PERIODONTAL EXAMINATION

AND
DIAGNOSIS

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 Dx defined as,
"identifying disease from an evaluation of the history,
signs and symptoms, tests and procedures."

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First visit Second visit
• Overall appraisal of • Oral examination
the patient
• Examination of the
• Medical history teeth and implant
• Dental history • Examination of the
• Intraoral periodontium
radiographical survey
• Cast
• Clinical photograph

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Medical History
Medical problems (cardiovascular, endocrine,
hematologic etc.( Abnormal bleeding Allergy
Puberty and pregnancy Previous surgery or
hospitalization Medications Family medical
history
Dental History
Oral hygiene regimes
Previous dental and periodontal procedures
Previous Periodontal problems
Restorative and orthodontic treatment
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 Stages of periodontal diagnosis
• History recording
( medical and dental)
• Examination
• A-extraoral
• B- intraoral (soft and hard tissue)
• Investigation
1. radiographical14( intra-oral films & 4 posterior bite wing)
and Panoramic.
2- Hematological( clotting time, bleeding time, RBC, WBC
count, Hb%, bl. Sugar analysis
3- Biopsy and bacterial smear
• Diagnosis 5
 MOST COMMON CHIEF COMPLAINT
• BLEEDING
• HEAVY CALCULUS
• HALITOSIS
• LOOSE TEETH
• FOOD IMPACTION AND PAIN
• ESTHETIC:-
COLOR , ASYMMETRY , RECEDING GUM , GUMMY SMILE

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• Examination
• A-extraoral (TMJ, LN,FACE, LIP)
• B- intraoral (soft and hard tissue)
• Soft TISSUE EXAMINATION ( MUCOSA, GINGIVAL AND PERIODONTALFEATURES)
• Hard tissue examination
1- TOOTH
2- proximal contact relation ship
3-FURCATION INVOLVEMENT
4-mobility
5-PATHOLOGIC MIGRATION
6-WASTING DISEASE
7-PULPUPERIODONTAL PROBLEM
8-OCCLUSAL ANALYSIS
9- TRAUMA FROM OCCLUSION
• PERIODONTAL EXAMINATION
• IDENTIFYING STATUS OF PERIODONTAL TISSUE
(HEALTH, GINGIVITIS ,PERIODONTITIS
• ( DETECT CLINICAL SIGNS OF INFLAMMATION IF
PRESENT
• DETECT THE CAUSE OF INFLAMMATION ( TRAUMA
OR DISEASE( ESTABLISH DIAGNOSIS AND
PROGNOSIS TREATMENT PLAN EVALUATION OF
EFFICACY OF TREATMENT

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ATTACHED GINGIVA
1. Width of attached is determined by subtracting sulcus or pocket
depth from total width of gingiva ( gingival margin to
mucogingival line ).

The amount of attached gingiva is considered insufficient when

stretching of lip or cheek induces movement of the free gingival
margin.

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 PROXIMAL CONTACT RELATIONS :
Slightly open contacts permit food impaction .
Abnormal contact relationship initiate occlusal changes :
1- Shift in median line between central incisors .
2- Labial version of the maxillary canine .
3- Buccal or lingual displacement of posterior teeth

Pathological migration of the teeth:

Contributing factor is
A- mouth breathing habit .
B- Premature contact in posterior region contribute to destruction of the maxillary anterior teeth and
to pathologic migration .

Pathologic migration of anterior teeth in young persons may be a sign of localized aggressive ( juvenile )
periodontitis .
Wasting disease of teeth:
Any gradual loss of tooth substance characterized by the formation of smooth , polished
surfaces.

Different forms :
a) Erosion .
b) Abrasion .
c) Attrition .

a) EROSION :

1-Wedged shaped depression in the cervical area with smooth, hard polished surfaces.
2-Affects a group of teeth.
3- May be confined to enamel or may extend up to dentine and cementum.
4- Cause not known.
5- Decalcification occurs by acid beverages, or citrus fruits along with combined effect of acid
salivary secretion and friction.

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ABRASION :
Refers to loss of tooth substance induced by mechanical
wear as a sharp “ ditching “ appears at cementoenamel
junction, due to softer cemental surface .
Causes :
1-Abrasive dentifrice .
2-Use of horizontal brushing technique .
Abrasion of incisal edges as a result of habits such as
holding objects .
ATTRITION :
It is occlusal wear resulting from
functional contacts with
opposing teeth .

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Occlusal analysis:
1- EXCESSIVE OVER BITE :
anterior region that cause impingement of the teeth on the gingiva and food
impaction .
Cause gingival inflammation, enlargement and pocket formation .
2- Open bite :
Abnormal vertical spaces between maxillary and mandibular teeth .
Occurs most often in anterior region , may lead to accumulation of debris,
calculus formation, and extrusion of teeth .

3- Cross bite :
Maxillary teeth are lingual to mandibular teeth , bilateral or unilateral .
Results in :
• Trauma from occlusion .
• Food impaction .
• Spreading of mandibular teeth, and associated gingival and periodontal
disturbances .
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TRAUMA FROM OCCLUSION :
Refers to tissue injury produced by occlusal forces .
Periodontal findings are :
1- Excessive tooth mobility .
2- Vertical or angular bone destruction .
3- Infra-bony pockets .
4- Pathologic migration ,especially anterior teeth .

• Interdental craters not detected with vertical

insertion of Probe, oblique positioning of the probe
reach depth of the crater.

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THANKS!
ANY QUESTIONS?

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