Perio Exams

When using the Perio Chart module, you can complete a variety of tasks related to perio exams, including:

  • View the patient's current perio chart

  • Perform and manage perio exams

  • Print the perio chart

The values and condition symbols from a patient’s most recent perio exam display on the odontogram in the Perio Chart window.

Note: A patient’s most recent perio exam is their latest exam, regardless of whether it is incomplete, complete, or closed.

Depending on how conditions are configured for your institution during setup, the color may be customized, the values may display as numeric, alphanumeric, or as yes/no, and the symbols may include lines, bars, text, or dots.

Example: In the case below, a bleeding condition has been identified on the sites 1, 2, 6 and 8. Each is marked with a B and a red dot on the odontogram.

If you want to monitor changes between multiple exams, you can also compare individual conditions across multiple exams.

  1. Select a patient and open the Perio Chart module.
  2. From the Perio Chart window, review the odontogram as necessary.

  3. To display upper or lower teeth, complete any of the following:
    • Click the Up () button to display the Maxillary option and display the upper teeth in the chart.
    • Click the Down () button to display the Mandibular option and display the lower teeth in the chart.

  4. (Optional) To view the patient’s perio chart in full-mouth view and see all teeth in the same window, complete the following:
    1. Click the Full View () icon to display the Perio Full View Selection window.

      2. Note: The Perio Full View Selection window only displays if the Perio Options window > Full Mouth View field is set to Selectable. If set to Text or Graphic, the applicable window opens automatically.

    2. Select a radio button and click OK.
      • Text Values: Opens the Perio Full Text View window and displays the patient’s chart details using only text values.

      • Graphic Values: Opens the Perio Full Mouth View window to display the patient’s chart graphically and allows you to choose which conditions to include.

        • Text view:

        Graphic view

    3. If in graphic view, under Conditions to display, select and deselect each checkbox as necessary.
    4. (Optional) Print the full-mouth view.
      • If viewing the Perio Full Text View window, right-click and select Print.
      • If viewing the Perio Full Mouth View window, click Print.

When there are multiple exams on a patient record, you can compare them by individual condition to gauge changes in a patient's perio health and monitor patient progress.

Note: You can compare up to five exams at a time.

When necessary, you can also print the perio record comparisons.

To compare conditions across exams:

  1. Select a patient and open the Perio Chart module.
  2. Click the Compare Form () icon to display the Periodontics Comparison Settings window.

  3. From the Condition drop-down list, select the condition you want to compare.
  4. Under Show, select a radio button:

    • Graph Differentials: Shows the comparison in graph form. Opens the Perio Full Mouth View window to display the patient’s chart graphically and allows you to choose which conditions to include.

    • Text Comparisons: Shows the comparison in text form. Opens the Perio Full Text View window and displays the patient’s chart details using only text values.

  5. To select an exam, complete the following:
    1. From a Date [x] drop-down list, select an exam date.
    2. Next to the drop-down list, click the color bar and select a color.
  6. Repeat Step 5 as necessary for each exam date you want to include.

    7. Note: If the Graph Differentials radio button is selected, you can only select two exam dates.

  7. Click Accept to display the Periodontics – Comparison View window.

    8. Graphic View:

    The patient name and condition being compared display at the top of the window.

    For each of the selected exam dates, axiUm displays the value(s) for the condition entered on that date. The amount of change between the two dates is listed under the last exam date and displayed in a bar graph below that.

    Text View:

    The patient name and condition being compared display at the top of the window.

    For each of the selected exam dates, axiUm displays the value(s) for the condition entered on that date.

  8. (Optional) Click Print to print the comparison data.

Tip: Ideally, a perio exam is performed at least once a year.

A perio exam offers a visual representation of the patient’s mouth and gums at a certain point in time and allows providers to chart the conditions of a patient’s mouth.

Examples: Pocket depth, plaque, and bleeding.

Each exam lists the conditions used by your institution on the left side of the window and a series of buttons on the right side, as well as the values available below. The entry portion is made up of cells that you can enter values into.

It also offers Up / Down buttons that allow you to alternate the jaw view between Maxillary and Mandibular.

When completing an exam, follow the charting method used at your dental institution to progress through the patient’s mouth.

Examples:

  • Chart site 1 > 32 facial then lingual.
  • Chart site 1 > 16 facial then lingual
  • Chart site 17 > 32 facial then lingual.

Depending on the condition, sites are charted on one or two sides (either buccal/facial and lingual), and each side has between one and three surfaces.

