Periodontal Examination

A periodontal examination is an examination which is performed by a dentist of the gums or periodontium. There are many techniques used to complete a periodontal examination across the globe.

Based on a report completed in 1978 by the World Health Organization (WHO), the Community Periodontal Index of Treatment Needs (CPITN) was created in addition to a periodontal probe called the WHO 621. This method of evaluation is used to evaluate and estimate the prevalence and severity of periodontal disease based on the periodontium’s probing depths and condition. The periodontal probe contains a ball end with a diameter 0.5 mm. The first colored band on the probe is located at the 3.5 - 5.5 mm mark. Another colored band may also exist at the 8.5 - 11.5 mm mark.

The CPITN’s goal was to set a global standard for clinical research and practice. However, there were several different periodontal screening tools which were adapted from the CPITN. In 1992, the American Academy of Periodontology (AAP) modified the Simplified Periodontal Examination (SPE), which was being used in New Zealand, and developed the Periodontal Screening and Recording (PSR) system for use in North America. The Basic Periodontal Examination (BPE) is widely used throughout the United Kingdom and New Zealand. In Australia, the Primary Essential Periodontal Examination (PEPE) is most commonly used. All methods mentioned above use the WHO 621 probe.

Basic Periodontal Examination

The Basic Periodontal Examination (BPE) is a technique which was recommended by the British Society of Periodontology after it was introduced in 1986. The BPE is a screening tool which can quickly evaluate a patient’s periodontal condition and treatment needs. It does not, however provide an exact periodontal diagnosis as a more thorough examination is required.

When conducting a BPE, the patient’s teeth are separated into six different parts or sextants. This includes the following areas:

  • upper right second molar to the upper right first premolar
  • upper right canine to the upper left canine
  • upper left first premolar to the upper left second molar
  • lower right second molar to the lower right first premolar
  • lower right canine to the lower left canine
  • lower left first premolar to the lower left second molar.

The wisdom teeth are not included in the BPE as pericoronitis and tooth impaction may cause isolated periodontal issues which are not representative of the patient’s overall periodontal status. In order to receive a score, at least two teeth must be present in the section. In cases where only one tooth is present in the sextant, the individual tooth is grouped with the adjoining sextant.

The probe is then used to measure the depth of the gingival crevices and periodontal pockets. A periodontal pocket is the gap which exists between the tooth and the gums. The worst score obtained in the sextant is used for the BPE score. The BPE is typically recorded in a table which contains six boxes. The scoring system is summarized below.

  • No disease identified, gingival pockets measure < 3 mm
    Treatment is not required
  • Bleeding occurs upon probing, gingival pockets measure < 3 mm
    Provide patient with oral hygiene instruction. Bleeding from probing often indicates plaque induced gingivitis
  • Periodontal pocketing of < 3mm are identified, calculus is also present Patient is provided with oral hygiene instruction. Plaque retentive factors are also removed 3 Shallow periodontal pockets of 4 - 5 mm are identified A more thorough periodontal evaluation is required 4 Deep periodontal pockets > 6 mm are identified A more thorough periodontal evaluation is required