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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 ITN (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 |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

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sextant, the tooth is included in the ading 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 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

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While the ITN 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 ITN, 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 (ITN). 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 (ITN) 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.

L

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 ITN scores. Community Dent and Oral Epidemiol 1990; 18:322-323. Baelum V Manji F, Fejerskov O, Wanzala P. Validity of ITN'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. lnflu€nc€-nr

of ITN partial recordings on estimates of prevalence and severity of various periodontal conditions in adults. Community Dent and Oral Epidemiol 1993; 21 :354-359.

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