Perio Competency - Exam/Diagnosis/TX Plan

This is just a quick run  down of my experience with this competency the other day:

I had Kyle Trammel (resident) grade my competency. Both he and Dr. Stevens attempted to discourage me from doing the competency due to lack of experience. So don't be shaken if they try to! If you are confident and know how to do a perio exam, then go for it because it's really not too bad.

The Competency

They basically just want you to fill out everything you can on the white Perio Eval sheet. Dr. Trammel said, "Basically we want you to fill out everything you can. Normally we wouldnt worry about things like Width of Keratinized Gingiva, but since this is a competency, I want you to record that as well"

Things that I recorded

1. Probing depths - probably the most important
2. Gingival Recession - one site per tooth
3. Width of Keratinized Gingiva - one site per tooth
4. Clinical Attachment Level - there isnt a column for this on the sheet so I just wrote it out above each tooth. Remember, CAL = PD + Gingival recession. This number is the important one when determining the severity of their periodontal disease
5. Mobility - remember to use either a hard object (mirror handle) and your finger, or two hard objects. And trust your judgement! I actually saw teeth move but was convinced I did it wrong. But Dr. Trammel checked, and they were actually moving. 
6. Plaque Index
7. Occlusion - I just recorded overjet, overbite, and then what molar classification and what dental classification they were.  I did not fill out that weird occlusion box on the back.
8. Review the check list - There is a list on the right side of the back page. Check to make sure none of those contributing factors are true for this patient (are they a smoker). Make sure you mark any that apply. 

Things They Actually Checked / Asked

1.  Probing depths - he went around and spot probed different areas
2. Mobility - all the teeth
3. radiographs - make sure you are familiar with the radiographs and what bone loss looks like, etc.

Diagnosing

1. Review how to diagnose periodontal disease. I heard Dr. Stevens say he considers 4-5mm pockets to be mild, 5-6mm pockets to be moderate, and anything over 6mm is severe. If they only have one or two 7's, then it would be localized severe for those areas.
2. It's generalized if it is >30% of the teeth (i think?) 

Treatment Planning

1. From my understanding, if they have generalized pockets, then the first line of treatment is ALWAYS scaling and root planing in the quadrants with deep pockets. This is because scaling and root planing typically can gain 1-2mm back and alleviate some of the problems.
2. So my treatment plan for a diagnosis of Generalized Severe Chronic Periodontitis looked like this:
1. UL, UR, LL, and LR quads of scaling and root planing.
2. Phase 1 Perio Eval (coded in salud as Limited Perio Reeval).
3. And that's it. You won't know whether to continue treatment until you get them back for the Phase 1 Eval.

hope this helped! Ask me if you have any other questions.
- Joe