Patient Assessment and Data Collection
Assessment is the foundation of the hygiene process of care: you gather subjective data (chief complaint, health history, symptoms) and objective data (vital signs, extraoral and intraoral examination, periodontal measurements, radiographs, indices). Know normal and abnormal findings: vital sign ranges, lymph node characteristics (tender vs. fixed, mobile), thyroid and salivary gland palpation, and the appearance of common oral lesions. Master periodontal charting - probing depth, clinical attachment level, bleeding on probing, recession, mobility, furcation involvement, and plaque/calculus indices - and understand the difference between probing depth (gingival margin to base of sulcus) and attachment level (CEJ to base of sulcus). Know the purpose and limitations of radiographs, including ALARA and selection criteria, and the meaning of key indices (e.g., DMFT, plaque index, community periodontal index). Recognize medical conditions and medications that alter care: anticoagulants, bisphosphonates, uncontrolled diabetes, pregnancy, and infectious diseases.
Traps: confusing probing depth with attachment loss; missing that a bleeding disorder or anticoagulant changes planning but not necessarily the need for gentle scaling; assuming radiographs are routine rather than selected by need; and overlooking extraoral findings. Questions often ask which data point is most significant - prioritize findings that change safety or diagnosis.
Rule of thumb: always compare the gingival margin and CEJ before interpreting a pocket; a shallow pocket with recession still represents attachment loss.
Worked example: Probing depth is 3 mm but the gingival margin is 2 mm apical to the CEJ. Attachment level is 5 mm - recession plus pocket depth. Report attachment loss, not just the pocket.