hello students this is perio chapter 19 lecture one an overview of the clinical periodontal assessment it is a fact Gathering process designed to provide a comprehensive picture of the patient's periodontal health status a clinical periodontal assessment is one of the most important functions performed by the clinician the information gathered during this assessment forms the basis of the individualized treatment plan for the patient the objectives are to look for clinical signs of inflammation and damage to the periodontium determine if the periodontium is healthy or diseased to collect data to assign periodontal diagnosis to collect Baseline data for long longterm monitoring of periodontal disease activity the dentist is responsible for screening and comprehensive periodontal assessment and this can also be done by a hygienist the diagnosing of periodontal disease is the responsibility of the dentist treatment planning non-surgical periodontal therapy can be done either by the dentist or the dental hygienist the dentist however is legally responsible for treatment planning and diagnosing dentists and dental hygienists have a legal responsibility to complete an accurate and thorough periodontal assessment on every patient failure to diagnose periodontal disease is the leading cause of dental malpractice claims Dental Health Care Providers must use periodontal assessment procedures that are standard for the profession the periodontal assessment is not complete until all information is gathered and has been accurately recorded in the patient chart documentation measures treatment outcomes document ation monitors periodontal health status over time findings documented during initial clinical periodontal assessment serves as Baseline data Baseline data is used in the long-term monitoring of the patient's periodontal health status in other words our pocket depths remaining the same or getting deeper there are two types of assessment the periodontal screening and the comprehensive periodontal assessment periodontal screening and recording or PSR is an efficient easy to use screening system for the detection of periodontal disease it determines the periodontal health status of the patient and helps to identify those patients needing a more comprehensive periodontal assessment PSR helps to identify which patients need a comprehensive periodontal assessment and results separate patients into two categories those with perodontal health or gingivitis where there is no further assessment needed and those with periodontitis where a comprehensive periodontal assessment is required a World Health Organization probe is used for this examination The Who probe has a colorcoded band called a reference Mark located 3.5 to 5.5 millim from the pro probe tip results of the screening are recorded as 0 to four one code is given for each SE seant of the mouth instead of recording six measurements per tooth the reference Mark is monitored as the probe is walked around a tooth their mark would be either completely visible partially visible or completely covered or not visible the PSR screening exam gives a code of zero if the marker in that seent is completely visible there is no calcul and there is no bleeding code one means that the marker was completely visible in that seant and there is no calculus but there is some bleeding code two says that the marker is completely visible there is calculus and there are also defective margins in a code three the marker is partially visible in code four the marker is not visible or it is completely under the gingival tissues an asterisk would indicate a mucco gingival defect the code assigned to each seent should represent the most advanced or worst periodontal finding on any tooth in the Sextant for patients with low PSR scores in all seant are considered periodontally healthy and no need for further periodontal assessment is required a complete periodontal assessment is indicated for patients who score two code three seant or one Code 4 seent mucco gingival defects indicated by an asterisk after the code are also charted on the periodontal charting on a PSR the asteris symbol indicates foration involvement Mobility mucco gingle problems or recession the asterisk is recorded next to the seant code an intensive clinical periodontal assessment is used to gather information about the periodontium on patients who SCH who score high on the PSR perodontal assessment components include probing depth measurements bleeding on probing presence of exudate level of free Gable margin level of mucco gingival Junction tooth mobility and fius the periodontal assessment also includes foration involvements presence of calculus deposits presence of dental plaque bofilm gingival inflammation radiographic evidence of bone loss and presence of local contributing factors supplemental tests are used for patients who fail to respond to Conventional periodontal therapy tests can be done to identify bacteria tests can be used to analyze the gingerful cicular fluid content and tests for genetic susceptibility can also be done these are rather expensive and are to be reserved for patients who are not responding to Conventional periodontal therapy despite compliance attached gingiva is the firm dense and tightly connected tissue to the cementum on the cervical third of the root or to the periosteum of the alve bone the attached gingiva lies between the free gingiva and the alv mucosa it extends from the base of the sulcus to the mucco gingival junction the attached gingiva functions to keep the free gingera from being pulled away from the tooth the width of attached gingiva is not measured on the pallet because it is impossible to determine where the attached gingiva ends and the palatal mucosa Begins the formula for calculating the width of the attached gingiva is shown in this image it is measured from the gingival margin to the mucco gingival junction you then measure the PO pocket depth and subtract the pocket depth from the total width of the attached gingera the clinical attachment level is an estimate of the periodontal support around the tooth as measured with a periodontal probe probing depths are measured from the gingival margin to the base of the sulcus or periodontal pocket clinical attachment levels are measured from a fixed Point usually the CJ to the base of the sulkus or periodontal pocket notations indicate position of the gingival margin zero shows that the free gingival margin is slightly coronal to the CJ minus indicates free gingival margin significantly covers the CJ and plus indicates that the free gingival margin is apical to the CJ calculations are a necessary part of the clinical periodontal assessment calculations are made to determine the width of the attached Ginga and clinical attachment levels probing depths are not reliable indicators of the extent of periodontal support around a tooth clinical attachment level is a more accurate indicator of periodontal support calal provides an accurate means to monitor changes in periodontal Support over time this concludes perio chapter 19 lecture 1