Periodontal Examination

The periodontium is the tissue surrounding the teeth, including the gum tissue. A periodontal examination is a medical examination of the periodontium that is usually executed by dental professionals and health specialists in related fields. In 1978, the World Health Organization presented a report that initiated the creation of a special probe, called WHO 621, that is used in periodontal examinations. This probe has colored bands at measured intervals, allowing dental health professionals to measure the depth of the pockets between the gums and the teeth and below the gumline. The WHO report also led to the creation of an index of needs for periodontal treatment, called the Community Periodontal Index of Treatment Needs. This index was created so that there is a global baseline for clinical practices and led to the production of several different screening tools used in periodontal examinations in different global locations.

The British Society of Periodontology has recommended the basic periodontal examination, or BPE, since the society was introduced in 1986. The BPE is used to obtain a general idea of the state of a person’s periodontal health and project individual treatment needs but is not used to make a specific diagnosis. To conduct a BPE, first, the patient’s mouth is divided into sextants, or six parts. These sextants are classified by the types of teeth each sextant contains; for example, the first sextant includes the teeth that are bounded by the upper right second molar and the upper right premolar, while the second sextant is bounded by the upper right canine and the upper left canine and contains all the teeth between and including these canines. The classification continues similarly for both the upper and lower teeth and does not include the wisdom teeth, which are prone to their own separate set of possible periodontal defects. If a patient is missing teeth in any particular sextant, and there are not at least two teeth in that sextant, that sextant is not scored; instead, the single tooth in that sextant is included in the adjacent sextant.

During the BPE, the WHO 621 probe is used to measure the depth of the crevices and any periodontal pockets below the gumline. Each sextant is scored according to the worst finding in that specific sextant. The scores are then recorded and their associated recommended treatment is noted. A sextant with a score of zero correlates to gingival pockets that are less than 3 mm, indicating that no disease is present and no treatment is necessary. A score of one indicates bleeding upon probing with pockets that are also less than 3 mm; corresponding treatment recommendation includes oral hygiene recommendations, as bleeding upon probing usually indicates that dental plaque has begun to cause gingivitis. A score of two indicates periodontal pocketing that is still less than 3 mm, but with the presence of dental calculus and possible risk factors like overhanging restorations. Recommended treatment for a score of two includes oral hygiene instruction along with the possible repair of existing risk factors, and may also include the professional removal of dental calculus. A BPE score of three suggests periodontal pockets between 4 and 5 mm in depth, which necessitates a more detailed examination to determine a specific diagnosis and treatment plan. Deep periodontal pockets of 6 or more mm are represented by a score of four and also necessitate a more detailed examination.