[Music] this video will look at muco gingival deformities and conditions that are around the teeth so let's this i know is a mouthful but let's examine this a lot more closely so muco comes from mucosa so think of your mucosa in your mouth think of like your alveolar mucosa i think it'll be a gum so think about the tissues that are surrounding your teeth and when we're looking at the tissues surrounding your teeth do you see or when you're looking at the tissue surrounding your patients or clients teeth do you see any deformities do you see any unique conditions around their teeth if so we need to note them we need to document that in our clinical worms so here is a list of all the different types of muco gingival deformities and let's look at um well let's start with what a periodontal biotite looks at what is that so periodontal biotype is basically is a term that explains the the differences in the bone and soft tissue so there are three types of biotype there are three types of um periodontal biopipes or three types of tissues that are around the teeth so let's look at these to add three types there's the thin scalloped biotype the thick flat biotype and the thick scalloped biotin and again why do we care why do we care what biotype our patients have well because if they have a thick biotype that's great because they have thick gums so thick biotypes or thick gums means that they're more resilient to inflammation and trauma that means you won't see them prone to recession you won't see them prone to inflammation so when you have thick gums we like that we like the thick karate nice gum but when we have thin gums or thin skeleton biotypes sorry thin scalloped biotype then what that means is they're more prone to inflammation they're more prone to recession so here's an example of a thin scalloped biotite and if you look at the the tooth over here you can see that the tooth is more triangular shape and the reason why it's more triangular actually i shouldn't say the reason why but what we're looking at is when we see a triangular shaped tooth like this we may notice that their gums or their tissues are a little more thin they have thin gingiva and so what does this mean well this means that they're more prone to infection when you have thin gums and not thick gums it means that you're more prone to recession you could even be more prone to inflammation so we do not like thin scalp biotype here's thick flat biotype so thick being your keyword we like thick gums because when we see thick gums they're less prone to inflammation they're less prone to recession and who has thick flat biotype well those people that have square teeth okay so you have to look at the shape of these and if it's more squared then likely the type of biotype or the type of tissues you would have are the thick uh fibrotic or thick tough gums and you tend to also have thick bone as well so we like seeing thick gums because when we see thick gums it's keratinized it's nice and thick for us and and these people have less chance of inflammation less chance of recession here's another example of thick scalloped biotype so the other one was flat because when you look at the papilla it's more flat but here we're looking at scalloped thick scallop biotype and here we can definitely see the scalloped the scalloping in the margin so it's not as flat if you look at the this biotype where it says thick flat biotype it's more flat but when you look at this one it's not as flat right it's more scalloped or you can you can see the knife edge over here and so this is happening with uh people that have slender or long tooth crowns that's what we see here and again that's great we like seeing these because they have thick fibrotic gums their gums are a lot more thicker the only downside with this one is that they have a narrow zone of keratinized tissue so the amount of keratinized tissue is a little less compared to the thick flat biotype where they have a broad zone of carotid nice tissue like this whole area is nice and keratinized whereas here it's a little more narrow it's a little more thin so that's the periodontal biotype so if you ever get asked you know what type of biotype does your patient have refer back to this so that you can figure out so always look at the shape of the tooth and that can help you whether they if they have a slender toothed crown is thick scalifier type if they have a square shaped tooth thick flat biotype is what they have and if they have a triangular slender triangular shaped tooth crown then they might have the thin scalloped biotype another thing that's in the muco gingival deformity is recession so anytime someone has recession we would say that they have a muco gingival deformity so we would check off gingival recession under the muco-gingival deformities um if they have a tension over phantoms if you see a phantom pole you see how this phantom is pulling down the gum is causing recession same thing here this phenom is pulling down and is causing the recession that is another thing you can check off under muco-gingival deformity that your patient or your client has a tension of a venom or a phenomena there are we used to look at miller classification but we're going to look at the kairos classification because that is what we use now so the new periods are saying let's look at a chiral classification of recession and so sometimes you could have patients who have recession and their recession type is rt1 recession type 1. what does that mean it just means that they're they have recession over here on the facial aspect they have attachment loss and it's three millimeters um but the key thing here is the yes they have recession on the facial but they do not they do not have any interproximal attachment loss they do not have any bone loss in the interproximal regions in between the teeth rt2 recession type 2 this is where they have a little more clinical attachment loss instead of three now they have four millimeters of clinical attachment loss and they also have interproximal attachment loss so they probably have bone loss in the mesials and distal and you can see here this is the recession is more concentrated on the facial aspect here whereas here the recession is leaning towards the mesial and distal and lastly rt3 recession type 3 this is where they have significant attachment loss so 6 millimeters or more and they have interproximal attachment loss as well and it gives you the exact numbers so here interproximal attachment loss or bone loss of three millimeters here interproximal attachment loss or bone loss of eight millimeters okay so that's gingival recession now let's look at vestibular depth so if someone has or lack of gingiva this is if someone has very little gums you don't see much of a gum here then um you would check off lack of gingiva under the muco gingival deformities or if someone has decreased vestibular depth so if you look here this is like the vestibule and when you pull down on the lip here their vegetable is very shallow right it's not deep like and if you look at your vegetable it would be deeper but this person's vegetable isn't as deep right so if someone has a decreased vestibular depth make sure you check that off under muco gingival deformities again we're looking at venom like a venom pole you would check that off if they have a venom pull such as this this venom is um causing this gap right if they um do a frenectomy the gap might not um be as prominent another thing that you would find under the muco-changeable deformity heading is gingival excess so anytime you see excess gums like a gummy smile you could check off gingival excess if they have a gingival enlargement too much gums that you see check off gingival excess another word or term rather that you see under muco gingival deformities is abnormal color and sometimes you can see abnormal color in their gums and this is not pigmentation that we're referring to this abnormal color we're referring to is possibly due to a type of surgery in this case an endodontic surgery and um amalgam tattoos amalgam tattoo plus the endosurgery cause this abnormal color in their gum so this happens to your patient a client make sure you check that off [Music] another condition that you would find under the other conditions um back in the periodontim is something called prosthetic and tooth related factors so all this really means is if you look around if you look at the tooth um or if you look at the prosthetics if you look at the denture or the bridges any prosthetic is anything um that had been inputted into their mouth any prosthetic that had been inputted into their muscle implants dentures bridges so if you look at or around these areas and you see something that can that is not right so for example something that's causing more plaque to retain to the tooth or something that's causing periodontal disease to um get worse that's when you would check off this area where you would check off that the client has some prosthetic or tooth related factors so let's look at some examples of prosthetic or tooth related factors so here are some examples so look at the enamel pearl this can cause plaque and calculus to retain in that area and so that is an issue because yes you can get more plaque retention when you have an enormous pearl so if your client has a normal pearl be sure to check off food-related factors if your client has a groove that is exposed and calculus and plaque can easily get stuck in there right so that's something to keep in mind and so if this happens to your client be sure to check off two anatomic factors or two truth-related factors in your clinical form if your client has braces again we know this is an example of someone who has extremely poor oral hygiene and you can see that by their inflammation and the redness you know when they have braces so if someone has braces and you see that the plaque is being retained in you know around the braces and the gums are getting angry and reacting negatively you want to check off tooth related factors because the braces is causing the inflammation so again any time you have um a unique situation such as a groove an enamel pearl make sure you check off tooth and atomic factors because that can predispose that can cause plaque to attach and um get in those areas even to malalignment if you see a client or a patient who has a lot of malalignment a lot of crooked teeth that's also going to be an issue because plaque will be retained in that area so if you have clients who have tooth malalignment be sure to check off prosthetic and tooth related factors be sure to check off that box in your clinical form you