Chief complaint

Some patients may be unaware of any problems.

However, many may report bleeding gums, loose teeth, spreading of the teeth with the appearance of spaces where none existed before, foul taste in the mouth, or an itchy feeling in the gums that is relieved by digging with a toothpick. There may also be pain of varied types and duration, including constant, dull, gnawing pain; dull pain after eating; deep radiating pain in the jaws; acute throbbing pain; sensitivity when chewing; sensitivity to hot and cold; burning sensation in the gums; or extreme sensitivity to inhaled air.

Clinical Examination

Extraoral

lymph nodes because periodontal, periapical, and other inflammatory oral diseases

Intraoral

Oral cavity

The entire oral cavity should be carefully examined, beginning with oral hygiene

The cleanliness of the oral cavity is appraised in terms of the extent of accumulated food debris, biofilm, calculus, and tooth surface stains, as well as biofilm coating of the dorsum of the tongue (Fig. 32.4).

Oral malodor, which is also termed fetor exore, fetor oris, or halitosis, is a foul or offensive odor that emanates from the oral cavity

Periodontium

Visual Examination

Biofilm Marginal gingiva Muco gingiva Inflammatory Colour Contour

• gingival recession

Inflammed

Tactile Examination

The tooth surface is carefully probed for aberrations, concavities, furcation, and subgingival calculus

Anatomy Marginal gingiva =>Marginal Bleeding,Suppuration Attached gingiva =>Bleeding on Probing,Pain on Probing,Attachment Loss Gingival cervice(sulcus) =>Probing Depth Tooth=> sensitivity to percussion

The probe is inserted into the gingival crevice vertically with the tip of the probe touching and sliding down along the tooth surface to the bottom of the crevice. The probe is “walked” circumferentially around each surface of each tooth

When Not to Probe

Probing Force Probe Angulation

Teeth and Implants

Inflammation Periodontal pockets Alveolar Bone Loss Furcation Invasion Periodontal Abscess Gingival Abscess Periapical Abscess Wasting disease of teeth =>abrasion,attrition,erosion Dental Stains Hypersensitivity Proximal contact relation Tooth mobility

Periodontal Charting

Indices