The periodontal examination data may be recorded on paper or saved in a digital format. There are many examples of periodontal charts.
What Adjunctive Techniques Are Available to Help in the Diagnosis of the Periodontal Diseases or Other Periodontally-Related Diseases or Conditions?
Bacterial culturing and sensitivity periodontal examination: Bacterial culturing is considered to be the gold standard of bacterial identification of bacteria associated with ongoing periodontal inflammation is indicated when the use of systemic or locally delivered antibiotics is contemplated.
Culturing requires the harvest of live bacteria from the pocket or pockets in question, placing these bacteria in a suitable transport media, and then shipment of the sample to a microbiologal laboratory for analysis and periodontal examination. Bacteria identified are those that survived the transport and are cultivable.
It is assumed that the identified bacteria are associated with the periodontal inflammation. An estimation of antibiotic sensitivity and resistance be determined with this method. Bacterial samples must be harvested on a Monday, Tuesday, or Wednesday and sent by overnight delivery to the selected lab in order to maximize the numbers and variety of cultivable species. Reports of this periodontal examination are generally available about 7 days after delivery to the laboratory.
DNA probe analysis in periodontal examination – DNA probe analysis uses special technology to identity bacterial DNA within a sample. The advantage to this technique is that time is not a factor as live bacteria are not necessary for analysis. Smaller absolute numbers of bacteria may be detected with this method.
Probes identify 4c-ttnobacillus actinomycetemcomitans, Bacteroides. Campylobacter rectus, Eikenella corro dens, Fusobacte. – nucleatum, Porphyromonas gingivalis, Prevotella and Treponema denticola. Antibiotic sensitivity testing is not possible with this technique.
lnterleukin-i (IL-i) genotype testing. This periodontal examination, the Periodontal Susceptibility Test( PST) determines if a patient possesses a conbination alleles in two interleukin-1 genes. A specific iInterleukin-i genotype is associated with increased product of IL-i from periodontal inflammation with subsequent increased attachment loss. Smoking significantly increases the amount of attachment loss in patients found to have an increase in IL-i production
Enzymatic periodontal examination methods of bacterial identification – While the analysis of gingival crevcelar fluid for enzymes related to specific bacteria or for the presence of inflammatory mediators is of scientific interest, there has yet to be consistent practical application developed for this technology.
Biopsy periodontal examination- The biopsy is used when a sample of tissue is needed for histopathological analysis. Biopsies may be occasional, where only a piece 01 the lesion and adjacent normal tissue is removed, or excisional. Where the entire lesion is removed with healthy tissue margins.
The biopsy should be done as atraumatically as possible to ensure intact tissue for analysis. Tissues to be submitted for immunofluorescence testing to rule out the vesiculobullous diseases must be placed in special fixative such as Michels solution.
Nikolsky sign. Apparently normal epidermis or gingiva may be separated at the basal layer and rubbed off when pressed with a sliding motion. This is done using the end of a mirror handle or a moist cotton swab. This periodontal examination technique is helpful in identifying the vesiculobullous diseases. Distinction among the diseases may be made only by biopsy.
Exfoliative cytology. This technique may be used to identify abnormal cells on the surface of a lesion. Several commercially available tests can be used to sample suspicious red lesions.
What Are the Dento-Legal Considerations of a Complete periodontal examination and Diagnosis in Periodontal Therapy?
The patient record should contain a complete periodontal diagnosis, and treatment plan for all patients with periodontal disease. Studies have shown that fewer than 20% of records in general practice contain these necessary elements. It is significantly easier for a practitioner to support claims of a complete periodontal examination, diagnosis, treatment.
