The Basic Periodontal Examination (BPE) is used as a basic screening method to check the periodontal status of a patient. It is a simple procedure and should be done on all patients to quickly identify any particular periodontal issues.
Which instrument do I use?
The instrument used for the examination is a CPITN Probe (also known as a WHO probe).
BPE/CPITN ProbeThis probe is specifically designed for this exam. The probe features a 0.5mm ball on its tip. It then has a black band from 3.5mm to 5.5mm and another black band from 8.5mm to 11.5mm. The first band is very useful when it comes to recording the patients BPE score.
What and how am I examining?
- The mouth is divided into 6 sextants i.e. lower left molars and premolars as one sextant, lower anteriors as another and lower right molars and premolars as a third sextant.
- A minimal force of around 20-25g should be used (enough to make your fingernail blanch).
- The probe should then be ‘walked around’ all aspects of the teeth. It is essential to ensure you access the interproximal areas correctly with the probe at correct positioning. This is something that is picked up through practice.
- All sextants should be examined and scored according to the scoring system below.
- The WORST score for each sextant is noted.
- In adults, all teeth in each sextant should be assessed.
- In children, six index teeth are used across the sextants – LL6, LL1, LR6, UR6, UR1 and UL6.
What are the BPE scores?
The BPE scores are quite simple and outlined below:
| 0 | This indicates that there are no pockets >3.5mm (i.e. the black band is completely visible), no bleeding and no calculus or plaque traps (e.g. overhanging restorations) |
| 1 | This indicates that there are no pockets >3.5mm (i.e. the black band is completely visible), no calculus or plaque traps (e.g. overhanging restorations) but there is bleeding after probing |
| 2 | This indicates that there are no pockets >3.5mm (i.e. the black band is completely visible) but there is calculus or plaque traps present |
| 3 | This indicates that probing depths between 3.5mm and 5.5mm have been found (i.e. black band is partially visible) |
| 4 | This indicates a probing depth of >5.5mm (i.e. black band is completely hidden in pocket) |
| * | Indicates furcation involvement |
This is quite a simple system to follow and the markings on the CPITN probe help with rapid scoring. Some other points:
- Generally, if a BPE score of 4 has been identified in a sextant then you can move on to the next sextant as there isn’t a worse BPE score. However, it is advised to still quickly check the remaining teeth for any furcation involvement.
- Furcation involvement is scored with the main BPE score e.g. 3*, indicating a BPE score of 3 with furcation involvement somewhere in that sextant.
- According to the British Society of Periodontology and the updated periodontal classification, if a patient has a BPE score of 3 and this is the first time, then you should carry out initial therapy and then review them in 3 months. If the BPE of 3 persists, then a full periodontal assessment should be carried out. If there is a BPE score of 4 identified in a sextant then a full periodontal assessment must be done of the entire mouth.
- In children, from the ages of 7-11, we use a simplified BPE and only score from 0-2. This is to account for any false pocketing.
Score-based Treatment
After recording the BPE, periodontal treatment for the patient can be tailored based on their needs. The following table summarises treatment pathways for each score.
| 0 | No periodontal treatment required; encourage patient |
| 1 | Basic oral hygiene instruction (OHI) given to the patient |
| 2 | OHI, removal of plaque retentive features e.g. calculus and overhanging restorations |
| 3 | OHI, removal of plaque retentive features and initial therapy if first time a BPE of 3 is recorded. If it persister, then full periodontal assessment and treatment |
| 4 | OHI, full periodontal assessment, RSD, the potential for surgical intervention |
Summary
- The BPE score is a quick and simple way to assess a patient’s periodontal status
- The instrument used is a CPITN probe
- BPE scores are given to each sextant, from 0-4.
- Periodontal treatment is tailored based upon the BPE score.
References and Recommended Reading
- Single Best Answer Questions for Dentistry
- The Good Practitioner’s Guide to Periodontology
- Periodontology at a Glance
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