PERIODONTAL ASSESSMENT

AND DIAGNOSIS
Contents

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 CLASSIFICATION OF PERIODONTAL DISEASES Periodontal
Infection in a
periodontal pocket
Freely draining
abscess

Aggressive
Gingivitis periodontitis

Gingival
enlargement
younger cohort of patients + familial
Inflammtion of gingiva
history
red, swollen tissues which
rapid and the degree of destruction
bleed on brushing or probing
severe response to irritation (palque,
trauma, medication, hormone)

Necrosing
Chronic ulcerative
periodontitis Perio-endo
gingivitis/
lesions
periodontitis

destruction of tooth attachment + bone Painful ulceration of the tips of the bacterial source originates
Slowly + amount bone loss ∈ age of patient either in the periodontium
interdental papillae
Grey necrotic tissue + halitosis or the root canal system
Classification of periodontal diseases
Classification of periodontal
diseases
CATON eT Al. (2018), A new classification scheme for periodontal and peri-implant
diseases and conditions – Introduction and key changes from the 1999
classification

https://doi.org/10.1111/jcpe.12935
 Risk factors
SYSTEMIC FACTORS LOCAL FACTORS

Diabetes Smoking
Calculus
Malposition
tooth

Osteoporosis
Cardiovascular Rheumatoic overhanging
diseases arthitis restorations
Hormonal
change partial
Stress dentures
Obesity
Medication
 SCREENING
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Bleeding Basic Screening of

Probing on Periodontal Screening
children +
force Probing Examination of adults
Adolescents
(BOP) (BPE)
SCREENING

Probing
force

Bleeding
on
Probing
(BOP)
 SCREENING + ask the patient if he/she
is aware of any
symptoms (bleeding
gums, drifted or loose
teeth or bad breath )
Basic
Periodontal
+ Divide the dentition
Examination
into 6 sextants + ‘Walk’
(BPE)
the probe around the
gingival margin of each
British Society of Periodontology tooth
in 1986 and revised in 2011

+ Record the highest

score for each sextant,
including any furcation
involvement
Screening
of adults + Recording plaque
scores for patients
 SCREENING
Basic
Periodontal
Examination
(BPE)

British Society of Periodontology

in 1986 and revised in 2011

Screening
of adults
 SCREENING + Explain to the patient
the reason for the
examination

Basic + Examine UR6, UR1,

Periodontal UL6, LL6, LL1 and LR6
Examination
(BPE)
+ Record the highest
British Society of Periodontology score for each tooth
in 1986 and revised in 2011

Screening of + recording plaque scores

children +
adolescents
+ refer any child with
evidence of periodontitis
7-17 years old or unexplained gingival
BPE codes 0 – 2 are used for 7 to 11 year olds (mixed dentition stage) to screen for bleeding
and the presence of local plaque retentive factors. The full range of codes, including any enlargement to a
furcation involvement, can be used in 12 to 17 year olds (permanent teeth erupted)
consultant
 Screening

Source:Council of the British Society of Periodontology. 2019

 Screening
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Full periodontal examination
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Naber’s probe
Full periodontal examination
Record any Record gingival recession observed, in millimetres, for both the buccal
missing teeth. and lingual surfaces of each tooth

Measure probing depth, in millimetres, at six sites around each tooth

Record the absence or presence (0 or 1) of bleeding on probing

Record any furcation involvement for multi-rooted teeth

Record any tooth mobility

Record any other observations, such as presence of dental
caries, occlusal discrepancies and problems with restorations

Radiographic examination to assess alveolar bone levels is appropriate.

 Full periodontal examination
Radiographs interpretation

Based on the 2013 FGDP(UK) guideline,

- For uniform probing depths ≥4 and <6 mm and little or no recession, take horizontal bitewing radiographs. If the
anterior teeth are affected, take intra-oral periapical views using the long cone paralleling technique.
- For probing depths ≥6 mm, take intra-oral periapical views of all affected teeth
- For irregular probing depths, take horizontal bitewing radiographs and supplement these with intra-oral
periapical radiographs.
- If a perio-endo lesion is suspected, take an intra-oral periapical radiograph
- Where large numbers of intra-oral periapical radiographs are required, consider taking a panoramic radiograph if
there is access to a good quality/low dose panoramic machine.
- Cone beam computed tomography (CBCT) is not indicated as a routine method of imaging periodontal bone support.

Source:Council of the British Society of Periodontology. 2019

Full periodontal examination
Radiographs interpretation

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 TREATMENT PLANING
Ensure the treatment plan has defined
therapeutic goals.

Explain to the patient what treatment

you wish to provide

Explain to the patient his/her role in

improving periodontal health.
REFERENCES
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