Basic Periodontal Examination PDF

19/09/2023 Basic Periodontal Examination Foundations in Clinical Skills and Practice Sarah Balian Intended Learning Outcomes By the end of this session students should be able to: Explain the key features and considerations for the basic periodontal examination (BPE) Be aware of the limitat...

19/09/2023 Basic Periodontal Examination Foundations in Clinical Skills and Practice Sarah Balian Intended Learning Outcomes By the end of this session students should be able to: Explain the key features and considerations for the basic periodontal examination (BPE) Be aware of the limitations of the BPE Explain the features found on a WHO probe and relate to usage of this probe Demonstrate usage of criteria associated with the BPE index Describe clinical findings and treatment needs associated with each BPE code WHO BPE PROBE 1  19/09/2023 Basic Periodontal Examination Please refer to British Society of Periodontology Guidance 2019 The BPE was first developed by the British Society of Periodontology in 1986. Previous versions of this document were produced in 1986, 1994, 2000, 2011 and 2016 Next review 2024 Stemmed form CPITN - Community Periodontal Index of Treatment Needs AKA PSR, PEPE 2  19/09/2023 Periodontal Screening Tool Simple & rapid screening tool that indicates the level of further examination needed Provide basic guidance on treatment needed Not prescriptive but represent a minimum standard of care for initial periodontal assessment. BPE should be used for screening only and should not be used for diagnosis Limitations of BPE Is not for monitoring patients Periodontal Is not a treatment outcome measure Won’t use at end of treatment to compare Does not provide a diagnosis Can you think of one more? 3  19/09/2023 What we take into account with a BPE? Calculus Bleeding BPE Overhangs Pocket Depths Feature Assessed by BPE? Reason Gingival colour NO Not possible with BPE probe. Gingival contour PARTLY Visually only, not recorded. YES Pocket Depth To know if further periodontal assessment needed. Bleeding on probing YES Inflammation, poor OH Mobility NO Used in periodontal assessment NO Plaque index used for this Levels of plaque / staining Presence & location of calculus YES To provide tailored OH to patient YES Presence & location of plaque retention factor To provide tailored OH to patient NO Radiographs – peri-apicals & OPG Used in periodontal assessment 4  19/09/2023 WHO / BPE Probe Ball height – 0.5mm Ball features & rationale Ball end reduces patient trauma Base of 1st black band - 3.5mm Top of 1st black band – 5.5mm Don’t use second black band What pressure? 20-25g How do we move the probe? Walking stroke 3.5 - 5.5mm 0.5mm Because they are so variable with the gingivea - third molars Recording a BPE All teeth except 8’s UNLESS first and/or Divided into second molar missing sextants UR (17-14) UA (13-23) UL (24 – 27) LR (47-44) LA (43-33) LL (34 – 37) Sextant must ‘-’ No teeth contain at least 2 accountable in teeth sextant ‘*’ furcation Add to adjacent sextant if only 1 tooth in sextant 5  19/09/2023 Example No teeth accountable in sextant - 2 or less 4 - 3* 2* 4 4* Furcation involvement Every new patient - initial assessment No screening tool only - should use full Yes - all clinicians Not for periodontal patient that you periodontal assessment - pre and post have seen before. treatment When should a Every examination BPEfor be non periodontal patient. recorded? Full periodontal assessment - as prone to bone loss and implantitis No - only in full periodontal assessment Yes - every clinician must to assess alveolar crest bone loss if carry out own BPE at justified - periapicals appointment Code 3 or 4 6  19/09/2023 Summary chart of BPE scoring No pockets >3.5mm No calculus or overhangs No bleeding on probing Black band completely visible Code 0 7  19/09/2023 CODE O Treatment indicated —NONE No treatment needed Encourage to continue Praise patient Good OH routine No pockets >3.5mm No calculus or overhangs Bleeding after probing Black band? Completely visable Code 1 8  19/09/2023 OH education and advice CODE 1 – Treatment indicated Good idea to do plaque and bleeding score to compare against initial assessment No pockets >3.5mm Any level of calclus No pockets >3.5mm Calculus (supra or sub) or overhangs ANY secondary local factor Calculus (supra or sub) or Black band? Completley visable overhangs Code 2 Black band? 9  19/09/2023 Tailored OH advice CODE 2 - Treatment Remove secondary local factors if modifiable - calculus and smoothing of overhangs - calculus a priority over overhangs. Probing depth 3.5 – 5.5mm Black band? Partly visable What was normal healthy pocket depth? 5.5mm Code 4 Full periodontal assessment required Pocket depth, recession, mobility, furcation Tailor OH advice Code 4 treatment Once engaged and onboard with cleaning - start quadrant PMPR 12  19/09/2023 Summary chart of BPE scoring Where do we go from here? 13  19/09/2023 Quiz 4 5 3* 4 5 3* 2* 4 4* 7mm* 4 7* 4 5 3* 6 0 3* -* 4 4* 2* 4 4* What are these BPE codes? Describe & treatment needs Initial phase therapy 14  19/09/2023 Image references Wel l Done GIFs | Tenor https ://www.signaturesmilesmi.com/blog/Why-Do-My-Gums-Bleed-When-I-Floss_AE25.html https ://www.healthline.com/health/dental-and-oral-health/calculus-bridge https ://pocketdentistry.com/3-patient-assessment-examination-and-diagnosis-and-treatment-planning/ https ://www.gskhealthpartner.com/en-sa/oral-health/conditions/gum-health/diagnosis/ https ://www.youtube.com/watch?v=vtowtYEqf5s https ://lowcountryfamilydentistry.com/dental-services/general-dentistry/dental-x-rays/bitewing-x-ray/ https ://www.researchgate.net/figure/Orthogonal-periapical-radiograph-PA-is-seen_fig2_282047450 https ://health.howstuffworks.com/wellness/oral-care/products/dental-scaler.htm https ://www.gskhealthpartner.com/en-sa/oral-health/conditions/gum-health/diagnosis/ https ://ct-dent.co.uk/opg-xray-panoramic-orthopantomogram/ https ://www.medicaldevicesgroup.net/medical-devices/healthcare-referral-system-broken/ https ://tenor.com/search/where-gifshttps://www.gskhealthpartner.com/en-sa/oral-health/conditions/gum- hea lth/diagnosis/ 15