Example: Mobility is only charted once per tooth, but pocket depth can be charted on multiple sides of a site.

Note: Your charting method is determined by your user group and user groups may have different charting method requirements.

Up to six surfaces that may be charted at each site during an exam. They include the following:

Surface Description Image
Buccal / Facial

The surface that faces the cheeks.
Lingual The surface that faces the tongue.
Mesial Buccal

The surface that is both closest to the midline of the face and faces the cheeks.
Mesial Lingual

The surface that is both closest to the midline of the face and faces the tongue.
Distal Buccal

The surface that is both farthest from the midline of the face and faces the cheeks.
Distal Lingual

The surface that is both farthest from the midline of the face and faces the tongue.

Examples: In most cases, pocket depth is charted on all six surfaces of a tooth, but furcation may only be charted on certain sides of a tooth, depending where it is located in the mouth.

Some conditions may be charted on sites that missing teeth and some may not.

Examples: A missing tooth may still have bleeding in the area, while you cannot chart mobility on a missing tooth.

When adding a perio exam, you have two options. You can add a blank exam or add an exam with the contents copied from a previous exam.

Note: This includes exams that have been deleted.

Example: You may want to copy a previous exam’s contents if the patient has previously attended your dental institution, and you want to quickly capture any changes to existing conditions.

Note: Depending on your configuration, a blank exam may display by default.

To add a perio exam:

  1. Select a patient and open the Perio Chart module.

    2. Tip: You can also add a perio exam from the EHR module > Perio tab.

  2. Click the Enter Perio Exam () icon to display the Create New Perio Exam window.

    3. Note: If an incomplete exam is on the patient’s record, the Resume Perio Warning window displays, prompting you to resume the previous exam.

    Note: If configured during setup, the Add Perio window may display automatically instead.

    • To add a blank exam, select the Empty radio button and click OK.

    • To add an exam based off the previous exam, select the Previous Exam to copy from radio button and click OK.

      • Tip: To select a different exam, click Select to display the Select Perio Date (for New exam) window, highlight a listed exam, and click Select.

      Tip: If you want to copy a deleted exam, select the Show All checkbox to include deleted exams in the list.

      The Add Perio window displays.

      Note: If the exam was copied from a past exam, the current date and the previous exam’s values display.

You can resume exams that are incomplete. Exams are considered incomplete if the user did not click Complete before closing.

  1. Select a patient and open the Perio Chart module.

    2. Tip: You can also add a perio exam from the EHR module > Perio tab.

  2. Click the Enter Perio Exam () icon, and when prompted with the Resume Perio Warning window, click Yes.

  3. From the Select Perio Date window, select a listed exam and click Resume.

  4. Complete the exam as necessary.

Once you have added or resumed a perio exam, you can chart the exam content. You will need to enter a variety of different conditions along with the correct value for that condition.

Example conditions and values: Pocket depths are entered using a numerical value that indicates the severity of the depth (usually 0 - 10) and plaque, bleeding, and suppuration are entered using a letter value that indicates whether the condition is present (usually P, B, and S).

Note: Conditions can be customized by your institution during setup. The exact conditions list and the applicable values are determined by your institution.

You can navigate and enter conditions using your keyboard arrow keys, num pad, and jump keys or using your mouse and the number pad in axiUm.

Conditions are typically charted one at a time, site by site as you examine a patient’s mouth. However, a jump key may be used to enter certain conditions while charting another. When a jump key value is entered, the associated condition is charted for the same site, but you can then continue on with the condition that was previously being charted.

Example: While charting pocket depth in the patient’s mouth, you notice the site you are currently charting is bleeding and press B to use the bleeding jump key. This allows you to jump to the bleeding condition line to enter the bleeding, and then return to charting pocket depth without having to move the cursor manually to the condition/site.

A yellow indicator displays to mark which cell you are in relation to a condition and site.

Once charted, conditions display on the exam with a line, bar, text, or dot symbol.

Depending on your institution’s setup, several customized features may be available to you during charting:

  • Auto-calculated attachments

  • Specific keyboard shortcuts

  • Alerts that display if severe values are entered

  • Auto-advance past missing teeth

  • Color-coding for conditions

  • Views for different provider levels

Your institution has configured perio charting details that determine how your perio exam progresses. This includes:

  • The order that teeth/surfaces are charted.

  • The conditions to be charted and their acceptable values.

Example charting methods:

  • Chart site 1 > 32 facial then chart site 1 > 32 lingual.

