Perio OSCE

Ramfjord teeth

Representative of each sextant in the mouth to assess the entire mouth (# 3, 9, 12, 19, 25, 28)

What's the ideal plaque score?

10% or less

How do you calculate plaque score?

(Total number of tooth parts with plaque / 6 X Number of teeth used for scoring) X 100

Initial lesion Develops within ___ days of plaque accumulation?


Initial lesion

— No clinical changes are evident; a subclinical lesion— Clinically looks healthy— Collagen fibers breakdown apical to the junctional epithelium

Early lesion Develops within ___ days of plaque accumulation?


Early lesion

— Associated with early gingivitis— Clinically we see erythema and bleeding on probing (BOP) — Color change: Redness due to increased vascularity (vascular proliferation)

Established lesion Develops within ___ days of plaque accumulation?

2-3 weeks (14-21 days)

Advanced lesion

Phase of periodontal breakdown or PERIODONTITIS(NOTE: this is no longer gingivitis)

Cellular infiltrate in the lamina propria is composed mainly of neutrophils (PMNs), but also includes lymphocytes,macrophages, plasma cells, mast cells

Initial Lesion

Predominance of T-lymphocytes

Early Lesion

60-70% collagen destruction occurs within lamina propria

Early Lesion

Predominance of plasma cells

Established Lesion

Established Lesion

— Associated with chronic gingivitis— Clinically see more edematous (swelling) tissues andmore BOP than in the early lesion— Pockets are first observed

Continued predominance of plasma cells in the inflammatory infiltrate within connective tissues

Advanced Lesion

Advanced Lesion

Loss of connective tissue attachment from the CEJresulting in an apical migration of the junctional epithelium

Microbes most associated with BOP:

P. gingivalis, T. forsythia and T. denticola

Clinical signs of gingivitis

— Redness(erythema) and sponginess of the gingival tissues— Bleeding on probing (BOP)— Changes in contour of the gingival tissues —> Enlarged gingival contours due to edema —> Loss of stippling —> Rolled gingival margins— Presence of plaque and/or calculus without any radiographic evidence of alveolar crestal bone loss

Chronic Gingivitis

Loss of Stippling, Friable Tissues

Steps of Plaque Formation

- Association- Adhesion- Proliferation- Microcolonies- Biofilm formation- Growth or maturation


Dental pellicle forms on the tooth, and provides bacteria surface to attach


Within hours, bacteria loosely binds to the pellicle


Bacteria spreads throughout the mouth and begins to multiply


Microcolonies are formed. Streptococci secrete protective layer (slime layer)

Biofilm formation:

Microcolonies form complex groups with metabolic advantages

Growth or maturation:


Forms of gingivitis

acute, chronic, recurrent

What's the effect on smoking on oral health and what can it cause?

- Higher CAL-

Tobacco Cessation 5 A's


What instrument do you use to examine furcations?

Nabor's probe

How many mm can UNC-15 probe measures up to?

15 mm

What is the most common medical emergency?

syncope (fainting)

Clinical Attachment Loss (CAL)=

PPD + recession

Miller Classification (Mobility)

Class 0-3

Class 0 mobility

complete tooth stability

Class 1 mobility

Slight mobility, up to 1 mm of horizontal displacement in a facial-lingual direction

Class 2 mobility

moderate mobility, 1mm) of horizontal displacement in a facial-lingual direction

Class 3 mobility

severely more than normal (>1mm) and can be vertically depressed in socket

Infrabony Defects

result when bone resorption occurs in an uneven, oblique direction

1 wall defect


2 wall defect

crater (most common)

3 wall defect


4 wall defect

circumferential (extraction socket)

Miller Classification (Recession)

- Determines likelihood of regaining root coverage- Class 1-4

Localized periodontitis

Less than 30% of sites in the mouth are affected

Generalized periodontitis

More or 30% of sites in the mouth are affectedAmt of sites x 6 for each tooth to determine # of sites affected


Extent and distribution is based on percentage- Stages I-IV-- Localized-- Generalized-- Molar/incisor pattern (classic localized aggressive periodontitis)


determined by rate of progression, responsiveness totherapy, and assessment of risk- Rate of CAL/RBL- Smoking- Diabetes• Measured from A to C

Periodont al probe:

Calibrated measuring instrument to measure depth of the periodontal sulcus or pocket

How do you probe?

Note the location of the probe Base of the pocket is on the root below the CEJ (not enamel) Attachment loss has occurred on the root apical to the CEJ Key: With a pocket, feel for CEJ, base will be apical to CEJ

How do you probe?

Stepping" a measuring device (periodontal probe) around the tooth (within the crevice) and recording the deepest reading in mm at 6 sites/tooth- Mesial buccal/facial - Facial/buccal - Distal buccal/facial - Mesial palatal/lingual - Palatal/lingual - Distal palatal/lingual

Probing depth (PD)

the distance from the gingival margin (GM) to the base of the probeable crevice (be it sulcus or pocket)

Glickman Classification based on tissue degradation in horizontal dimension:

Grade I, II, III, IV

Where is Furcation most common?

The maxillary molarsMost readily seen radiographically in the mandibular molars

Furcation Grade I:

incipient or early stage bone loss

Furcation Grade II:

Partial bone loss. Probe in a horizontal direction more than 3 mm but not through and through

Furcation Grade III:

Total bone loss. Involvement is through and through and completely probed. Probe tip not seen through the gingival tissues

Furcation Grade IV:

total bone loss with gingival recession exposing the furcation to view clinically. Probe tip is seen coronal to the gingival tissues