DENTAL CLINICAL PRACTICE 1

PERIODONTAL EXAMINATION AND

CHARTING (PART I)
DR. ABIER ABDULSATTAR MOHAMMED
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Objectives:
1. Recognize different periodontal probes types, and
calibration.
2. Describe correctly the “walking stroke”.
3. Distinguish different pocket types.
4. Identify how to measure the periodontal pocket depth.
5. Demonstrate the ability to measure gingival recession,
and clinical attachment loss.
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Periodontal Charting Includes:

• Gingival examination ;(color, contour, consistency, texture ,
presence of exudate )
• Bleeding on probing
• Probing depth (pocket depth)
• Gingival recession
• Clinical attachment loss
• Furcation involvement
• Tooth mobility
• Examine the radiographs.
Periodontal charting is done using a calibrated Periodontal
Probe.
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• The periodontal probe is the most important clinical tool for obtaining information about the health status of
the periodontium.
• A periodontal probe has a blunt, rod-shaped working-end that may be circular or rectangular in cross section
and is calibrated with millimeter markings . The working-end and the shank meet in a defined angle that is
usually greater
• than 90°
• The calibrated periodontal probe is used to measure sulcus and pocket depths, measure clinical attachment
levels, measure gingival recession , to determine the width of attached gingiva, to assess for the presence of
bleeding and/or purulent exudate (pus), and to measure the size of oral lesions.
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University of North Carolina (UNC-12 and UNC-15) Probe

The UNC-15 probe has millimeter markings at 1, 2, 3, 4, 5, 6,
7, 8, 9, 10, 11, 12, 13, 14, and 15 mm. Colored bands
between 4 and 5 mm, 9 and 10 mm, and 14 and 15 mm
facilitate reading of the markings.

Williams Probe
Millimeter grooves at 1, 2, 3, 5, 7, 8, 9, and 10 mm

World Health Organization (WHO)

Has a unique ball-end of 0.5 mm in diameter, which is
attached to a 16-mm-long working-end
Markings at 3.5, 5.5, 8.5, and 11.5 mm
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Function of Periodontal Probes

a. Primary Function
Detect periodontal pockets to determine the health status of the
periodontium.
b. Other Functions
• Measure clinical attachment loss
• Measure extent of recession of the gingival margin
• Measure the width of the attached gingiva
• Measure the size of intraoral lesions
• Assess bleeding on probing
• Determine mucogingival relationships
• Monitoring the longitudinal response of the periodontium to treatment
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How to Grasp the Periodontal Probe?

• The modified pen grasp is the recommended grasp for holding a
periodontal instrument. This grasp allows precise control of the
working- end, permits a wide range of movement, and facilitates good
tactile conduction.
• Modified pen Grasp & Intraoral finger rests should be applied during
periodontal charting .
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Basic Concepts of Probing Technique

THE WALKING STROKE
• The walking stroke is the movement of a calibrated probe
around the perimeter of the base of a sulcus or pocket.
Walking strokes are used to cover the entire
circumference of the sulcus or pocket base. It is essential
to evaluate the entire “length” of the pocket base because
the junctional epithelium is not necessarily at a uniform
level around the tooth. In fact, differences in the depths of
two neighboring areas along the pocket base are common
Insertion and Adaptation. Once a probe is inserted into a periodontal
pocket, the working-end is kept parallel to the root surface.
The tip should be kept as flat against the root surface as possible as the
working-end is inserted to the base of the pocket.
This illustration
1. Walking strokes are a series of bobbing strokes that are made within the shows correct
sulcus or pocket. The stroke begins when the probe is inserted into the adaptation of the
sulcus while keeping the probe tip against the tooth surface. probe with the
working- end
2. The probe is inserted until the tip encounters resistance of the junctional parallel to the
epithelium that forms the base of the sulcus. The junctional epithelium root surface.
feels soft and resilient when touched by the probe.
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3. Create the walking stroke by moving the

probe up and down in short bobbing strokes
and forward in 1-mm increments. With each
down stroke, the probe returns to touch the
junctional epithelium.
4.The probe is not removed from the sulcus
with each upward stroke. Repeatedly removing
and reinserting the probe can traumatize the
tissue at the gingival margin
5.The pressure exerted with the probe tip
against the junctional epithelium should be
around 25 grams. A sensitive scale that
measures weight in grams can be used to
standardize your probing pressure.
6. Either wrist or digital (finger) activation may
be used with the probe because only light
pressure is used when probing.
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INTERPROXIMAL TECHNIQUE
When two adjacent teeth are in contact, a special technique is used to probe the area
directly beneath the contact area.
A two-step technique is used:
Step 1: Position the probe with the tip in contact with the proximal surface. While
maintaining the tip in contact with the tooth surface, walk it between the teeth until it
touches the contact area. The area beneath the contact area cannot be probed directly
because the probe will not fit between the contact areas of the adjacent teeth.
Step 2: Slant the probe slightly so that the tip reaches under the contact area. The tip of the
probe extends under the contact area while the upper portion touches the contact area.
With the probe in this position, gently press downward to touch the junctional epithelium.
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Record the Deepest Reading per Area. In the illustration shown here, the depth of the
pocket base varies considerably at points A, B, and C in the facial surface.
Because only a single reading can be recorded for the facial surface, the deepest reading at point C is
recorded for the facial surface.
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• Once you reach the base of the sulcus: Observe where the Gingival
Margin is on the probe
• Now- count down from the top marking on the probe (10 mm reading)
to the last marking that you actually see so, in this case: 10, 9, 8, 7, 6,
5, 4, 3, 2.
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Examination of the Gingiva

