

Extraoral Examination
General appraisal
Skin
Eyes
Facial Asymmetries
TMJ
Muscles of mastication
Lymph nodes
Infections (e.g. herpes simplex)

Intraoral Examination
Oral hygiene
Halitosis
Oral mucosa
Chief complaint
Teeth

Teeth
Attrition
Erosion
Abrasion
Hypersensitivity
Cracks
Proximal contacts
Caries
Mobility
Migration
TTP
Occlusion

Special investigations
Radiographs
Vitality tests
Microbiological tests
Blood investigations
Biopsy

Differential diagnosis
Definitive diagnosis

Periodontal Examination

Plaque & calculus

Don’t forget:
Value of disclosing agent

Gingiva

Indices
Plaque Index
Gingival Index

Plaque Index
PI of Silness and Löe (1964)
Records the plaque thickness on the gingival 1/3 of the tooth
Complementary index to GI

Criteria
0 = No plaue in the gingival area
1 = A film of plaque adhering to the free gingival margin and adjacent area of the tooth. The plaque may be recognised only by running a probe across the tooth surface
2 = Moderate accumulation of soft deposits within the gingival pocket and on the gingival margin and/or adjacent tooth surface, which can be seen by the naked eye.
3 = Abundance of soft deposits within the gingival pocket and/or on the gingival margin and/or adjacent tooth surface

Gingival Index
Of Löe and Silness (1963)
Assesses severity of gingivitis and its location in 4 areas:
Distofacial
Facial
Mesiofacial
Lingual

Criteria

KG = 5 mm
PD = 2 mm
AG = ?
Keratinized (KG) and Attached (AG) gingiva
Attached gingiva AG = KG-PD

Gingival Recession
Gingival Margin
Gingival Recession
CAL = recession + PD
CEJ
KG

BOP+
BOP+
∨
∨

Miller’s Recession Classification
Graft ROOT COVERAGE success:
100 % success
100% success
80-90% success
Unpredictable outcome

Are we Able to Answer the Following Questions?

Disease present or not?
Type
Extent
Severity
Pathological process
Proper Diagnosis

Diagnosis is a changing and ongoing process
Patient periodontal and systemic conditions continuously change

Diagnosis
Treatment plan Prognosis
Maintenance

Classification
Main Disease Categories
Gingival diseases
Chronic periodontitis
Aggressive periodontitis
NPD
Abscesses of the periodontium
Endo-perio lesions
Developmental or acquired deformities

How to Write a Diagnosis ?
Diagnosis statement:
Extent + Severity + Disease Entity
Localized early/moderate/advanced chronic periodontitis
Localized early/moderate/advanced aggressive periodontitis
Generalized mild/moderate/advanced marginal gingivitis

Diagnose

Diagnosis
Prognosis
Treatment Plan