Periodontal charting is a way of measuring the space between a tooth and the gum tissue next to it. A dentist or dental hygienist uses an instrument called a probe and gently inserts it into this space. This probe has markings like a tape measure that shows them how deep it can reach into the space to check the health of your gums. The users of periodontal charting include dental assistants, providers, clinical staff. Let's dive into the description of gum measurements.
Dive deep with this detailed walkthrough video.
Description of Gum Measurements
You can record the following gum measurements in the system:
1. Pocket Depth: Pocket Depth is the most important variable for evaluating the health of a pocket. PD is measured in millimetres from the gum line. PD is the most common measurement recorded.
PD will display in colour on the chart if it meets or exceeds the alert depth specified in the Practice Settings.
2. Gingival Margin: Gingival Margin is the area of the gingiva closest to the tooth surface, commonly referred to as the 'gum line'.
GM reflects the recession of the gum line. GM measures from the Cemento-Enamel Junction (CEJ). GM is assigned a positive value when the gum line is below the CEJ and a negative value when the gum line is above the CEJ.
3. Clinical Attachment Level: CAL is a calculation of Pocket Depth and Gingival Margin: CAL=PD+GM. The CAL rating reflects the overall risk of losing the tooth. The higher the CAL number, the greater the chance of losing the tooth.
4. Mucogingival Junction: MGJ is the meeting of the thick, protective gingival tissue around the teeth and the friable mucous lining of the cheeks and lips. MGJ concerns the health of the area where the gum tissue and cheeks meet. MGJ is assigned a value between 0-9.
5. Mobility: MOB is the amount of mobility a tooth has within its socket, and one of the following ratings is assigned to each tooth. MOB is assigned a value between 0-3.
- No apparent mobility.
- Grade I: Slightly more than normal (< 0.2 mm horizontal movement)
- Grade II: Moderately more than normal (1-2 mm horizontal movement)
6. Furcation Grade: FG is the amount of tissue destruction in areas on a multi-rooted tooth where the roots diverge. FG is measured if the gums have receded enough to expose the roots. FG cannot be measured on anterior teeth because they only have one root.
FG is assigned grade ratings as follows:
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1 = Incipient bone loss. 2 = Partial bone loss 3 = Total bone loss with through and through an opening of furcation 4 = Grade 3 with gingival recession exposing the furcation to view. |
7. Bleeding on probing: BoP refers to bleeding that is induced by gentle manipulation of the tissue at the depth of the gingival sulcus or interfaces between the gingiva and a tooth. BoP is a sign of periodontal inflammation and indicates some sort of destruction.
8. Plaque: A sticky film that coats teeth and contains bacteria. Dental plaque can damage a tooth and lead to tooth decay or tooth loss.
9. Suppuration: The production or discharge of PUS.
Enter the number of your measurements in the blue-highlighted box (pictured below). The chart may auto-advance to the next field to help you complete the chart faster (determined by your practice settings). The probing directions and site details are also configured in the practice settings. If a measurement of 10+ is required, Hold the ALT key then type the full number. To enter a negative gingival margin, Hold the ALT key then type the number.
The periodontal charting page is divided into four basic sections.
- Perio chart
- Numeric chart
- Perio graph
- Numeric Comparison
1. Perio Chart
There is a Measurement summary box on the right end of the page which captures the following details.
Tooth #: Indicating the currently selected tooth
- GM
- CAL
- MGJ
- BOP
- SUP
- PL
- MOB
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Conditions
- Missing: Marks the tooth as missing.
- Impacted: Marks the tooth as impacted.
- Hide 3rd molar: Hides the 3rd molar from the Maxilla and Mandible region.
- Interproximal bleeding: Conversion of bleeding to a non-bleeding state.
Entering Probing Measurements
Enter the following probing measurements.
Pocket depth (PD), Gingival Margin (GM), Mucogingival Junction(MGJ)
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Enter the probing measurements into the respective fields by placing the cursor on the required teeth and on the required column OR they can use the Measurement Summary box on the right side of the page to key in the measurements.
- Either way, measurements can be recorded. Once it is selected, the selected box will be highlighted in Blue.
- Users can type in the probing measurements.
- A coloured indication of the depth (Based on the Perio Charting Configuration in Practice Settings) will be shown alongside the teeth as you input the measurements. Once a value is entered, it automatically jumps to the next box selecting it in both places. If a measurement of more than 10 is required, hold the ALT key and then input the full measurements. If the inputted value exceeds the warning / danger level configured in the practice settings, the entries will be in Red.
BOP, SUP, FUR, and PL can be entered by using the measurement summary box on the right side, where you can choose the tooth and input as required. Also, another way to indicate Bleeding on probing and Suppuration is by holding B & S when a pocket is selected. This will mark the bleeding sites or suppuration on the selected pocket.
- If a tooth is marked missing / Hide 3rd molar, then the pocket depth boxes and tooth in the Perio chart page will be greyed out.
- While auto-advancing of pocket depth, the selector will skip if the tooth is greyed / check-boxes are greyed out.
- The same will be indicated in the patient’s odontogram with the condition added accordingly. If the Missing / Hide 3rd molar is unselected, the same will be removed from the odontogram as well.
2. Numeric Chart
A numeric chart lets you enter all the charting measurements on a single page without the tooth representation in a single go.
3. Perio Graph
This tab gives a graphical representation of your pocket depth measurements. Generates graphs based on the previous examination measurements which will help the clinical staff / providers in analysing the patient's health over a period of time. This is ideal for a visual presentation to the patient. Values cannot be inputted / edited in this tab.
4. Numeric Comparison
This tab compares the measurements with the previous exam data in terms of numbers rather than the graphical representation. There is a print icon available at the top right to print the entire numeric comparison page.
Practices can use this resourceful guide to learn everything about periodontal charting in CareStack.