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BASIC PERI(}D(INTAL EXAMINATI(IN

A SIMPIE S(REENI NG T()()L I N GENERAT

PRAffIG

BTK Tnn

ABsrRAcr
Periodontal screening is a tool that has been employed widely by dentists to routinely identify
patients who have a healthy periodontium from those with periodontal disease and who
may require more comprehensive ex-amination.
This paper aims to introduce the Basic Periodontal Examination (BPE), a periodontal screening
system modified after the CPITN (Community Periodontal lndex of Treatment Needs). The
BPE is simple in its assessment process, simple to record, provides a treatment guideline for

dentists to follow and can be rapidly carried out in about 3 minutes.

It

is a useful system

that all dentists can adopt and employ in daily practice.

lntroduction

Periodontal Screening

ln its annual review 2OO1 , the Dental Protection of


the Medical Protection Society warned that untreated
periodontal disease is the source of one of the fastest
growing allegations in the dento-legal fieldl. The early

What in fact is needed to address this problem is a


periodontal screening tool that is sensitive enough to
detect existing periodontal diseases, while at the same
time, is quick, simple, inexpensive to use for the dentist,
and is safe for the patient.

warning signs of periodontal disease are subtle. There


are usually no acute throbbing pains like those that
accompany caries or pulpitis, no sensitivity to hot, cold
or sweets. Unfortunately, the end consequences are
potentially devastating, including multiple tooth loss
before the age of 40.

Periodontal screening does not aim to make a specific


diagnosis nor is it meantforthe institution of complextreatment plans. The objective is to separate periodontally
healthy patients from those with periodontal disease and

who will require a more comprehensive examination.


Every patient who enters the dental office should
be examined for all major oral disease including but
not limited to caries, peri-apical disease, oral canceL
cranio-facial abnormalities and periodontal diseases.
While a comprehensive periodontal examination may
be carried out for all patients, a full examination that
assesses

pocket depths, gingival recession, furcation

involvements, mobility and mucogingival problems may


take more than 30 minutes to complete. This is obviously
not cost-effective, both for dentists and for patients.
Many haphazard approaches have evolved over the years
in an attempt to circumvent this problem.2 Professor MK

Jeffcoat points out 3 common misconceptions regarding


periodontal examination. One misconception is that
all periodontal diseases are accompanied by visible
moderate to severe gingival inf lammation and therefore

only patients presenting with inflammation need a


periodontal examination. A second misconception is
that "spot probing" a subset of periodontal pockets
will detect all periodontal disease. Athird misconception
is that only adult patients over age 35 need to be
examined for periodontal disease.

Basic Periodontal Examination (BPE)

A simple periodontal screening tool that fulfills the


above requirement is the Basic Periodontal Examination
(BPE). The BPE requires inexpensive equipment and can
readily accomplish the task of separating periodontally
healthy from periodontally diseased patients usually in

two to three minutes.2


It is based on a modification of the CP|TN,3 recommended
by the British Society of Periodontologyo as well as the
Medical Protection Societyl and is currently a widely used

periodontal screening tool in the United Kingdorn.s


BPE Examination
ln the BPE system, the mouth is divided into six sextants
(one anterior and two posterior tooth regions in each

dental arch; excluding wisdom teeth). The treatment


need in a sextant is scored when two or more teeth are
present in that sextant. lf only one tooth remains in the

Benjamin Tan, Private Practice

Singapore Dental Journal Vol . 25 No.1 Dec 2003

55

sextant, the tooth is included in the adjoining sextant.


The periodontal tissues are examined for bleeding,

plaque retentive factors and pocket depths.


The use of a periodontal probe is mandatory. While the
use of a WHO colour-coded probe3 is recommended, the
use of other periodontal probes with 3mm gradations
such as the William's Probe can also be conveniently
used. Probing force should not exceed 20-25 grams.

