An understanding of the dental health status of an individual is essential to the diagnosis and treatment plan of an individual (Matsuda, 2005). A clinical periodontal assessment has significant implications in the early detection and documentation of periodontal diseases in an individual (Horn, 2001). The clinical periodontal assessment provides such an understanding, for according to, Neild-Gehrig and William 2008, p.181, “the clinical periodontal assessment is essentially a fact-gathering process designed to provide a comprehensive picture of the patient’s periodontal health status”. The clinical periodontal assessment makes it possible to know whether there are clinical signs of inflammation to the periodontium, as well as any the existence of any damage to it, and whether the periodontium of the individual is in a healthy condition, or whether there is disease present in it. Finally, the clinical periodontal assessment helps in assessing the success achieved through the interventions put in place, as the documentation of the findings in the clinical periodontal assessment acts as the baseline in the monitoring of the health condition of the individual and the progress attained over time (Neild-Gehrig & William, 2008).
There are several components involved in a clinical periodontal assessment. The component of probing depth measurements are measurements that are taken from the free gingival margin up to the base of the pocket. Six definite sites on each tooth are involved in the recording of probing depth measurements. These sites are distofacial, facial, mesiofacial, distolingual, lingual, and mesiolingual (Neild-Gehrig & William, 2008).
On gentle probing there is the likelihood of bleeding occurring, giving rise to the next component of bleeding on probing. This bleeding occurs from the soft tissue wall of a periodontal pocket and demonstrates ulceration of the wall of the pocket and signifies that portions of the epithelium have been destroyed. Such bleeding may occur spontaneously on probing, or there may be a slight delay in the bleeding occurring. This feature makes it necessary for each probed site to be observed for a few seconds, prior to the probing of the next site. Excessive force used during probing may also cause bleeding. Hence it is necessary to have a probing pressure of 10 to 20 grams of pressure, taking assistance from sensitive pressure scales that are available (Neild-Gehrig & William, 2008).
The presence of exudates is the next component. These exudates are essentially pus, which consists of dead white blood cells, and signifies the presence of infection. It is pale yellow in color and can come out from the orifice of any pocket on manipulation of the gingival in any form, like the application of light pressure from a finger (Neild-Gehrig & William, 2008).
Many relationships are possible between the level of the free gingival margin and the cementoenamel junction (CEJ), making the level of the free gingival margin a significant component in a clinical periodontal assessment. The natural level of the free gingival margin is marginally coronal or above the CEJ. When there is a significant upward change in the free gingival margin in relation to the CEJ, the gingival tissue is either inflamed or enlarged. When the free gingival margin is lower than the CEJ, the relationship is known as a recession, and such a relationship implies a risk for exposure of the root surface (Gehrig & William, 2008).
The junction between the keratinized gingival and the non-keratinized mucosa is called the level of the mucogingival junction, which is another component in a clinical periodontal assessment. The level of the mucogingival junction assists in understanding the width of the attached gingiva. (Gehrig & William, 2008).
Tooth mobility and fremitus are other components in a clinical periodontal assessment. Tooth movement may be horizontal or vertical. Horizontal tooth mobility is the facial to the lingual direction of the tooth movement and is assessed with the help of two dental instrument handles, by trapping the tooth between them. Vertical tooth mobility is the possible movement through the depression of the tooth into its socket, which is assessed through the use of the handle of the dental instrument, by exerting pressure with the handle of the dental instrument on the occlusal or incisal surface of the tooth. Normally in a healthy tooth, there should be no horizontal or vertical tooth movement. Fremitus represents the visible movement of a tooth during its function (Gehrig & William, 2008).
Most of the molars are multi-rooted teeth. In some cases, the pre-molars also develop with two roots. Hence furcation involvement is a possibility in the multi-rooted molars and pre-molars. Furcation involvement is another component in a clinical periodontal assessment, as it signifies possible periodontal infection in the area between the roots of the tooth. It is significant because it suggests the possible severity of the infection and the requirement for surgical intervention after the completion of the non-surgical interventions (Gehrig & William, 2008).
The presence of calculus contributes to the development of gingivitis and periodontitis, making it a component in a clinical periodontal assessment. The presence of calculus has to be documented so that it can be identified and removed as a part of the non-surgical intervention at a later stage as a part of successful patient treatment (Gehrig & William, 2008).
Plaque contains living periodontal pathogens that can cause gingivitis and periodontitis. This makes identifying the presence of plaque on the teeth and documenting it an important component in a clinical periodontal assessment, as it not only assists in the removal of the plaque but also suggests the need for patient education in plaque control measures (Gehrig & William, 2008).
Any proper clinical periodontal assessment includes identifying and recording the presence of gingival inflammation, which may be present overtly in the form of redness or swelling of the gingival margins or not so overtly when present in the deeper structures of the periodontium (Gehrig & William, 2008).
The final component of the clinical periodontal assessment is radiographic evidence of alveolar bone loss. Its importance lies in the assistance that it provides in the periodontal diagnosis and the planning for the non-surgical intervention (Gehrig & William, 2008).
Probing depths tend to be less accurate than measurements of clinical attachment levels. This factor arises from the differences in the methods employed. In probing depths measurement is made from the free gingival margin to the base of the pocket of the tooth. Factors like tissue swelling and the like may change the position of the gingival margin reducing the accuracy of this method. On the other hand, calculating the attachment level is an accurate means of establishing the periodontal support as it is made from the fixed point of the CEJ that does not change. Accurate measurement of periodontal support over time is crucial in distinguishing between gingivitis and periodontitis, as inflammation with no loss of attachment is a distinguishing factor for gingivitis and inflammation with loss of attachment is a distinguishing factor for periodontitis (Gehrig & William, 2008).
It is hypothesized that gingival crevicular fluid has markers present in it that can assist in understanding the progress of the periodontal disease. It is still in the research stage, with no evidence available to substantiate the hypothesis. Another possibility in helping in the understanding of the progress of the periodontal disease is the study of the gingival crevicular contents, but even here no tests have emanated from these studies. DNA probe analysis holds out the promise of identifying the periodontal pathogens in an individual’s mouth, but currently, very few bacterial pathogens can be identified using this test. The advantage with all these possible methods is the promise of more efficient and early detection of periodontal disease, but the disadvantage is that they are mostly in the study stage with no definite tests available (Gehrig & William, 2008).
Dentists and dental hygienists are legally bound to ensure that every patient has a complete and accurate periodontal clinical assessment done as per the current standards of the assessment. If not, they are likely to face dental malpractice charges. Essentially the dentist is responsible for the periodontal diagnosis but is dependent on the input from the dental hygienist in the making of the diagnosis and planning of the non-surgical intervention. Since they work as a team, it is the team that is held responsible in the case of any failure to maintain the standards required in the dental care of the patient. The dental hygienist plays a major role in the periodontal clinical assessment, which requires the maintenance of several records and becomes an important part of the functioning of the dental hygienist (Gehrig & William, 2008).
Literary References
Horn, J. (2001). Periodontal screening affirms our vital role as professionals concerned about patients health. Web.
Matsuda, S. A. (2005). THE POWER OF THE PROBE: Using the periodontal probe to detect periodontal destruction is essential to assessment. Dimensions of Dental Health Hygiene, 3(5), 24, 26. Web.
Neild-Gehrig, J. S. & William, D. E. (2008). Foundations of Periodontics for the Dental Hygienist. Second Edition. Lippincott Williams&Wilkins: Baltimore, MD.