Classification of periodontitis

Question 1

What is the BPE screening system and how does it work?

Answer 1

It is a screening tool to help reach a diagnosis. All new patients should have it recorded.
The codes for it are 0,1,2,3,4 and *. * means a furcation which is bone loss between roots. The dentition is divided into 6 sextants.
Record the highest score in each sextant.

Question 2

What are the increments on the BPE probe?

Answer 2

0.5mm ball
first black line - 3.5-5.5 mm
second black line - 8.5-11.5mm

Question 3

What do BPE codes 0, 1 and 2 mean?

Answer 3

Health of gingivitis.

0 = no calculus/overhands, no bleeding on probing, black band entirely visible

1 = no calculus/overhangs, bleeding on probing, black band entirely visible

2 = supra or sub gingival calculus/overhangs, black band entirely visible

Question 4

For 0, 1 or 2, how do we measure if it is localised or generalised gingivitis or heath?

Answer 4

We test % bleeding on probing.

<10% = gingival health
10-30% is localised gingivitis
>30% is generalised gingivitis

Question 5

For 3 or 4 - what do we do to measure extent?

Answer 5

BPE probe
black line partially showing = 3
black line completely not showing = 4

We then go on to stage and grade.
We do this by taking radiographs and pocket charts.

Molar-incisor pattern = periodontitis molar-incisor pattern

<30% teeth recession = localised periodontitis

> 30% tooth recession = generalised periodontitis

Question 6

How does staging work?

Answer 6

Looks at bone loss using worst site by dividing root into 3:

<15% (attachment loss from cej) = stage 1

Coronal third of root = stage 2

Mid third of root = stage 3

Apical third of root = stage 4

Question 7

How does grading work?

Answer 7

% bone loss / patient age

<0.5 = grade A
0.5-1 = grade B
>1 = grade C

Question 8

What categories come under assessment of current periodontitis status?

Answer 8

1. Currently stable -
2. Currently in remission
3. Currently unstable

Question 9

How do we write a diagnosis statement?

Answer 9

Extent - Periodontitis - Stage - Grade - Stability - Risk Factors

Question 10

Give details on health and plaque induced gingitivits

Answer 10

No radiographs required
Bleeding on probing:
<10% = health
10-30% = localised gingivitis 
>30% = generalised gingivitis

Question 11

If we classify with periodontal health, what is the difference between intact periodontium and reduced periodontium?

Answer 11

Intact:

• no probing attachment loss
• probing pocket depths < 3mm
• bleeding on probing <10%
• no radiographic bone loss

Reduced:

• Successfully treated periodontitis
• Evidence of probing attachment loss
• probing pocket depths < 3mm
• bleeding on probing <10%
• signs of radiographic bone loss

Question 12

Plaque induced gingivitis:

• type of gingivitis
• type of periodontium

Answer 12

1. Can be localised or generalised depending on bleeding scores
2. Can be intact or reduced depending on attachment loss and signs of radiographic bone loss

Question 13

What do we need to measure when diagnosing periodontitis?

Answer 13

Need to take radiographs and do a pocket chart.

Measure disease extent, staging, grading, current disease status and risk factor assessment.