Faculty of Dentistry

Clinical Periodontology Log Book

5th Year

2019 / 2020

Student’s name: ------------------------------------

Code number: -----------------------------------
Group number: ----------------------------------

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 Table of Content
 Student manual of Periodontology clinic.

 Requirements & assignment.

 Requirements’ Sheet.

 Evaluation Sheet.

 How to use periodontal chart

 Diagnosis of periodontal disease

 Guide for Instrumentation

 Periodontal Chart

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 Student Manual of Periodontology Clinic

Dear Student:

 You are allowed to enter the clinic with only fifteen minutes delay.

 You are allowed to attend your clinic only with your instruments sterile
and packed (mirror, periodontal probe, tweezer, sickle and jaquette
scalers, anterior and posterior curettes, cotton, plastic cup, two napkins
,napkin holder and tissue) and your logbook.
 Each surface going to be touched during work have to be disinfected and
rapped before work.

 All infection control measures should be taken before you start your work
(wearing gown, mask, gloves, head cap and eye goggle or face shield).
 Every case should be documented in periodontal Chart before any
procedure and signed by the supervisor.

 DO NOT start performing periodontal probing before obtaining a medical

history! This is not only a poor patient management but it could be, in
certain cases, detrimental to the patient’s health.

 It is not allowed to leave the clinic for any reason before taking
permission.

 It is not allowed to use your mobile phone during work in the clinic.

 Before leaving the clinic make sure that:

 You take your attendance by your supervisor
 You signed your case in the requirement sheet by your supervisor
 You filled your evaluation sheet.

 Blood left anywhere at the working area during or after your appointment
will prevent you from entering the clinic for two weeks.

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 Requirements & assignment

1- End of the year: Three fully documented cases (Code 3 or 4)

2- First week in the second term: Group assignment
 Topic: updates in periodontics.
 Format of paper assignment: Times New Roman, size 12,
spacing 1.5, 10 pages.
 Presentation: 15 minutes.
 Number of students: 10 students under the supervision of their
instructor.

3- Last week in the second term: Case presentation of a well-

documented case with:
 Pre-operative and postoperative photographs
 Initial assessment chart (diagnosis, prognosis and treatment
plan)
 Re-evaluation chart
 Spider diagram for risk assessment

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 Requirements’ Sheet

Date Patient’s name Procedures Supervisor

signature

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 Requirements’ Sheet

Date Patient’s name Procedures Supervisor

signature

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 Evaluation Sheet

Student name: Section: Year: 5 th year

Date Patient’s name Procedures Supervisor clear Examination Communicat Infection Pain control Calculus Tissue Time
& Signature & Diagnosis* -ion Control removal** Trauma Management
Site
Stud. Sup. Stud. Sup. Stud. Sup. Stud. Sup. Stud. Sup. Stud. Sup. Stud. Sup.

A: excellent (following all standards), B: satisfactory (minor error), C: unsatisfactory (major error)
*Evaluated for new cases only
**Add + to identify the amount of calculus that covers the tooth before scaling: + (one third), ++ (two thirds) , +++ (more than two thirds)

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 Evaluation Sheet

Student name: Section: Year: 5 th year

Date Patient’s name Procedures Supervisor clear Examination Communicat Infection Pain control Calculus Tissue Time
& Signature & Diagnosis* -ion Control removal** Trauma Management
Site
Stud. Sup. Stud. Sup. Stud. Sup. Stud. Sup. Stud. Sup. Stud. Sup. Stud. Sup.

A: excellent (following all standards), B: satisfactory (minor error), C: unsatisfactory (major error)
*Evaluated for new cases only
**Add + to identify the amount of calculus that covers the tooth before scaling: + (one third), ++ (two thirds) , +++ (more than two thirds)

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 Major errors

Procedure Criteria

Examination & diagnosis Failure to reach proper diagnosis

Communication Failure to instruct the patient for oral hygiene

measures

Infection control Failure to follow standards of personal protective

equipement and sterilization

Pain control Failure to control pain with topical anesthesia

/injection

Calculus removal Failure to remove calculus completely

Tissue trauma Any tissue trauma

Time management* Late attendance (after 15 minutes)

Take more than 30 minutes in diagnostic chart

(supervisor may extend the time according to the case)

Any other error that is not mentioned in major errors is considered a minor one
* Students who completed the task in time will be allowed to use ultrasonic scaler in the last 15
minutes (either sharing other students or alone according to the number of students)

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 How to use the periodontal chart?

1. Medical history reviewed before the first patient visit:

Prior to dealing with a patient for the first time, the student should obtain and review the
patient’s general dental and periodontal situation. The student should specifically look for
medical cautions of contradictions to dental treatment. Reviewing the Medical and Dental
History will often reveal the potential need for medical consultation or pre-medication.

2. Pocket depths recorded:

 It’s the distance from the free gingival margin to the base of the pocket. Measuring
six points per tooth (MB, B, DB, ML, L, DL), the student will measure and record all
pocket depth.

3. Gingival margins recorded:

 It’s the distance from the free gingival margin to the CEJ. The student will measure
and chart all areas of recession and/or hyperplasia from the CEJ. In case of recession
put (-) next to the reading. e.g. -3 means the recession equals 3mm.

4. Attachment loss recorded:

 It’s the distance from the CEJ to the base of the pocket. Measuring six points per
tooth (MB, B, DB, ML, L, DL), the student will calculate clinical attachment loss. The

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 student may chart the site of the most severe attachment loss for each tooth for the
time factor.

5. Mobility evaluated:

 The student will measure and record all teeth with mobility noting all depressible
teeth.

