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

BASIC PERI(}D(INTAL EXAMINATI(IN -

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lntroductionln its annual review 2OO1 , the Dental Protection ofthe Medical Protection Society warned that untreatedperiodontal disease is the source of one of the fastestgrowing allegations in the dento-legal fieldl. The earlywarning signs of periodontal disease are subtle. Thereare usually no acute throbbing pains like those thataccompany caries or pulpitis, no sensitivity to hot, coldor sweets. Unfortunately, the end consequences arepotentially devastating, including multiple tooth lossbefore the age of 40.

Every patient who enters the dental office shouldbe examined for all major oral disease including butnot limited to caries, peri-apical disease, oral canceLcranio-facial abnormalities and periodontal diseases.While a comprehensive periodontal examination maybe carried out for all patients, a full examination thatassesses pocket depths, gingival recession, furcationinvolvements, mobility and mucogingival problems maytake more than 30 minutes to complete. This is obviouslynot cost-effective, both for dentists and for patients.

Many haphazard approaches have evolved over the yearsin an attempt to circumvent this problem.2 Professor MKJeffcoat points out 3 common misconceptions regardingperiodontal examination. One misconception is thatall periodontal diseases are accompanied by visiblemoderate to severe gingival inf lammation and thereforeonly patients presenting with inflammation need aperiodontal examination. A second misconception isthat "spot probing" a subset of periodontal pocketswill detect all periodontal disease. Athird misconceptionis that only adult patients over age 35 need to beexamined for periodontal disease.

Periodontal Screening

What in fact is needed to address this problem is aperiodontal screening tool that is sensitive enough todetect existing periodontal diseases, while at the sametime, is quick, simple, inexpensive to use for the dentist,and is safe for the patient.

Periodontal screening does not aim to make a specificdiagnosis nor is it meantforthe institution of complextre-atment plans. The objective is to separate periodontallyhealthy patients from those with periodontal disease andwho will require a more comprehensive examination.

Basic Periodontal Examination (BPE)

A simple periodontal screening tool that fulfills theabove requirement is the Basic Periodontal Examination(BPE). The BPE requires inexpensive equipment and canreadily accomplish the task of separating periodontallyhealthy from periodontally diseased patients usually intwo to three minutes.2

It is based on a modification of the CP|TN,3 recommendedby the British Society of Periodontologyo as well as theMedical Protection Societyl and is currently a widely usedperiodontal 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 eachdental arch; excluding wisdom teeth). The treatmentneed in a sextant is scored when two or more teeth arepresent in that sextant. lf only one tooth remains in the

ABsrRAcrPeriodontal screening is a tool that has been employed widely by dentists to routinely identifypatients who have a healthy periodontium from those with periodontal disease and whomay require more comprehensive ex-amination.

This paper aims to introduce the Basic Periodontal Examination (BPE), a periodontal screeningsystem modified after the CPITN (Community Periodontal lndex of Treatment Needs). TheBPE is simple in its assessment process, simple to record, provides a treatment guideline fordentists 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.

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 theuse of a WHO colour-coded probe3 is recommended, theuse of other periodontal probes with 3mm gradationssuch as the William's Probe can also be convenientlyused. Probing force should not exceed 20-25 grams.

Allteeth present are to be examined. At least six pointson each tooth should be examined (mesio-buccal, mid-buccal, disto-buccal and the corresponding lingual sites).The most severe measurement in the sextant is chosento 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 isbleeding after gentle probing.

Code 2: No pockets exceeding 3mm. Supra or sub-gingival calculus is detected or the defectivemargin of a restoration is present.Pockets of 4-5 mm are present.Pockets of 6mm or deeper are present.Pocket plus g ing iva I recession tot als 7 m m ormore. Or there is furcation involvement.

Code 3:Code 4:Code *:

A simplescore for

box chart (see below) is used to record theeach sextant:

Upper rightposteriors

Upperanteriors

Upper leftposteriors

Lower rightposteriors

Loweranteriors

Lower leftposteriors

Whenever Codes 4 or * are recorded, the examiner maypass on to the next sextant.

Management of Patients Accordingto ScoresCode 0: No treatment.Code 1: Oral hygiene instructions (OHl).Code 2: OHl. Removal of calculus or plaque retentive

factors. Patients whose BPE score for allsextants are codes 0,1 ,2 should be screenedagain after an interval of one year.

Code 3: Same as for code 2, but a longer time will beexpected for treatment. Plaque and bleedingscores are collected at the start and end oftreatme nt (reassessm ent).Probing depths in the sextant scoringCode 3 a re ta ken at the end of treatment(reassessme nt).Subsequently, these records (probing depth,plaque and bleeding scores) should be takenat intervals of not more than 1 year along withBPE screening of other sextants.

Code 4 and *' A comprehensive periodontal chart isrequired including all relevant clinical details.

56 Singapore Dental Journal Vol. 25 No.1 Dec 2003

While the CPITN may have been an inappropriate toolfor assessing the incidence, prevalence and severity ofperiodontal disease in a large population, that by nomeans imply that the BPE, a modified version of theCPITN, is unsuitable as a screening tool for assessingindividual periodontal treatment needs in the dentaloffice. The BPE aims simply to separate patients withdisease from those who are healthy. ln patients withdisease, further comprehensive periodontal examinationis done in order to arrive at a proper diagnosis anda suitable treatment plan. lmportantly, all teeth areexamined during the BPE screening process.

Conclusion

It is the responsibility of the dentist to assess patients forperiodontal diseases during routine dental visits.

The BPE is simple in its assessment process, simple tore-cord, provides a treatment guideline for dentists tofollow and can be rapidly carried out in about 3 minutes.It is a system that all dentists can easily adopt for dailyp ractice.

References

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

Jeffcoat MK. Diagnosis of Periodontal Diseases;Building a bridge from today's methods totommorrow's technology. J Dent Educ 1994; 58:61 3-

619,Ainamo J. Development of the world healthorganisation (WHO) community periodontal index oftreatment needs (CPITN). lnt Dent J 1982; 32:281-5.A system of periodontal screening for general dentalpractice. The British Society of Periodontology 1986.Referral policy and paramefers of care. The BritishSociety of Periodontology 2000.Butterworth M, Sheiham A. Changes in the CommunityPeriodontal lndex of Treatment Needs (CPITN) afterperiodontal treatment in a general dental practice. BrDent J 1991; 171 :363-366.Lang Ne Adler R, Joss A, Nyman S. Absence of bleedingon probing. An indicator of periodontal stability,J ClinPeriodont 1990; l7:714-721 .Holmgren CJ, Corbet EF. Relationship betweenperiodontal parameters and CPITN scores. CommunityDent and Oral Epidemiol 1990; 18:322-323.Baelum V Manji F, Fejerskov O, Wanzala P. Validityof CPITN'S assumptions of hierarchical occurrence ofperiodontal conditions in a Kenyan population aged15-65 years. Community Dent and Oral Epidemiol1993; 21 :347-353.Baelum ll Fejerskov O, Manji E Wanzala P. lnflunc-nrof CPITN partial recordings on estimates of prevalenceand severity of various periodontal conditions inadults. Community Dent and Oral Epidemiol 1993;21 :354-359.

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