Perform Perio Exams

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.