2: Basic Periodontal Examination Flashcards
a basic periodontal examination (BPE) should be carried out for?
- all new patients
- patients who have not received a periodontal examination of any kind for more than 1 calendar year
what is the specific probe used for BPE? what is the prescribed probing force?
WHO or CPITN (community periodontal index of treatment need) probe
- probing force 20-25g
WHO/CPITN probe - distance from ball end to bottom of first black band?
3.5mm
WHO/CPITN probe - distance from ball end to top of first black band?
5.5mm
BPE - process 1?
divide mouth into sextants, single box chart for each sextant
BPE - process 2?
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
what does an asterisk * added to the BPE numerical code indicate?
furcation involvement detected
describe BPE code 0
black band completely visible in deepest pocket of sextant
- no calculus or defective margin detected
- no BOP
describe BPE code 1
black band completely visible in deepest pocket of sextant
- no calculus or defective margin
- BOP present
describe BPE code 2
black band completely visible in deepest pocket of sextant
- calculus & defective margins detected
in which codes is BOP not observed?
codes 2, 3, 4
describe BPE code 3
code 3 indicates a probing depth of?
black band partially visible in deepest pocket of sextant
- indicates probing depth of 3.5mm to 5.5mm
describe BPE code 4
indicates probing depth of?
black band disappears completely in deepest pocket of sextant
- indicates probing depth of >5.5mm
why is it not possible to determine a periodontal diagnosis from BPE alone?
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
BPE should not be used around ___? what should be used instead?
- implants
- 4 or 6 point pocket charting should be used
management of code 0 & 1 BPE
0 - no periodontal treatment required
1 - oral hygiene instruction
management of code 2 BPE? x3
- OHI
- remove calculus (SAP)
- correction of plaque retentive margins on fillings and crowns if required
management of code 3 BPE?
as for code 2
+ periodontal examination of all teeth and root surface instrumentation where necessary
management of code 4 BPE?
as for code 2
+ periodontal examination of all teeth and root surface instrumentation
+ assess need for more complex treatment and consider referral to specialist
what does a full periodontal examination refer to?
recording probing (pocket) depths (6 sites per tooth) pre&post treatment, for entire dentition
what if there is only 1 sextant with BPE score of 3 & no sextants with code 4?
only record probing depths in that 1 sextant
management for BPE code * ?
carry out treatment recommendations for the BPE scores 0 to 4, assess need for complex treatment, referral to specialist may be indicated
general rule: when should radiographs to assess alveolar bone levels be obtained?
what is the issue with this rule?
- 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
limitations of BPE?
cannot be used to assess/monitor response to periodontal treatment: does not give details of measurements within sextants
how should assessment of response to treatment be carried out?
done by recording probing depths at 6 sites per tooth pre&post treatment
advantages of using BPE? x 7
- 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
disadvantages of BPE? x7
- 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
how differently is BPE carried out in children and adolescents
use of index teeth: e.g. upper & lower 6s, UR1 & LL1
- to avoid problem of false pockets
for BPE in children & adolescents, why are those specific teeth chosen? x3
- first permanent teeth to erupt
- least likely to have false pockets
- most likely to reveal true periodontal breakdown
children 7-11y/o: what BPE codes should be used?
children 12-17y/o: what codes can be used?
- BPE 0, 1, and 2
- full range of codes 0-4, and * can be used
children & adolescents: when to refer? x8
- 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
