BSP flowchart

Question 1

What do you start off your investigation with

Answer 1

1. history
2. examination
3. screening for perio disease- including BPE and assessment of historic periodintitiis (interdental recession)

Question 2

how do you determine the diagnosis of a patient with codes of 0/1/2 (with no obvious evidence of interdental recession)

what should the diagnosis also comment on

Answer 2

<10% bleeding on probing= clinical gingival health
10-30% bleeding on probing= localised gingivitis
>30% bleeding on probing= generalised gingivitis

Question 3

how do you determine the diagnosis of a patient with a code of 3 (with no obvious evidence of interdental recession)

Answer 3

1. appropriate radiographic assessment
2. inital periodontal therapy and review in 3 months with loclaised 6PPC in involved sextant(s)
   -> no pockets equal to or greater than 4mm and no radiogrpahic evidence of bone loss due to periodontitis
   -> pockets equal to or greater than 4mm remain and/or radiogrpahc evidence of bone loss due to periodontitis

Question 4

how do you determine the diagnosis of a patient with code 4 (and/or obvious evidence of interdental recession)

Answer 4

1. appropriate radiographic assessment
2. full periodontal assessment (including detailed 6PPC, PPD, BoP, PFS, recession, mobility)
   -> molar-incisor pattern (periodontitis molar-incisor pattern)
   -> less than 30% of teeth (localised periodontitis)
   -> more than or equal to 30% of teeth (generalised periodontitis)

Question 5

how to determine staging for perio

Answer 5

1. radiographic assessment (PAs or OPG/DPT) if not clinically justified or if bitewings only available use CAL or bone loss from CEJ
2. interproximal bone loss (use worst site of bone loss due to periodontitis)
   -> less than 15% (or 2mm attachment loss from CEJ) = Stage 1 (early/mild)
   -> coronal third of root = Stage 2 (moderate)
   -> mid third of root = Stage 3 (severe)
   -> apical third of root = Stage 4 (very severe)

Question 6

how to determine grading for perio

Answer 6

1. radiogroahic assessment (PAs or OPG/DPT) if not clinically justified or if bitewings only available use CAL or bone loss from CEJ
2. % bone loss / pt age (use worst site of bone loss due to periodontitis)
   -> less than 0.5 = Grade A (slow rate of progression)
   -> 0.5-1.0 = Grade B (moderate rate of progression)
   -> more than 1.0 = Grade C (rapid rate of progression)

Question 7

how to determine assessment of current periodontitis status

Answer 7

1. currently stable
   - BoP less than 10%
   - PPD less than or equal to 4mm
   - no BoP at 4mm sites
2. currently in remission
   - BoP more than or equal to 10%
   - PPD less than or equal to 4mm
   - no BoP at 4mm sites
3. currently unstable
   - PPD more than or equal to 5mm
   or
   - PPD more than or euqal to 4mm AND BoP

Question 8

Give 2 examples of risk factor assessment

Answer 8

• smoking, including cigarettes/day
• sub-optimally controlled diabetes

Question 9

how to state the diagnosis

Answer 9

extent - periodontitis - stage - grade - stability - risk factors