  • Chart site 1 > 16 facial and site 16 > 1 lingual, then chart site 17 > 32 facial and site 32 > 17 lingual.

Standard charting workflow:

  1. Open an exam and select the exam type.
  2. Chart the site conditions according to your designated charting method.
    1. Starting with the first highlighted cell, enter a value for the condition for each spot in the cell.
    2. (Optional) If necessary, add any jump key conditions for the site using the applicable jump key.
    3. As the yellow indicator progresses to the next cell, repeat Steps a-b as necessary for each site.
    4. (Optional) If you must chart something out of order, navigate to the correct cell manually and enter the value(s) as necessary.
  3. Once the condition has been fully charted on all applicable sites, repeat Step 2.

    4. Tip: While charting an exam, click Save often as you progress.

To chart a perio exam:

  1. Open the Add Perio window according to your usual workflow.

    2. Tip: This may require you to add an exam or resume an incomplete exam.

  2. From the Exam Type drop-down list, select the type of perio exam.

    3. Note: This list is configured by your institution during setup.

  3. (Optional) If you want to move to a specific quadrant, you can click the Up () and Down () buttons as necessary to change the quadrant:
    • Maxillary Right: Displays the upper right quadrant.
    • Maxillary Left: Displays the upper left quadrant.
    • Mandibular Right: Displays the lower right quadrant.
    • Mandibular Left: Displays the lower left quadrant.
  4. To enter a condition:
    1. Starting with the first highlighted cell, enter a value for the condition for each spot in the cell using your keyboard or the displayed keypad.

      2. Note: The acceptable value(s) and jump keys for each condition are displayed in the legend on the left.

    2. (Optional) Add any other jump key conditions for the site using the applicable jump key.
    3. If necessary, repeat Steps a-b for up to three surfaces in the cell.

      4. After entering 3 facial values on one site, axiUm automatically moves to the next site to continue charting.

      Once you've charted all applicable surfaces on the site, axiUm automatically advances to the next site and/or quadrant.

      Note: This is based on your configuration. You may need to manually move to the next site using your arrow keys or mouse.

    4. As the yellow indicator progresses to the next cell, repeat the steps as necessary to chart the condition on all remaining sites.

      5. Example: Site 1 > 32 facial.

      Note: Follow the charting method used at your dental institution.

    5. (Optional) If you must enter something out of order, use the conditions list and the teeth sites for reference and navigate to the correct cell manually and enter the value(s) as necessary.

      6. Tip: You can navigate via your keyboard arrow keys, computer mouse, or the Up, Down, Previous, and Next buttons in axiUm.

      Example: Navigate to the cell next to PROBE (pocket depth) and above site 1.

  5. Repeat Step 4 as necessary for each condition.
  6. To perform another task on the exam, complete any of the following:

    7. This clears a condition value from one surface on a site.

    1. Navigate to the applicable surface within a cell on the chart and click Clear.

    This clears condition values from all surfaces on a site.

    1. Navigate to the correct cell on the chart and click Clr Tooth.

    This allows you to remove conditions from all sites in the exam.

    1. At the top of the exam, click Clr Condition to display the Clear Condition Values window.

    2. Select a radio button:
      • Entire Perio Exam: This removes values for all conditions in the exam.
      • Selected Condition(s): This removes values for all selected conditions in the exam.
    3. From the Condition list, select all conditions you want to clear.

      4. Note: This list is only enabled if the If the Selected Condition(s) radio button is selected.

    4. Click OK.
    5. When prompted with a Clear Condition Warning window, click Yes to confirm.

    This allows you to revert any changes made since you last saved the exam.

    Note: This button is only enabled if you are working on a resumed exam.

    1. At the top of the exam, click Reset to revert the exam to the last saved entries.
    1. Click the Notes/Conditions… button to display the Tooth Notes/Conditions window for the current site.

    2. Complete the tooth note or condition.
  7. When ready to close the exam, complete any of the following:
    • If the exam must be completed later, click Incomplete to save your changes and mark the exam as incomplete, then close the Add Perio window.

      • Note: You can also click Save and close the Add Perio window to mark the exam as incomplete.

    • If the exam is complete, click Complete to save your changes and mark the exam as complete, then close the Add Perio window.

      • Note: Complete exams cannot be edited later.

  8. If you require approval, obtain approval for the exam.

    9. Once the exam is complete, the values may display in the EHR module > Tx History tab and above and below the odontogram.

axiUm allows you to record notes and conditions for individual teeth and surfaces during a perio exam. If a condition is added, a symbol that represents it displays on the tooth or surface.

