BSP Roadshows 2008/9

Contents
Periodontal assessment in general terms
Clinical Assessment

Core Values for Treating Patients in Practice

1. Periodontal Assessment

Usage, value and mishaps with the BPE Risk factors and their impact upon disease
Patient Assessment

Chair side tools for risk factor analysis

How do we assess Health/Disease?

Gingival colour Gingival contour Pocket depth Bleeding on probing Mobility Levels of plaque Presence & location of calculus Presence & location of plaque retention factors Radiographs long cone periapicals/OPG

Gingival colour & contour

Clinically healthy periodontium

Pink in colour Stippled Triangular interdental papilla Firm in consistency Knife-edged gingival margin Probing pocket depths <2mm No bleeding to probe No recession No mobility

Pocket / Probing Depths

Bleeding on Probing
best indicator of active disease Only 10-20% of sites that bleed are active (poor sensitivity) The absence of bleeding on probing is almost 100% predictive of health (good specificity) Assumes the patient is a non-smoker Smoking drastically affects gingival bleeding and masks the presence of the disease

Suppuration

Mobility

Any signs of disease here?

The BPE is a.

BPE

Purpose of the BPE

BPE is a screening method BPE allows rapid identification of periodontal disease BPE allows the clinician to differentiate a simple periodontal case from the complex

Typical Patient
Initial Presentation
24 sites of >5.5mm per sextant 4 4 4 4 4 4

After OH & Scaling

15 sites of >5.5mm per sextant

4 4

4 4

4 4

After RSD
2 sites of >5.5mm per sextant

4 4

4 4

4 4

So what has happened to the patient..better, worse or stayed the same?

Category / Code *
BPE is not good for monitoring patients Furcation detected BPE is not a treatment outcome measure or Detailed periodontal charting is necessary Attachment loss of > 7mm

2mm

5mm

7mm

The use of the *

This is a grey area with different schools and clinicians interpreting the BPE system differently Some clinicians use the * without any further information e.g.
* 2 * 3 4 4

Both situations are BPE Code 4

Others, use the * alongside the numerical code e.g.

4* 2 1* 3 4 4

True Pocketing

False Pocketing

BPE Code 4

Periodontal Diagnosis

?
True or False Pocketing Aggressive or Chronic Periodontitis

6mm 9mm 6mm 6mm

Feature Gingival colour Gingival contour Pocket depth Bleeding on probing Mobility Levels of plaque Presence & location of calculus Presence & location of plaque retention factors Radiographs long cone periapicals/OPG

Assessed by BPE?
x In part Yes Yes x x Yes Yes x

Reason
Degree of erythema not assessed Denoted by * if AL and hence recession >7mm Only by banding not definitive depth recording Only Codes 0 or 1 provide information Degree of mobility not assessed Amount of plaque not assessed Code 0 or 2 only Code 0 or 2 only Clinical examination only

Risk Assessment..

60

56 56

107 subjects recruited Clinician groups GDPs Expert Periodontists Risk Calculator

50

40 % of Patients Over-Score 30 Correct

24 24
20

20 21

Under-Score

Clinician groups examined Clinical photographs Detailed Charts Full Mouth PAs

10

0 GDP Exam iner

Subjective judgment is not reliably accurate

So, We need to measure the extent of the disease We need to assess the risk of future disease As clinicians we are poor at predicting the risk What do we need?

Periodontal Assessment
Periodontal assessment in general terms Usage, value and mishaps with the BPE Risk factors and their impact upon disease Chair side tools for risk factor analysis

10