Classification of periodontal diseases

Question 1

how would you record a BPE?

Answer 1

1. divide the dentition into 6 sextants
2. all teeth in each sextant are recorded - except 3rd molars unless 1st and 2nd molars are missing
3. walk probe around each tooth and record the highest score in each sextant

Question 2

how much force should be used when carrying out a BPE?

Answer 2

20-25g

Question 3

how many teeth should a sextant have to qualify it for recording?

Answer 3

2 teeth

Question 4

what should you do if a sextant only has one tooth present?

Answer 4

do not record for that sextant and that tooth should be included in the adjacent sextant

Question 5

what probe is used when recording a BPE?

Answer 5

WHO BPE probe

Question 6

describe the WHO BPE probe

Answer 6

• 0.5mm diameter ball end
• black band 3.5-5.5mm
• second black band from 8.5-11.5mm

Question 7

describe the UNC 15 probe

Answer 7

• 15mm long
• markings ar each mm and colour coding at the 5th, 10th and 15th mm

Question 8

what does a code 0 mean?

Answer 8

• pockets <3.5mm
• no calculus / overhangs
• no bleeding on probing
• black band is completely visible
• no need for periodontal treatment

Question 9

what does a code 1 mean?

Answer 9

• pockets <3.5mm
• no calculus / overhangs
• bleeding on probing
• black band entirely visible
• OHI given

Question 10

what does a code 2 mean?

Answer 10

• pockets <3.5mm
• supra or subgingival calculus / overhangs
• bleeding on probing
• black band entirely visible
• OHI given and removal of plaque retentive factors and supra and subgingival calculus

Question 11

what does a code 3 mean?

Answer 11

• probing depth 3.5-5.5mm
• supra or subgingival calculus / overhangs
• bleeding on probing
• black band partially visible
• OHI given and removal of plaque retentive factors and supra and subgingival calculus, RSD given if required

Question 12

what does a code 4 mean?

Answer 12

• probing depth >5.5mm
• supra or subgingival calculus / overhangs
• bleeding on probing
• black band not visible
• OHI given and removal of plaque retentive factors and supra and subgingival calculus, RSD given if required and assess need for more complex treatment

Question 13

what does a code * mean?

Answer 13

• furcation involvement
• treat according to the BPE code 0-4
• assess need for more complex treatment

Question 14

what should you do if a patient has a score of 3 in a BPE exam?

Answer 14

• carry out initial treatment (step 1 and 2)
• then after treatment, record a 6ppc in the sextant only
• if 3 or more sextants have a score of 3 consider whole mouth 6ppc

Question 15

what should you do if a patient has a score of 4 in a BPE exam?

Answer 15

record a 6ppc throughout entire dentition

Question 16

what is interdental recession? what does it show? what should you do if present in a periodontitis patient?

Answer 16

• lower gingivae levels between teeth
• sign of bone loss and periodontitis
• should trigger a full periodontal assessment

Question 17

when should you carry out a BPE exam?

Answer 17

• with all new patients
• at every routine examination for scores of 0,1,2

Question 18

how would you assess the response to treatment?

Answer 18

record a 6ppc pre and post treatment
cannot use a BPE to measure as it does not provide information on how sites within a sextant change after treatment

Question 19

what is a BPE used for?

Answer 19

• screening tool
• BPE and clinical exam guide what to do next and diagnosis

Question 20

what are the types of periodontal disease?

Answer 20

• localised
• generalised
• molar incisal pattern

Question 21

what is the difference between localised and generalised bleeding on probing for periodontitis?

Answer 21

• localised = <30%
• generalised = =>30%

Question 22

what is molar incisal pattern periodontitis?

Answer 22

• type of localised periodontitis that occurs around 1st molars and commonly upper incisors
• usually occurs in young people (under 20)
• 1st molars and incisors are usually first to erupt
• emerges in people who are highly susceptible to periodontal disease

Question 23

what does the staging of periodontitis tell you?

Answer 23

the severity of bone loss

Question 24

how would you stage periodontitis? what are the different stages?

Answer 24

measure on radiograph the maximum site of worst bone loss
* stage 1: early/mild - <15% or 2mm in coronal 1/3
* stage 2: moderate - coronal 1/3 of root (3-4mm)
* stage 3: severe - mid 1/3 of root (=>5mm)
* stage 4: very severe - spical 1/3 of root (=>5mm)

Question 25

what does grading of periodontitis tell you?

Answer 25

the speed of bone loss

Question 26

how would you grade periodontits? what are the different grades?

Answer 26

divide percentage of bone loss by age
* grade A: slow - <0.5 (bone loss less than half patient’s age)
* grade B: moderate - 0.5-1.0
* grade C: rapid - >1.0 (bone loss more than patient’s age)

Question 27

what should you do if the patient has grade 3’s in BPE and then after a 3 month review they have no pockets =>4mm and no radiographic evidence of bone loss due to periodontitis? or if they have pockets =>4mm and/or radiographic evidence of bone loss due to periodontitis?

Answer 27

• if no pockets =>4mm and no radiographic evidence of bone loss due to periodontitis - continue with code 0/1/2 pathway
• if pockets =>4mm and/or radiographic evidence of bone loss due to periodontitis - continue with code 4 pathway - staging, grading, current status and risk factor assessment

Question 28

what is the diagnostic pathway of periodontitis?

Answer 28

• history taking (medical, dental, social, family)
• oral examination
• further investigations
• type of disease
• extent of disease - localised, generalised
• stage of disease - severity 1,2,3,4
• grade of disease - rate of progression A,B,C
• current status of disease - stable, remission, unstable
• risk factor assessment (diabetes, obesity, smoking, alcohol, stress, genetics)