Intro to Clinic

• Instrument Grasp


  Perio Probe & Perio Exam
• Instrument Grasp


  1. Describe the proper fingers used in the modified pen grasp

  2. Demonstrate proper relationship and correct finger position in the modified pen grasp

  3. Describe the function of each finger in the modified pen grasp
• Use of the Periodontal Probe

  Describe the use of the periodontal probe to detect pocket depth
• The Periodontal Exam


  1. List the structures of the periodontium and normal range of clinical appearance

  2. Describe the rationale for a periodontal evaluation

  3. Describe the assessments or measurements, which compose a periodontal evaluation

  4. Classify the patient's periodontal status based on the American Academy of Periodontology Classification System
• Attached Gingiva


  • Tightly connected to cementum & alveolar bone; covers alveolar bone
  • Healthy color

  
• Interdental Gingiva


  • Portion of the gingiva that fills the area between two adjacent teeth (papilla)
  • Facial and lingual papilla meet at the col (apical to contact area)

  
• Gingival Sulcus


  • The space between the free gingiva and the tooth surface
  • A periodontal probe is inserted into this space to assess its health

  
• Dental Hygiene Process of Care

  1. Assessment

  2. Dental Hygiene Diagnosis

  3. Care Plan

  4. Implementation/Treatment

  5. Evaluation
• Types of Instruments


  • Assessment instruments: periodontal probe, explorer
  • Treatment instruments: curettes, sickles
• AAP Classifications


  Includes a stage and grade
• Parts of An Instrument


  Identifies the parts of a periodontal instrument
• Calibrated Periodontal Probes


  • Measure sulcus and pocket depths
  • Assess for the presence of bleeding
  • Measure the size of oral lesions
• Assessment Probes


  • UNC 15 probe has millimeter markings at each millimeter (1-15)
  • Marquis Color-Coded probe is marked at 3, 6, 9, and 12 mm
• Probe Tip


  • 1 to 2 mm of the side of the probe
  • Must stay in contact with the tooth at all times

  
• Adaptation of Probe Tip

  • The probe tip is kept in contact with the tooth surface throughout the walking stroke
  • Understanding the morphology of each tooth is extremely important

  
• Probe Position in Healthy Tissue

  Probe touches junctional epithelium near CEJ
• Probe Position in Pocket

  • Probe tip touches the root somewhere below the CEJ
  • Probing depth is usually greater than 3 mm
• Probe Walking Stroke


  1. Bob the probe within the sulcus while keeping the probe tip against the tooth surface

  2. Bob probe in 1 mm increments
• Production of Walking Strokes

  The probe is NOT removed from the sulcus with each stroke
• Why do we walk and bob?

  • It is common for the depth of a pocket to be deeper in one place
  • Periodontal pockets can be very narrow
  • Not "bobbing" enough can lead to missed pockets
• Record the Deepest Measurement

  The deepest reading would be recorded for the facial reading
• Measurements Recorded


  Measurements are recorded for 6 specific sites on each tooth

  
• Probing Technique


  • Light touch at the base of the pocket
  • Correct angulation for patient comfort
  • Study and know your morphology
• Probing Sequence


  1. Insertion is at the distal line angle

  2. Probing sequence for the mandibular right posterior sextant, facial aspect

  3. Use a similar sequence on the lingual aspect
• Interproximal Technique


  1. Touch the Contact Area

  2. Tilt the Probe
• Proximal Surfaces are Assessed from Facial and Lingual

  The deepest interproximal area is called the col
• Intraoral Fulcrum/Finger Rest


  • Right handed: Established a finger rest/fulcrum to the right or 2 teeth away from the area being probed
  • Left handed: Established a finger rest/fulcrum to the left of the area being probed
  • Pad of ring finger is placed on the occlusal, incisal surface of a tooth
  • Keep the middle finger and ring finger together
• Intraoral fulcrum/finger rest


  • 1 to 4 teeth away from the tooth being worked on
  • Established out of the line of fire
  • Never rest directly above the tooth surface being worked on

  
• Handle Position: Mandibular


  • Palm slightly down
  • Rest handle against hand somewhere in the green shaded area
• Handle Position: Maxillary


  • Palm UP
  • Rest handle against hand somewhere in the green shaded area
• Reading the Probe


  • Use only whole numbers
  • Always round up
• Probe in a Healthy Sulcus

  Probe inserted into a healthy gingival sulcus
• Disease


  A probing depth deeper than 3 mm indicates disease
• Recording Probe Readings on Paper

  • Enter probe readings on the Dental Chart
  • Start with the line closest to the teeth
  • Enter date and initials
  • Use ink – this is a permanent record
  • Any corrections are made with one line through the number
  • Any numbers that are scribbled out are alterations to the patient's record
• Handle


  Against hand somewhere in the green shaded area
• Reading the Probe
• Probe reading


  1. Use only whole numbers (1,2,3,4,...)

  2. Always round up - 2.3 is recorded as 3mm, 3.1 is recorded as 4mm, 4.5 is recorded as 5mm, 5.8 is recorded as 6mm
• Recording Probe Readings on Paper

  1. Enter probe readings on the Dental Chart

  2. Start with the line closest to the teeth

  3. Enter date and initials

  4. Use ink – this is a permanent record

  5. Any corrections are made with one line through the number

  6. Any numbers that are scribbled out are alterations to the patient's record
• Perio Exam


  • Gingival description : color, consistency, contour etc..
  • Dental charting : missing teeth, watch areas, erosions, abrasions, restorations present
  • Perio charting : mobility, furcations, rotations, recession, probe readings
  • Calculus charting
  • X-ray evaluation

  
• Clinical Attachment Level


  • Procedure
  • Select a fixed point
  • Measure in presence of recession
  • Measure with CEJ covered by gingiva
  • Measure with free gingival margin at CEJ