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