Allteeth present are to be examined. At least six points


on each tooth should be examined (mesio-buccal, midbuccal, disto-buccal and the corresponding lingual sites).
The most severe measurement in the sextant is chosen
to represent the sextant.
BPE Scoring

The periodontal conditions are scored as follows:


Code 0: Healthy gingivaltissues with no bleeding after

gentle probing.
Code

1: No pockets exceeding 3mm. No calculus or


defective margins are detected. There is

Code

2: No pockets exceeding 3mm. Supra or

bleeding after gentle probing.


sub-

gingival calculus is detected or the defective


margin of a restoration is present.
Code 3: Pockets of 4-5 mm are present.
Code 4: Pockets of 6mm or deeper are present.
Code *: Pocket plus g ing iva I recession tot als 7 m m or

more. Or there is furcation involvement.

A simple box chart (see below) is used to record the


score for each sextant:
Upper right
posteriors

Upper
anteriors

Upper left
posteriors

Lower right
posteriors

Lower
anteriors

Lower left
posteriors

Whenever Codes 4 or * are recorded, the examiner may


pass on to the next sextant.

Management of Patients According

to Scores
Code

Code
Code

0: No treatment.
1: Oral hygiene instructions (OHl).
2: OHl. Removal of calculus or plaque retentive

factors. Patients whose BPE score for all


sextants are codes 0,1 ,2 should be screened
again after an interval of one year.
Code 3: Same as for code 2, but a longer time will be
expected for treatment. Plaque and bleeding
scores are collected at the start and end of
treatme nt (reassessm ent).
Probing depths in the sextant scoring
Code 3 a re ta ken at the end of treatment
(reassessme nt).
Subsequently, these records (probing depth,
plaque and bleeding scores) should be taken
at intervals of not more than 1 year along with
BPE screening of other sextants.

*' A comprehensive periodontal chart is


required including all relevant clinical details.

Code 4 and

56

Singapore Dental Journal Vol. 25 No.1 Dec 2003

While the CPITN may have been an inappropriate tool


for assessing the incidence, prevalence and severity of
periodontal disease in a large population, that by no
means imply that the BPE, a modified version of the
CPITN, is unsuitable as a screening tool for assessing
individual periodontal treatment needs in the dental
office. The BPE aims simply to separate patients with
disease from those who are healthy. ln patients with
disease, further comprehensive periodontal examination
is done in order to arrive at a proper diagnosis and
a suitable treatment plan. lmportantly, all teeth are
examined during the BPE screening process.

2.

3.

4.
5.
6.

Jeffcoat MK. Diagnosis of Periodontal

Diseases;

Building a bridge from today's methods to


tommorrow's technology. J Dent Educ 1994; 58:61 3
- 619,
Ainamo J. Development of the world health
organisation (WHO) community periodontal index of
treatment needs (CPITN). lnt Dent J 1982; 32:281-5.
A system of periodontal screening for general dental
practice. The British Society of Periodontology 1986.
Referral policy and paramefers of care. The British
Society of Periodontology 2000.
Butterworth M, Sheiham A. Changes in the Community
Periodontal lndex of Treatment Needs (CPITN) after
periodontal treatment in a general dental practice. Br
Dent J 1991; 171 :363-366.

Conclusion

7.

It is the responsibility of the dentist to assess patients for


periodontal diseases during routine dental visits.

The BPE is simple in its assessment process, simple to


re-cord, provides a treatment guideline for dentists to
follow and can be rapidly carried out in about 3 minutes.
It is a system that all dentists can easily adopt for daily
p

9.

ractice.

References
A World of Complaints, Annual Review 2001 . Dental
Protection Ltd, Medical Protection Society. 2001 ;
30-31

Periodont 1990; l7:714-721 .


Holmgren CJ, Corbet EF. Relationship between
periodontal parameters and CPITN scores. Community
Dent and Oral Epidemiol 1990; 18:322-323.
Baelum V Manji F, Fejerskov O, Wanzala P. Validity
of CPITN'S assumptions of hierarchical occurrence of
periodontal conditions in a Kenyan population aged
15-65 years. Community Dent and Oral Epidemiol
1993; 21

10.

l.

Lang Ne Adler R, Joss A, Nyman S. Absence of bleeding


on probing. An indicator of periodontal stability,J Clin

Baelum

:347-353.

ll

Fejerskov O, Manji E Wanzala P. lnflunc-nr

of CPITN partial recordings on estimates of prevalence


and severity of various periodontal conditions in
adults. Community Dent and Oral Epidemiol 1993;
21 :354-359.

Singapore Dental Journal Vol . 25 No.1 Dec 2003

57

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