Example: Tooth 1 displays a ( ) symbol to indicate that the tooth has been Rotated Mesially.

Note: Symbols are configured by your institution and may vary from those shown here.

Tooth conditions can also be added from the odontogram in the EHR.

To manage tooth notes/conditions during an exam:

  1. From the Add Perio window, navigate to the correct tooth.
  2. Click the Notes/Conditions… button to display the Tooth Notes/Conditions window.
  3. Review the listed entries.

  4. To enter a new tooth condition:
    1. Click the Add a new Condition () icon to display the Tooth Conditions window.

    2. Select the condition from the list and click the Add a new Record () icon.

      3. Note: You can also delete conditions or mark as resolved from this window by clicking the Delete Record () or Resolve Condition () icons respectively.

    3. Close the Tooth Conditions window.
  5. To enter a new tooth note:
    1. Click the Add a new Note () icon.
    2. If prompted, select the type of note to add and click OK.
    3. Enter the note as necessary.

    Note: When you enter a note that pertains to a specific tooth, the tooth number displays with an N on the odontogram.

  6. To perform another task, complete any of the following:
    1. Select a listed note and click the Edit Record () icon to display the General Note window.
    2. Make any edits and click Modify to save your changes and close the General Note window.
    1. Select a listed note or condition and click the Delete Record () icon.
    2. When prompted, click Yes to confirm the deletion.
    1. Select a listed condition and click the Resolve Condition () icon.
    2. When prompted, click Yes to confirm the condition has been resolved.

      3. The record now displays as struck out.

You can complete a variety of perio exams tasks when working with the Perio Chart module. This may include editing, closing, reopening, and deleting perio exams.

  1. Select a patient and open the Perio Chart module.

    2. Tip: You can also edit a perio exam from the EHR module > Perio tab.

  2. Click the View Form History () icon to display the Select Perio Date window.

  3. To perform a task, complete any of the following:

    4. When necessary, you can edit saved, incomplete exams.

    Important: Once an exam is completed and approved by a faculty member or instructor, it cannot be edited.

    1. Select a listed exam and click Edit/Review.

      2. Tip: Look for exams with an Incomplete status. All exams with a Complete status cannot be edited.

    2. From the Edit/Review Perio window, modify the exam cells as necessary.

    When necessary, you can close exams. A closed exam is still considered a valid part of the patient record because it includes some charting, but it is incomplete and will not be completed in the future.

    Note: A closed exam cannot be resumed or edited, and it does not display by default in the Select Perio Date window. However, its values are considered part of the patient record and display on the perio chart if it is the most recent exam.

    1. Select a listed exam and click Close Off.

      2. Tip: Look for exams with an Incomplete status. All exams with a Complete status cannot be edited.

    When necessary, you can re-open closed exams.

    Example: The exam was closed in error and you want to resume your progress.

    1. Select the Show All checkbox to include all closed exams.
    2. Select a closed exam and click Reopen.

    When necessary, you can delete perio exams.

    Examples: The perio exam was completed in error or entered for the wrong patient.

    Tip: If deleting a perio exam that is on the wrong patient record, print the exam before deleting, then use the printed copy to add the exam to the correct patient.

    1. Select a listed exam and click Delete.
    2. When prompted, click Yes to confirm your deletion.

      3. The deleted exam is removed from the list.

      Tip: To include deleted exams in the list, select the Show All checkbox. Deleted exams display in grey text.

      Note: When you select the Show All checkbox, two additional columns display:

      • Deleted Date: Displays the date an exam was deleted.
      • Deleted by User: Displays the user that deleted an exam.

You can print a patient’s updated perio chart after you perform an exam.

  1. Select a patient and open the Perio Chart module.
  2. Click the Print Form Report () icon to display the Perio Print Options window.

  3. To specify which types of information you want to include on the Perio Chart report, complete the fields as necessary and click OK.
    4. Field Description
    Show Perio Tx history

    Select the checkbox to display the patient’s perio treatment history on the Perio Chart report.

    Note: If selected, this enables the checkboxes below.
    Treatment Plan / In Process / Completed / PreExisting / Conditions

    If enabled, select each checkbox as necessary to display that item type on the Perio Chart report.
    Print with Patient Name

    Select the checkbox to display the patient’s name on the Perio Chart report.
    Print with Patient chart # Select the checkbox to display the patient’s chart number on the Perio Chart report.