Early signs and symptoms of periodontal disease
found in the interdental papilla and marginal gingiva
include the following:
Redness
Tendency to bleed easily
Evidence of exudate
Tenderness
Sponginess
Slight swelling
Probing depth of pockets
such as bone loss around the teeth, calculus, poor
margins and overhangs on restorations, and open tooth
contacts that are visible. In addition to radiographs,
some dentists may take clinical photographs of their
patient's mouth and in some cases, diagnostic study
casts are made.
CHARTING
Periodontal treatment is indicated when a
periodontal condition cannot be eliminated through
preventive care, including prophylaxis, and improved
oral hygiene and diet. Resorption of the alveolar bone
and the periodontal tissues are also indications for
treatment. If the progress of the disease is stopped, the
teeth may have adequate support for retention. For
successful periodontal treatment, a patient must be
willing to accept treatment and follow the
requirements necessary to maintain good oral hygiene.
Several situations contraindicate periodontal
treatment. A patient in poor general health with a poor
prognosis for successful treatment and healing is one
example. Another would be a patient with an extensive
infection within the periodontium and/or bone loss too
extensive to provide support for the tooth following
periodontal surgery.
Periodontal treatment is
definitely contraindicated if the patient has a negative
attitude and unwillingness to cooperate in establishing
and maintaining good oral hygiene and nutrition.
EXAMINATION, CHARTING, AND
TREATMENT PLAN
The initial examination of the periodontal patient
includes thoroughly reviewing the patient's
medical/dental health history, dental treatment history,
and radiographs; charting of periodontal probing
depths, occlusion, and tooth mobility; and determining
a treatment plan.
The review of the patient's medical-dental health
history provides valuable information regarding the
dental status of the patient, such as past dental
treatment, the patient's oral hygiene habits, and
attitude toward dental health. A current full series of
periapical radiographs and vertical bite-wings are
necessary for a thorough periodontal examination.
Radiographs are extremely useful in the diagnosis and
treatment of periodontal disease because of conditions
Your primary responsibility during the
examination is to record the findings as the dentist
dictates them. The results of the examination are
recorded on a NAVMED 6600/2, Periodontal Chart.
This two-sided form (figs. 6-1 and 6-2) provides a
permanent record of the examination, diagnosis, and
treatment plan for initiation of each new course of
therapy for the treatment of periodontal disease.
The form is an anatomical chart that contains
diagrams of the teeth with spaces for comments. It
permits documentation of changes in the teeth,
occlusal relations, soft tissue alterations, and
information gained from radiographs. The findings
related to the teeth that are charted include missing,
unerupted, malpositioned, or replaced teeth, dental
caries, open or poor contacts, defective or poor
restorations, food impaction, pain on percussion, and
plunger cusps. Findings of the periodontium include
the gingival level on the tooth, areas of recession or
clefts, gingival enlargement or craters, probing depths,
frenum attachments, furcation invasion (disease
extension between the roots of multirooted teeth),
bleeding and purulence points, tooth resection, and
tooth mobility.
Instructions and symbols for charting are located
in the left column on the front page. Charting notations
for the front section are made in blue pencil, red pencil,
and regular black pencil.
Use black ink on the following front sections:
Place of examination, examiner, date, and patient
identification section. Also record the reverse side
information in black ink.
Pocket Depth
One of the most important findings in the
periodontal examination are the probing depths of the
gingival sulcus or periodontal pockets. The dentist
determines these measurements using a periodontal
probe calibrated in millimeters. The dentist inserts the
periodontal probe into the gingival sulcus to the depth
of the epithelial attachment. The distance between the
attachment and the gingival margin is measured and
6-2