2: Basic Periodontal Examination

Question 1

a basic periodontal examination (BPE) should be carried out for?

Answer 1

• all new patients

- patients who have not received a periodontal examination of any kind for more than 1 calendar year

Question 2

what is the specific probe used for BPE? what is the prescribed probing force?

Answer 2

WHO or CPITN (community periodontal index of treatment need) probe
- probing force 20-25g

Question 3

WHO/CPITN probe - distance from ball end to bottom of first black band?

Answer 3

3.5mm

Question 4

WHO/CPITN probe - distance from ball end to top of first black band?

Answer 4

5.5mm

Question 5

BPE - process 1?

Answer 5

divide mouth into sextants, single box chart for each sextant

Question 6

BPE - process 2?

Answer 6

probe introduced into gingival sulcus with recommended probing force
probe walked around buccal and lingual/palatal surfaces of each sextant
- record highest score code for each sextant

Question 7

what does an asterisk * added to the BPE numerical code indicate?

Answer 7

furcation involvement detected

Question 8

describe BPE code 0

Answer 8

black band completely visible in deepest pocket of sextant

• no calculus or defective margin detected
• no BOP

Question 9

describe BPE code 1

Answer 9

black band completely visible in deepest pocket of sextant

• no calculus or defective margin
• BOP present

Question 10

describe BPE code 2

Answer 10

black band completely visible in deepest pocket of sextant

- calculus & defective margins detected

Question 11

in which codes is BOP not observed?

Answer 11

codes 2, 3, 4

Question 12

describe BPE code 3

code 3 indicates a probing depth of?

Answer 12

black band partially visible in deepest pocket of sextant

- indicates probing depth of 3.5mm to 5.5mm

Question 13

describe BPE code 4

indicates probing depth of?

Answer 13

black band disappears completely in deepest pocket of sextant
- indicates probing depth of >5.5mm

Question 14

why is it not possible to determine a periodontal diagnosis from BPE alone?

Answer 14

the codes do not give any detail within sextants
- little information regarding BOP
- no information of LOA
BOP and LOA are both required to make periodontal diagnosis

Question 15

BPE should not be used around ___? what should be used instead?

Answer 15

• implants

- 4 or 6 point pocket charting should be used

Question 16

management of code 0 & 1 BPE

Answer 16

0 - no periodontal treatment required

1 - oral hygiene instruction

Question 17

management of code 2 BPE? x3

Answer 17

• OHI
• remove calculus (SAP)
• correction of plaque retentive margins on fillings and crowns if required

Question 18

management of code 3 BPE?

Answer 18

as for code 2

+ periodontal examination of all teeth and root surface instrumentation where necessary

Question 19

management of code 4 BPE?

Answer 19

as for code 2
+ periodontal examination of all teeth and root surface instrumentation
+ assess need for more complex treatment and consider referral to specialist

Question 20

what does a full periodontal examination refer to?

Answer 20

recording probing (pocket) depths (6 sites per tooth) pre&post treatment, for entire dentition

Question 21

what if there is only 1 sextant with BPE score of 3 & no sextants with code 4?

Answer 21

only record probing depths in that 1 sextant

Question 22

management for BPE code * ?

Answer 22

carry out treatment recommendations for the BPE scores 0 to 4, assess need for complex treatment, referral to specialist may be indicated

Question 23

general rule: when should radiographs to assess alveolar bone levels be obtained?
what is the issue with this rule?

Answer 23

• for sextants where BPE codes 3 or 4 are found
• BPE is based on pocket depths, not LOA. it is possible to have BPE scores of 3/4 with no LOA, making it inappropriate to take radiographs as there is no bone loss

Question 24

limitations of BPE?

Answer 24

cannot be used to assess/monitor response to periodontal treatment: does not give details of measurements within sextants

Question 25

how should assessment of response to treatment be carried out?

Answer 25

done by recording probing depths at 6 sites per tooth pre&post treatment

Question 26

advantages of using BPE? x 7

Answer 26

- identifies those requiring more detailed periodontal assessment - internationally recognized - quick & easy to carry out - equipment inexpensive - encourage examination of periodontium in GP - summarizes periodontal condition in readily communicable form - indicates treatment requirements, and who should treat the pt

Question 27

disadvantages of BPE? x7

Answer 27

- requires special probe - lacks detail within sextant - cannot be used to monitor disease - no info on BOP/disease activity - cannot distinguish between true and false pockets, lacks info on LOA - lacks detailed information about furcation involvements - limited use in young adults

Question 28

how differently is BPE carried out in children and adolescents

Answer 28

use of index teeth: e.g. upper & lower 6s, UR1 & LL1 | - to avoid problem of false pockets

Question 29

for BPE in children & adolescents, why are those specific teeth chosen? x3

Answer 29

- first permanent teeth to erupt - least likely to have false pockets - most likely to reveal true periodontal breakdown

Question 30

children 7-11y/o: what BPE codes should be used? children 12-17y/o: what codes can be used?

Answer 30

- BPE 0, 1, and 2 | - full range of codes 0-4, and * can be used

Question 31

children & adolescents: when to refer? x8

Answer 31

- diagnosis of aggressive periodontitis - developing chronic periodontitis and not responding to treatment - medical history and affects perio treatment, or require multi-disciplinary care - genetic conditions predisposing to periodontal destruction - root morphology adversely affecting prognosis - non-plaque induced conditions requiring complex care - drug-induced gingival overgrowth - cases requiring evaluation for periodontal surgery