The following classification will be used:

o Grade 0: No apparent mobility.

o Grade 1: Perceptible mobility <1mm in buccolingual direction.
o Grade 2: > 1mm but <2mm.
o Grade 3: > 2mm or depressibility in the socket.

6. Furcation involvement charted:

 The student will record and correctly classify all areas of furcation involvement.
 The following classification ( Glickman) will be used:

Grade I : Pocket formation into the flute, but intact interradicular bone (incipient).

Grade II: Loss of interradicular bone and pocket formation, but not extending through to the
opposite side.

Grade III: Through-and-through lesion.

Grade IV: Through-and-through lesion with gingival recession, leading to a clearly visible
furcation area.

7. Bleeding on probing site score measured:

 Introduce periodontal probe into the sulcus and move from mesial to distal along the
buccal and lingual surface. the student will record all gingival areas that bleed upon

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 gentle probing (a sulcular bleeding response can take up to 30 seconds).Measure six
points per tooth (MB, B, DB, DL, L and ML),

8. Plaque score accomplished:

 Measuring four points per tooth (M, B, D, and L ), the student will record all surfaces
with detectable plaque. The plaque score shall be performed either by running
horizontally an explorer at cervical part of the tooth or disclosing solution.

9. Radiographic evaluation:

 The full-mouth periapical radiographs must be current (not more than two years
old). The student will record on the chart radiographic changes consistent with the
periodontally involved dentition. All teeth with the following will be noted:

a. Horizontal or angular bone loss

b. Crown/root ratios (Greater than 1:1)
c. Furcation involvement (only radiographic evidence, NOT clinical)
d. Overhanging Restorations
e. Thickness of periodontal membrane space

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10. Calculus Assessment:

 Indicate the degree of calculus present, subgingivally and supragingivally. This

information will help determine the extent of treatment needed.

11. Classification of bone loss:

 Slight = bone loss of <25% of the distance from a point 1.5-2 mm apical
to the CEJ to the root apex.
 Moderate = bone loss of 25% - 50% of the distance from a point 1.5-2 mm
apical to the CEJ to the root apex
 Severe = bone loss of over 50% of the distance from a point 1.5-2mm
apical to the CEJ to the root apex.
12. Case Type:
 The case type will reflect the “worst” condition present in the mouth as a
“generalization”.

13. Prognosis:
 The student will be able to offer an opinion on the relative prognosis of the
periodontally involved teeth.

14. Treatment Plan:

 The student will be able to make a general assessment of the amount of plaque
and calculus present and resultant pathologic state and be able to plan what

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 treatment regimen would be necessary (including necessary surgery) to
achieve a state of periodontal health.

N.B

PD, GM, FN, MOB are recorded only for cases with periodontitis (with attachment loss
i.e. the periodontal probe extends apical to CEJ on probing)

Presence of plaque or bleeding is recorded as small dot.

Diagnosis of periodontal disease

Check the presence of clinical attachment loss in ≥ 2 non-adjacent teeth

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 Yes No
With PD ≤ 3 mm with PD ˃ 3 mm
BOP ≤ 10 % BOP ˃ 10 %
Healthy on reduced periodontium non-stable periodontitis
 Non-periodontitis determine stage and grade
 Stable periodontitis patient

With PD ≤ 3 mm
BOP ˃ 10 %
Gingivitis on reduced periodontium
Gingival inflammation on reduced periodontium
With PD ≤ 3 mm
Check BOP %

BOP ≤ 10 % BOP ˃ 10 %

Healthy on intact periodontium Gingivitis on intact periodontium

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Page | 16
 Guide For Instrumentation
Site Operator Patient Mirror Finger rest Demonstration
Aspect: 9 O’clock Away Retraction Incisal edge/occlusal
Buccal from of the surface of adjacent teeth
Sextant: operator cheek
Mandibular Chin down
right
Aspect: 9 O’clock Away Retraction Incisal edge/occlusal
Lingual from of tongue surface of adjacent teeth
Sextant: operator OR
Mandibular Chin down Cross arch
left
Aspect: 10-11 O’clock Toward Retraction Incisal edge/occlusal
Buccal the of the surface of adjacent teeth
Sextant: operator cheek
Mandibular Chin down
left
Aspect: 10-11 O’clock Toward Retraction Incisal edge/occlusal
Lingual the of tongue surface of adjacent teeth
Sextant: operator
Mandibular Chin down
right
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 Site Operator Patient Mirror Finger rest Demonstration
Aspect: 9 O’clock Away Retraction 1- Incisal edge/occlusal
Buccal from of the surface of adjacent teeth
Sextant: operator cheek OR
Maxillary Chin up 2- Extra-oral
right
Aspect: 9 O’clock Away Indirect 1- Incisal edge/occlusal
Palatal from vision for surface of adjacent teeth
Sextant: operator distal OR
Maxillary left Chin up aspect 2- opposing arch

Aspect: 10-11 O’clock Toward Retraction 1- Incisal edge/occlusal

Buccal the of the surface of adjacent teeth
Sextant: operator cheek OR
Maxillary left Chin up 2- Extra-oral

Aspect: 10-11 O’clock Toward Indirect 1- Incisal edge/occlusal

Palatal the vision surface of adjacent teeth
Sextant: operator (OR)
Maxillary Chin up 2- finger on finger support
right

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NB.

 The closer the fulcrum to the working area, the more control over the instruments.
 Mirror could be used for both reflection and indirect vision at the same time.
 Always follow a neutral position to avoid muscloskeletal disorders.
 Sharpen your instruments to work efficiently.

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