Planes, Terrains and Perio-Charting Skills

Consider this analogy:  If a pilot knows the altitude of his plane relative to sea level, but not the altitude of the terrain he’s actually flying over, he’s in trouble. Yes, he might be flying at five thousand feet, but what if he is in Colorado?!

What does this have to do with periodontal charting?

Dentists risk making the same mistake if they do not keep both the “altitude” and the “terrain” foremost in mind.  Think of the “altitude” above sea level as the gingival margin (GM) and the altitude above the terrain as the pocket depth (PD).  You simply must have both to know how to manage a patient’s periodontium.

But mapping GM and PD in relation to the cementoenamel (CEJ) is often not done. As a result we are “flying blind”.

Common charting practice:

Often, periodontal charting starts by noting the GM relative to the junction of the CEJ. These measurements are commonly done and patients recognize the clinicians calling out the numbers as they move through their gum area.

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Added to that must be charting of the periodontal pocket depth (PD) relative to the GM.

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The Problem

Most clinicians will chart the PD making one pass around the entire mouth.

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And then they may or may not record the GM.

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Why wouldn’t clinicians chart both PD and GM?  Charting PD and then going back and charting GM is onerous. A reason periodontal charting is boring and laborious is because the separation of the charting of the GM and PD does not reveal the clinical picture readily or clearly.

Recording the PD without recording the GM prevents one from knowing the change of the PD relative to the CEJ.  A 3 millimeter PD reading relative to the GM means one thing if the GM is positioned at the level of the CEJ (a GM reading of 0).  However a 3 millimeter PD reading relative to the GM means something else entirely if the GM actually is 3 millimeters apical to the CEJ.  In the first case there is no attachment loss, but in the second case there has been a 3 mm attachment loss!

Therefore a 3 millimeter pocket depth reading does not in and of itself tell the clinician any more than that the pocket is probably cleansable.

How Can Periodontal Charting Become Clinically Relevant?

We need to make periodontal charting a real time clinical investigation. This can happen if the clinician adopts a new single pass two-step charting method:

First, call out the GM position at each tooth site.

Second, while still at that site, move the probe into the pocket to the full extent of the pocket and call out the millimeter reading seen on the probe relative to the just measured GM.

Adopting this method helps the clinician develop a real understanding of the terrain of the attachment level in that quadrant.  By virtue of focusing on both the GM and PD at the same time at the same site, one can gain a more coherent and deep view. It only takes a few teeth to realize that “single pass – dual charting” of the GM and PD enables diagnosis and treatment planning more readily.

 

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Admittedly, one of the challenges in adopting this method is that your charting software might make it difficult. If that is true for you, check out Dental Symphony ePerioCare’s “Single Pass – Dual Charting” feature that enables this practice.

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