SYMPTOMS:

Gingival Bleeding, Pain and Swelling.

Tooth mobility.

Bad breath and taste.

The main concerns of the patient

Bleeding

Spontaneous During Mastication Tooth Brushing

A sudden onset or deterioration may suggest an underlying systemic factors

PainAcute Periodontal Lesions (NUG)

Caries Pulp and Periapical Disease

Dentine Hypersensitivity

Bleeding

Spontaneous During Mastication

Bleeding

Spontaneous Tooth BrushingDuring Mastication

Bleeding

Spontaneous

Pain

Tooth BrushingDuring Mastication

Bleeding

Spontaneous

Acute Periodontal Lesions (NUG)

Pain

Tooth BrushingDuring Mastication

Bleeding

Spontaneous

Caries

Pain

Tooth BrushingDuring Mastication

Bleeding

Spontaneous

Pulp and Periapical DiseaseCaries

Pain

Tooth BrushingDuring Mastication

Bleeding

Spontaneous

Dentine Hypersensitivity

Pulp and Periapical Disease

Caries

Acute Periodontal Lesions (NUG)

Pain

Tooth Brushing

During Mastication

Bleeding

Spontaneous

Causes of tooth mobility: Marginal or apical inflammation. Loss of connective tissue attachment and

supporting bone, usually due to marginal periodontal disease but occasionally due to periapical disease.

Apical root resorption. Increase in width of periodontal ligament,

usually due to occlusal forces.

Tooth Movility

Any Increased?

When?(Duration)

Masticatory Difficulty

Any Increased?

When?(Duration)

Masticatory Difficulty

Any Increased?

When?(Duration)

Tooth Mobility

Masticatory Difficulty

Any Increased?When?

(Duration)

OBJECTIVES:1. To identify systemic factors which may help to

account for the periodontal condition, ex: Pregnancy, Diabetes Mellitus.

2. To note the existence of systemic condition for which especial precautions (ex. Antibiotic prophylaxis) are required to safeguard the patient during the periodontal therapy.

3. To note the presence of any transmissible disease which may present a hazard to the clinician, dental surgery staff or other patients.

Patient's attitude toward dental health. Date and nature of the last dental treatment. Regularity of previous dental treatment. Oral hygiene habits. a. Tooth brush (type and frequency)

b. Dental floss. c. Others. Habits related to oral health or disease

(bruxism, smoking)

1. Gingival Inflammation, Plaque and Calculus

GINGIVITIS

Changes of the colour

Enlargement(edema or hyperplasia)

GingivalExudate

Bleeding

Supuration, Ulcerationor Sweeling (acute inflammation)

GINGIVITIS

Changes of the colour

GingivalExudate

Bleeding

GINGIVITIS

Changes of the colour

GingivalExudate

Supuration, Ulcerationor Sweeling (acute inflammation)

Bleeding

GINGIVITIS

Changes of the colour

GingivalExudate

Enlargement(edema or hyperplasia)

Supuration, Ulcerationor Sweeling (acute inflammation)

Bleeding

GINGIVITISChanges of the colour

GingivalExudate

1. At the initial visit.2. During the subsequent appointments to

control the progress of the treatment.

• Is used to:1. Identify pockets which bleed on probing.

2. To measures the pockets depth.

The depth to which the periodontal probe can penetrate beyond the gingival

margins depends on:1. The amount of gingival enlargement.2. The extent of connective tissue

attachment loss.3. The resistance of the tissue to probing,

determined by the extent to which gingival collagen has been replaced by inflammatory infiltrate.

4. The size, shape and tip diameter of the probe.

5. Use of the probe, angle of insertion and pressure applied.

6. The presence of obstructions such as subgingival calculus.

7. The patient's reaction to the discomfort on probing.

• Each tooth should be rocked between an instrument handle and index finger in a buccolingual direction and mesiodistal direction (when the adjacent tooth is not present).

• The amplitude of tooth movement of the crown tip from its most extreme buccal (or mesial) position to its most extreme lingual or distal position should be observed:

Grade 1- Visible horizontal mobility up to 1 mm.Grade 2- Visible horizontal mobility between 1 and

2 mm.Grade 3- Visible horizontal mobility greater than 2

mm or rotation or vertical mobility (depression).

• The occlusion should be examined for detect premature or interfering contacts as contributory factors.

• Vertical bone destructive pattern is often associated with traumatic occlusion.

Parafunctional habits

Non- vitalTeeth Unerupted teethUnerupted teeth

Non- vitalTeeth Unerupted teeth

Caries

Unerupted teeth

Caries

Non- vitalTeeth Unerupted teeth

Caries

Unerupted teethNon- vitalTeeth

Unerupted teeth

Missing Teeth

Overhanging Restorations

• Radiographs may:1. Show the proportion of support loss in

relation to root length, the pattern of bone loss and the rate of destruction.

2. Reveal unerupted teeth, periapical pathology, inadequate endodontic treatment, proximal caries, overhanging margins, etc.

Pulp Vitality Test

Haematological investigations, ex: full blood count in patients where blood dyscrasias are suspected(neutropenia, leukemia, etc)

Teeth associated with deepPeriodontal pocket

(pulpitis or pulp necrosis)

To distinguish a periapical from periodontal abscess

Teeth associated with deepPeriodontal pocket

To distinguish a periapical from periodontal abscess

Tooth by tooth diagnosis.

Whole dentition.

For an individual patient.

It depends on:• The adequacy of the diagnosis.• The quality of the treatment, including home

care and recall maintenance.

Factors that may influence the prognosis:The extent and significance of mucogingival

problems.The extent of furcation lesions.The combined periodontal and endodontic lesions.The presence of the hopeless teeth.