- Ravin Patel

Periodontal History, Examination, Diagnosis and Treatment plan

History

Personal Details
Name: Age: Gender: Address:

Chief complain:
Origin Duration Progress Aggravating and relieving factors

Common Complaints Pain Bleeding gums Moving tooth/teeth Bad breath

Ask Which tooth? When (On biting?) Locate, When? Which tooth? , Progressive?(Aggressive) Mouth/Nose, When, Food?, Noticed by whom?(Self conscious or noticed by

Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel others) Sores, Lumps.. etc Location, Origin ,duration, progress

Medical History (A to L)
Always look at the medical history provided and ask questions accordingly. Dont need to ask all of following questions. Anaemia, Allergy Bleeding Disease Cardio respiratory Drugs, Drug allergy, over the counter drugs Endocrine (e.g. Diabetes) Fits and fall Gastro intestinal track Disease Hospitalisation, GA history Infection Jaundice, liver disease Kidney disease Likeliness of pregnancy, menstrual problems, hormonal treatment

Dental History
How often you visit dentist? Regular/ irregular/ When needed When the last visit was/ what did the dentist do? When was the last scaling? Resto/Endo/Crown and bridge/Implants Exo? Why? (Caries, Perio or other reasons) Any replacement? Dentures? Ortho tx? Splints or other dental therapy?

Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel

Oral Hygiene History

Brushing Electric/manual? Once/twice a day/ more/less Circular/Horizontal/Vertical method Gum massage after brushing? How often you change your brush? (Every 3 monthly advisable)

Which dentifrice?

Floss/tooth pick/ inter proximal brush? Regular/Irregular/When food stuck?

Bleeding? Never/sometimes/often/regularly/when use floss or toothpick?

Mouth wash? Which? Since when and how many time a day?

Diet/Habits
Taking meals regularly? Favourite food/drink? (Sweet, Saur food, soft drinks ) Habits: Teeth grinding, nail biting, pencil/pen chewing, thumb sucking, tongue thrusting

Social and family history

Country of origin , years of migration Married/ unmarried/ Separated Children: 1/2/3/4.. Occupation

Working/ Retired/ Non working/ Pensioner

Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel Living with family? Difficulty in attending in dental appointment Parental/Sibling dental history (History of teeth loss) Any other illness in family (Diabetes, CVS, Hypertension, genetic disease) Alcohol: Amount/ frequency/ why? Smoking: What (Cigarette/pipe/cigar), since when?, how many per day?, Why? (Habit or stress), wish to quit?

Examination

Extra oral
Face: Symmetry Swelling/scars/paralysis/cold sore Lips: competent/ incompetent Smile line (Teeth/ gums showing) Lymph nodes TMJ: Pain, clicking, crepitus, restricted opening, deviation from opening Muscles of mastication palpation: tender/pain?

Intra oral
Lips/ Buccal mucosa/ Labial mucosa/ Floor/ Tongue- Lateral ventral dorsum/ tonsils/ facial pillars/ uvula/ hard and soft palate/ frenal attachment/ tori Saliva: normal/ thin/thick/xerostomia Oral hygiene: Halitosis, tongue stains, plaque and calculus (Tooth, site, amountmild moderate severe) Gingiva: Colour: Red/pigmented/normal Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel Teeth: D: Which tooth, which site, which resto, M: Which tooth, why F: Which tooth, site, material, quality (Overhang, rough surface, over Consistency: Thick/Oedematous/normal Texture: Loss of stippling? Contour: Loss of contour Size: Enlarged? Shape: Blunt or crater in papilla? Surface ulceration Exudates

contour, open contact, food impaction, access for hygiene) Attrition, erosion, abrasion, abfraction (tooth, site) Mobility (1/2/3) Sensitivity Surface stains Fractured tooth/cusp/resto Plunger cusp Food impaction Infected root stump

