BPE, radiographs and clinical decisions

Question 1

disadvantages of BPE?

Answer 1

• Tend to overestimate disease as only scoring the worst site in each sextant
• No indication of which teeth are effected
• Don’t test mobility
• Don’t know bone loss
• Ball end may underestimate pockets
• Cant use to monitor disease

Question 2

what is used for diagnosis of periodontal disease ?

Answer 2

BSP implementation guidelines

Question 3

referring to the BSP implementation guidelines how is clinical gingival health diagnosed?

Answer 3

BPE code 0/1/2
with no obvious interdental recession
<10% BOP

Question 4

referring to the BSP implementation guidelines how is localised gingivitis diagnosed?

Answer 4

BPE code 0/1/2
with no obvious interdental recession
10-30% BOP

Question 5

referring to the BSP implementation guidelines how is generalised gingivitis diagnosed?

Answer 5

BPE code 0/1/2
with no obvious interdental recession
>30% BOP

Question 6

using the BSP implementation guidelines what should you do if BPE score is 3 with no evidence of interdental recession?

Answer 6

radiographic assessment
initial periodontal therapy
review in 3 months with localised 6 point pocket chart

if no pockets >4mm and no radiographic bone loss due to periodontitis use code 0,1,2 (gingivitis)

if pockets >4mm remain and/or radiographic bone loss due to periodontitis -> continue with code 4 pathway

Question 7

referring to the BSP implementation guidelines how is periodontitis molar-incisor pattern diagnosed?

Answer 7

BPE code 4
and/or obvious interdental recession
radiographic assessment
full perio assessment (6 point)
molar-incisor pattern

Question 8

referring to the BSP implementation guidelines how is localised periodontitis diagnosed?

Answer 8

BPE code 4
and/or obvious interdental recession
radiographic assessment
full perio assessment (6 point)
<30% of teeth affected

Question 9

referring to the BSP implementation guidelines how is generalised periodontitis diagnosed?

Answer 9

BPE code 4
and/or obvious interdental recession
radiographic assessment
full perio assessment (6 point)
>30% of teeth affected

Question 10

what is incipient gingivitis?

Answer 10

very little BOP but almost localised and don’t think it will get better on its own so want to give OHI

Question 11

remember this

Question 12

disadvantages of radiographs

Answer 12

• Superimposition: bone on bone, tooth on tooth and tooth on bone
• Does not show disease activity
• No indication of timescale
• Doesn’t show periodontal pockets
• Underestimates bone loss

Question 13

what are the things you need to include in your periodontitis diagnosis? refering to the BSP guidelines

Answer 13

extent of disease
periodontitis
stage
grade
stability
risk factors

Question 14

how is the extent of periodontitis in your diagnosis worked out?

Answer 14

Localised: <30% teeth involved

Generalised: >30% teeth involved

Molar/incisor pattern

Question 15

what does the stage of periodontitis mean?

Answer 15

severity of the disease and complexity of management

Question 16

is it likely for a periodontitis patient to change stage?

Answer 16

no

Question 17

how is stage I periodontitis diagnosed?

Answer 17

<15% bone loss
borderline between gingivitis and periodontitis

Question 18

how is stage II periodontitis diagnosed?

Answer 18

Coronal 1/3 bone loss
established periodontitis

Question 19

how is stage III periodontitis diagnosed?

Answer 19

Mid 1/3 bone loss
<4 teeth lost due to periodontitis

Question 20

how is stage IV periodontitis diagnosed?

Answer 20

Apical 1/3

> 4 teeth lost due to periodontitis

Question 21

what does the grade of periodontitis mean?

Answer 21

rate of progression and how quickly u need to get them back

Question 22

how is Grade A periodontitis diagnosed?

Answer 22

percentage bone loss at worst site is less than half the patients age

Question 23

how is grade B periodontitis diagnosed?

Answer 23

percentage bone loss at worst site is more than half the patients age, less than the patients age
<2mm loss over 5 yrs

Question 24

how is grade C periodontitis diagnosed?

Answer 24

percentage bone loss is more than the patients age e.g. >40% for 40yr old
>2mm loss over 5 yrs

Question 25

how is it determined that the periodontitis is currently stable?

Answer 25

BOP <10% of sites
Pocket depth <4mm
No BOP at sites >4mm

Question 26

how is it determined that the periodontitis is currently in remission?

Answer 26

BOP >10% of sites
Pocket depths <4mm
No BOP at sites >4mm

Question 27

how is it determined that the periodontitis is currently unstable?

Answer 27

Pocket depth >5mm (grade 4 BPE)

4mm pockets display BOP

Question 28

what are som/e risk factors for periodontitis

Answer 28

○ Plaque control
○ Smoking
○ Diabetes
If no identifiable risk factor worth noting down

Question 29

remember this for stage of periodontitis

Question 30

remember this for periodontitis diagnosis