1. Color
Change in color is an important clinical sign of gingival disease.
The normal gingival color is “coral pink”.
Light to dark brown areas of pigmentation may also occur normally and is
related to skin complexion (melanin pigmentation).
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• Pink - in long-standing periodontal lesions the gingiva may become

fibrotic, masking any color changes. In these cases, the gingiva will still
appear pink, so you will have to rely on other tissue changes to make
your diagnosis.
• Pale pink: fibrotic gingival, less vascularization, epithelial keratinization
increases.
• Red - this is associated with early or acute inflammation. Gingiva
becomes red when vascularization increases, or the degree of epithelial
keratinization is reduced or disappears
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• Bluish-purple - this is cyanosis and is associated with more

established, chronic inflammation.
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2. Contour:
• The normal contour of the marginal gingiva is scalloped
with a knife edge.
• Diseased gingiva may exhibit any or all the following:
• Rounded or rolled enlargement.
• Recession - margin located apical to the cemento-enamel
junction.
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• Clefts - marginal tissue may be destroyed over the root, producing

narrow, slit-like recession to varying degrees of severity in relation to
the mucogingival junction
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Interdental Papillae
• Bulbous or enlarged - fills gingival embrasure but is no
longer pyramid shaped
• Blunted - does not fill gingival embrasure to contact point;
receded
• Cratered - does not fill embrasure space; depression
instead of peak in center of papilla
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3. Consistency and Tone

• Healthy gingiva is dense and firmly

bound down to underlying tooth
and bone. Normal gingiva is firm
resilient.
• When gingiva is inflamed you may
find the following changes in tissue
tone.

• Soft, spongy tissue is swollen,

fluid- filled (edematous) and no
longer firm. The side of a probe is
easily pressed into the tissue.

• Gingiva can become fibrotic in

people who have had chronic
gingivitis for most of their lives. In
such cases the tissue is quite firm.
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4. Texture
Texture is perhaps the least reliable diagnostic sign of gingival
inflammation. Healthy gingiva has a smooth, somewhat shiny surface.
Healthy attached gingiva and central of interdental papilla often has
hundreds of tiny indentations called ‘stippling’.
As a result of inflammation, the surface of the attached gingiva
becomes smooth and shiny, but this is not a universal finding.
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5. Exudation:
• The presence of an abundant number of neutrophils in the gingival fluid
transforms it into a purulent exudates
• Clinically, placing the ball of the index finger along the lateral aspect of
the marginal gingiva and applying pressure in a rolling motion toward
the crown determine the presence of exudates in a periodontal pocket

(Purulent exudates expressed from a periodontal pocket by

digital pressure)
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6. Bleeding on probing
• Non-inflamed sites rarely bleed.
In most cases, bleeding on
probing is an earlier sign of
inflammation than gingival colour
changes.
• To test for bleeding after probing,
the probe is carefully introduced
to the bottom of the pocket and
gently moved laterally along the
pocket wall.
• Sometimes bleeding appears
immediately after removal of the
probe; other times it may be
delayed for a few seconds.
Therefore the clinician should
recheck for bleeding 30 to 60
seconds after probing
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Periodontal Pockets
• The periodontal pocket, defined as a pathologically deepened gingival
sulcus, is one of the most important clinical features of periodontal
disease.
Classification
• Deepening of the gingival sulcus may occur by coronal movement of
the gingival margin, apical displacement of the gingival attachment, or
a combination of the two processes.
Pockets can be classified as follows:
• Gingival pocket (False pockets, pseudo pockets) is formed by gingival
enlargement without destruction of the underlying periodontal tissues.
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• Periodontal pocket (True pockets) produces destruction of the

supporting periodontal tissues. Two types of periodontal pockets exist,
as follows:
• Suprabony (supracrestal or supraalveolar), in which the bottom of the
pocket is coronal to the underlying alveolar bone.
• Infrabony (subcrestal, intraalveolar), in which the bottom of the pocket is
apical to the level of the adjacent alveolar bone. In this second type, the
lateral pocket wall lies between the tooth surface and the alveolar bone.
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A, Gingival pocket. There is no destruction of the supporting periodontal tissues.

B, Suprabony pocket. The base of the pocket is coronal to the level of the
underlying bone. Bone loss is horizontal.
C, Infrabony pocket. The base of the pocket is apical to the level of the adjacent
bone. Bone loss is vertical.
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Pocket Depth
• Measured with a periodontal
probe in millimeters
measured with a calibrated
probe from the gingival
margin to the bottom of the
pocket on the mesial, buccal,
distal and lingual tooth
surfaces. It is sufficient to
record the deepest value for
each tooth surface. Only
depths ≥ 4 mm to be
recorded as pockets .
• Pockets are not detected by Pocket depth is from gingival margin till the base
radiographic examination. (Junctional epithelium).
The periodontal pocket is a
soft tissue change.
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Probing Depth. A pocket is measured from the gingival margin to the attached
periodontal tissue. Shown is the contrast of probe measurements with gingival
margins at the same level.
(A) Deep periodontal pocket (7 mm) with apical migration of attachment.
(B) Shallow pocket (2 mm) with the attachment near the cementoenamel
junction.
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