The Periodontal

Examination
Hope you studied

Comprehensive Perio Exam

Requires understanding of the whole
patient
RFP
Dental History
Family & Social History
Oral Hygiene
Smoking History

Medical History
Cardiovascular/Circulatory
(Infective Endocarditis)
Bleeding Disorder
(LA, Multiple appt.)
Infective risks
(Special IC measures)
Allergic reactions
(Latex, LA, medications)

Symptoms of Periodontal
Disease

Bleeding
Mobility
Pain (Hypersensitivty/pulpal)
Halitosis and bad taste
Recession
Swelling

Signs of Periodontal Disease

Gingiva Erythematous and swollen

Recession Also helps identify AL
Oral Hygiene Levels of plaque and calculus
Occlusal changes Drifting of teeth
Mucogingival changes Biotype of gingivae, frenal
attachments
Migration
Mobility
Bleeding and Suppuration
Probing depth
Furcation

Bleeding on Probing
Does not indicate disease severity or
progression of the disease
Absence is a good predictive (98.5%)
indicator of gingival stability
Suppuration, or pus in pocket should
also be recorded.
Tiny drop/ Profuse bleeding and
suppuration should be noted

Periodontal Probing Depth

Inflammed tissue offers less resistance to perio
probe penetration, deeper PD
-Increased force on pocket = deeper PD
-Depending on the gingival inflammation, the
probe will stop at different points about the
connective tissue attachment (Includes the
gingival attachment and the PDL)
-Due to probe force being non-standardised, probe
depths are +/- 1.0mm
-If no effort made to standardise probe force and
consider level of inflammation,
probe depths +/- 2.0mm

Attachment Loss
Calculated from PPD + Recession
Less than 4mm = Mild-Moderate
Periodontitis
More than 4mm = Severe
Periodontitis

Furcation Involvement

Classified using Nabers probe/sickle explorer

Degree I: Less than 1/3 tooth or horizontal probing
depth of up to 3mm
Degree 2: 1 site with at more than 1/3 tooth or
horizontal probing depth >3mm
Degree 3: Through-and-through destruction or 2 or
more sites with > 1/3 tooth

Mobility
Miller Index
Degree 0: Physiological mobility. 0.1-0.2mm
mobility horizontally
Degree 1: Crown mobile up to 1mm horizontally
Degree 2: Crown mobile from 1-2mm horizontally
Degree 3: Crown mobile >2mm horizontally,
moves vertically, may be rotated, depressed in
socket, etc.
Always consider CAUSE of mobility; perio,
hyperocclusion, parafunction, etc.

Special Investigations

Radiographs*
Plaque Index (and General Calculus)
Percussion Tests
Occlusal analysis

Diagnosis
Gingivitis

Mild-Moderate
Periodontitis

Advanced/Severe
Periodontitis

P 1-3mm, possibly
P Pseudopockets
D >3mm

4-6mm

6+

Furcation
involvement
Periodontitis

B Yes
O
P

Yes

Yes

Yes

B No AL or BL
L
/

Tends to have
horizontal or angular
bone loss. Infrabony
lesions can be
classed as 1,2 or 3
wall defects*

Tends to have
horizontal or angular
bone loss. Infrabony
lesions can be
classed as 1,2 or 3
wall defects*

N/A: Adjunctive
diagnosis for
multirooted teeth.
Superficial if Degree
1 FI, else considered
deep

A
L

Questions?