Classification of Periodontal Diseases: Gingivitis & Perio

• What is BPE?


  A screening tool to reach provisional diagnosis

  
  

  A BPE (WHO) probe is used

  
  

  You record the highest BPE code for each sextant

  
• What's the minimum amount of teeth a sextant can have to qualify?

  Minimum of 2 teeth, if only one tooth is present in a sextant, you include it in the sextant next to it
• What are the possible BPE codes?

  0, 1, 2, 3, 4 and a * to indicate presence of furcation

  
  

  BPE 3- black band partially covered

  BPE 4- Black band is fully covered

  
• How many sextants is the dentition divided into?

  6 sextants

  
• What is the 2017 classification of periodontal diseases?

  
• What should you do if your patient has a BPE code of 3 or 4?

  -Take radiographs

  
  

  -Record 6 point pocket chart (if there is a 4 present, you do the whole dentition but if there is a code max of 3, you only do it for the sextant that has code 3)
• What do you need to do once you've ascertained the disease extent?

  Stage and grade

  
• Describe BPE codes 0,1,2:

  Black band is always visible

  
  

  0- no bleeding on probing + calculus

  1-Bleeding on probing, no calculus

  2-Bleeding, overhangs and calculus.

  
• How can we use bleeding percentage?

  
• What is an intact periodontium?

  
• What is a reduced periodontium?

  
• What is staging and what is it based on?

  Staging reflects the severity of disease and is based on Radiographic bone loss alone, specifically the percentage of bone loss in relation to Bone length.
• What is grading?


  Grading (rate of progression) reflects the patients susceptibility to periodontitis and is determined by working out the ratio of bone loss percentage over age

  
• How is periodontitis status assessed?

  
• What will your final diagnosis include?

  - staging

  - grading

  - extent

  - current disease status

  - risk factor assessment

  
  

  Example of a diagnosis in pic attached

  
• What is not required with BPE codes 0,1,2?

  No radiographs required
• What are the three BoP classifications after a BPE of 0,1,2 is taken?

  1. Clinical gingival health: <10% bleeding
  2. Localised gingivitis: 10-30% bleeding
  3. Generalised gingivitis: >30% bleeding
• What are the two classification of ‘health’?


  intact periodontum and reduced periodontum
• What are the two types of plaque induced gingivitis and what are their two features?

  Localised and generalised gingivitis.

  >10% bleeding sites and <3.5mm pocket depths
• What is the difference between BPE scores 3 and 4?

  3 - black band is partially covered (3.5-5.5mm pocket depth)

  4 - black band is fully covered (>5.5mm pocket depth)
• What action is taken immediately after BPE scores of 3 and 4 are taken?

  Radiographs are taken.

  Afterwards, for a score 3 perform initial therapy (like PMPR) then a 6pp on affected sextants after three months, and for a score 4 do a 6pp on whole mouth immediately
• What are the three disease extents of periodontitis?

  1. Periodontitis molar-incisor pattern
  2. Localised periodontitis (<30% of teeth have boneless)
  3. Generalised periodontitis (>30% of teeth have boneless)
• What are the four stages of staging and how are they judged?

  Viewed using radiographs to analyse bone loss:

  • Stage I (early/mild): <15% (or 2mm loss from CEJ)
  • Stage II (moderate): coronal 1/3 of root
  • Stage III (severe): mid 1/3 of root
  • Stage IV (very severe): apical 1:3 of root
• What are the three stages in current periodontitis status?

  1. Currently stable: BoP<10%, PPD<=4mm, no BoP at 4mm sites.
  2. Currently in remission: BoP>=10%, PPD<=4mm, no BoP at 4mm sites.
  3. Currently unstable: PPD>=5mm or PPD>=4mm + BoP.
• What are the three grades in grading and how are they judged?

  Grading test (rate of progression) - indicates a patient’s susceptibility to periodontitis.

  Judged by % bone loss (at worse site of loss due to periodontitis) divided by patient age:

  • Grade A (slow progression rate)<0.5
  • Grade B (moderate progression rate) 0.5-1.0
  • Grade C (rapid progression rate)>1.0
• What is the order of diagnosis statement?

  Extent-Periodontitis-Stage-Grade-Stability-Risk factors

  
  

  e.g. Generalised Periodontitis Stage 3 Grade B - Currently Unstable - Risk: Smoker 15/day, poorly controlled diabetes
• What probe is used to measure degree of furcation and explain the class system used

  Naber's probe:

  • Class I - Concavity just above furcation entrance can be felt with probe but not inserted
  • Class II - Probe can partially enter (~1/3 of width of tooth)
  • Class III - Probe passes completely through but furcation is not clinically visible
  • Class IV - Probe passes completely through but entrance to furcation is visible clinically due to recession