Periodontal Examination

The Basic Periodontal Examination, commonly referred to as the BPE, was developed in 1986. Though the BPE was developed by the British Society of Periodontology, the examination is a widely used tool in dental examinations around the world. The BPE is an invaluable method that helps dental health practitioners diagnose and determine the extent of periodontal disease. As a guideline, the BPE should be used with all new dental patients, and with patients who have not undergone any type of periodontal examination within a year. When patients are in the maintenance stage of treatment for periodontal disease, a more specialized assessment tool is used. While the BPE is not sufficient to provide specific periodontal diagnoses, it is an effective way of screening for an approximate picture of the condition of the periodontium, or gum tissue, and assists in determining the overall treatment needs of the patient.

In 1978, the World Health Organization compiled a report that spurred the creation of the CPITN, or Community Periodontal Index of Treatment Needs. The WHO team also designed and manufactured a periodontal probe, known as WHO 621; this probe, which has a specifically measured ball tip as well as differently colored bands at different intervals, measured in millimeters, allows for a ready determination of the depth of periodontal pockets in the gums and has helped in developing an international standard for measurement of periodontal disease. The screening method itself may vary from nation to nation, but all of the clinically certified methods that are in wide use around the world use the WHO 621 probe.

The teeth are known, collectively, as a person’s dentition. The first step toward categorization periodontal disease using the BPE is to divide the dentition into sextants, for the purposes of classifying and noting the location or locations of possible periodontal disease. Using even pressure, the WHO 621 probe is placed in the periodontal pockets of all the teeth in a noted sextant. Periodontal pockets are loosened areas of gum tissue where the gums have begun detaching from the surfaces of the teeth at the gingival sulcus, which is the crescent-shaped edge of the gum tissue that borders and supports the teeth. The tip of the WHO 621 probe is used to efficiently and gently measure the depth of the periodontal pockets in all the teeth in each sextant, and the numerical code that corresponds with the deepest pocket in each sextant is noted. This allows for a quick and cost-effective evaluation that helps dental professionals note cases of periodontal disease that may require a referral to a periodontal specialist. At least two of a patient’s natural teeth must be present in a sextant, or the sextant is not included in the examination and the teeth in it will be coded in the adjacent sextant. The BPE also does not assess the third molars, or wisdom teeth, which may manifest periodontal conditions that are specific to them and do not indicate anything about the overall periodontal condition.

The Basic Periodontal Examination assesses the probing depth of periodontal pockets; determines the presence and extent of any loss of attachment; evaluates based on the presence or absence of bleeding on probing; gauges the involvement of the roots of the teeth in disease and determines whether any abscesses are present; and ascertains the mobility of each tooth. Each sextant is coded numerically based on the tooth with the most significant symptoms. A score of 0 indicates that no disease is present. Scores of 1 and 2 indicate the presence of minor symptoms that can be remedied with oral hygiene instruction and possibly the removal of plaque-retentive factors. A score of 3 or 4 indicates the necessity for a more thorough periodontal examination, and a starred notation indicates that there is damage to the root of the tooth and possible abscess presence, which necessitates more immediate treatment.