Occlusion: Mid line Drifting, tipping, rotation, crowding, open contact, supra eruption Fremitus Over jet, Over bite Over bite causing gingival recession Open bite Occlusion Molar: (Right)Class 1/2/3 (Left) Class 1/2/3 Occlusion Canine: (Right)Class 1/2/3 Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel (Left) Class 1/2/3 Occlusion Incisor: (Right)Class 1/2/3 (Left) Class 1/2/3 Lateral excursive: (Right) Ant/Canine/Group (Left) Ant/Canine/Group

Prosthetic Examination Type: Partial Upper /Partial Lower Acrylic/ Chrome cobalt Years old denture Retention Stability Patient satisfaction How patient keeps denture clean Does patient keep denture out at night Effect on abutment and gingiva

Fixed Prosthesis Occlusion Patient satisfaction, ability to eat properly, aesthetics Oral hygiene access, embrasure, pontics, Super floss? Contour Food impaction

OPG Examination Bone loss (Horizontal/ vertical) Furcation Calculus Caries, Resto, Overhang, secondary caries Endo, Adequacy of endo tx Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel PDL widening Periapical Other abnormalities

Periodontal Charting (Acc to chart given in ADC)

Tell DA to cancel missing teeth on chart Restoration (If you are comfortable to mention them on chart), material, site (MO/DO/MOD/B etc.) Recession (6 points- 3 on buccal. 3 on lingual) Probing depth 6 points Bleeding on probing +/Furca: 1/2/3/facial/lingual Mobility: 1/2/3 Prognosis of individual tooth: good, Fair,Poor Radio findings (in chart as well) Diagnosis Overall diagnosis (Randomly check probing depth for teeth in other quadrants as you see in OPG and put your overall periodontal diagnosis)

Investigations
IOPA, Bitewing, Pulp vitality (According to case) Blood sugar analysis if in doubt of undiagnosed diabetes mellitus Diet analysis, Saliva flow rate test, Saliva Ph, Buffer check for high caries rates/risks patients/xerostomic/radio therapy patients

Diagnosis
1) Diagnosis of chief complain

Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel 2) Periodontal diagnosis 3) Other findings (e.g. Caries, attrition, erosion, abrasion, infected root stump, soft tissue lesions, etc.)

Risk factors/Etiological factors

1) Local Factors Plaque (site) Calculus(site) Mobility (uncomforting and pain associated with mobility hampers brushing and cleaning) Furcation Anatomical variation (Enamel pearl, cervical enamel projections, root approximation) Crowding Over contoured resto, Over hanging margins Access for oral hygiene problems

2) General/Systemic factors Smoking Diabetes Stress Medication Disability- Physical/Mental Age

Prognosis
Consider Perio findings, local and systemic factors, patient understanding and compliance, habits, medical history, all controllable and uncontrollable factors Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel

Give range for prognosis Good to fair Fair to poor Poor to Questionable Questionable to hopeless

Give explanation of prognosis given

Treatment Plan
Case presentation to the patient, explain the condition. Explain patients role is vital in management along with dental treatment. Address any medical condition which needed attention first (Undiagnosed diabetes, uncontrolled Diabetes, hypertension etc) Address Acute dental problem (Acute pain or trauma, Pain relief, ANUG, Abscess) Address the chief complain Scaling and cleaning (1 or 2 appointment according to severity of disease and comfort of both patient and dentist) Correct faulty restorations Occlusal corrections Oral Hygiene Instruction: Brushing technique, selection of brush, dentifrice, mouthwash, floss etc Smoking cessation advice- GP ref Remove caries and temporise Restore if advisable on first visit RCO and temporise Ask patient whether he/she want to replace missing teeth or not and what kind of replacement patient wants (Dont plan by your self which replacement is best for Periodontal History, Examination, Diagnosis and Treatment plan

- Ravin Patel patient. Patients wish is only matters in these situations. Examiners always ask in viva does patient want replacement. And does he/she wants removable of fixed? Is it affordable for him?) Re evaluation appointment after 6-8 weeks. Check stability and response of treatment done, check OHI followed by patient Check chief complaint is resolved or not Plan Surgical and Restorative treatment according to that. Maintenance programme according to severity and response of initial treatment. (Usually every 3-4 months then 6 monthly and then yearly)

Periodontal History, Examination, Diagnosis and Treatment plan