A Probing

Report with Hatem Algraffee

BDS, MSc, [Link]., N
umerous reports have been published by
UK dental defence societies outlining
that one of the current highest litigation
periodontal assessment. The BPE guideline
was slightly modified in March 2016 and is
outlined below.
MRD RCS, MFDS RCS costs are from undiagnosed and untreated
Specialist Periodontist periodontal disease. Added to this it has also Basic Periodontal Examination
been suggested that simple careful thorough This is an essential means of screening
Hatem Algraffee qualified as a dentist
documentation and treatment planning will all new patients and recall examinations.
from the Royal London Hospital. He then reduce such cases. Added to this each category will provide
worked in an oral and maxillo-facial The key aspects are assessment, diagnosis, the clinician with treatment suggestions. It
surgery department, followed by several
positions for various health authorities
monitoring and documentation by the provides a clear written documentation of
and general practice. He completed four clinician. Recording Basic Periodontal your continued periodontal screening.
years full time specialist training in Examination (BPE) is paramount and is Below are the six categories that need
Periodontology at Guys London Hospital.
Hatem dedicates his time to co-running PerioAcademy
seen as the initial screening tool and seen to be remembered and treatment needs
certificate teaching course and private practie. as a minimal standard of care for initial implemented:

Score Implication/Treatment need

BPE 0: No bleeding and probing ≤3mm No treatment needed
BPE 1: Bleeding on probing Hygiene instruction
Plaque retentive factors present Hygiene and scaling removal
BPE 2:
No pocketing >3.5mm of plaque retentive factors
Hygiene, supra and Subgingival scaling.
Then review patient several months
BPE 3: Pockets >3.5mm but <5.5mm
later with a record a 6-point pocket
chart in that sextant only
Full periodontal Assessment
BPE 4: ≥5.5mm pocket depths 6 point pocket chart.
Followed by periodontal treatment.
Full Periodontal Assessment.
BPE * Furcation involvement Assess need for more complex
treatment/specialist referral

This index is for treatment need. It does not estimate the level of disease
present, for which a measurement of attachment loss is required.

50 APRIL 2017 // [Link]

Essential recommendations: Sample template version
• Code 3: initial therapy including OHI,
Initial therapy of scaling. Then review Date:
patient several months later with a Patient Name:
record a 6-point pocket chart in Clinican Name:
that sextant only
• BPE should not be used around implants.
Non Smoker/Current Smoker/previous Smoker/e cigarettes
A full detailed periodontal chart is
recommended. Following dental examination I have noted the following diagnosis:
• Radiographs should be available for all
Gingivitis
Code 3 and Code 4 sextants. The crestal
bone levels should be visible. Gum disease (Periodontal Disease).
• Bleeding on probing should always be
recorded in conjunction with a 6-‐point In order to treat and stabilize the above condition I have discussed
pocket chart
with you the following:
Parameters of Care: A tailored made treatment plan to attempt to stabilize and address
• It is the responsibility of the clinician to the gum condition.
monitor and screen all patients for the The role of smoking in gum disease.
presence of periodontal disease.
The need for improved oral hygiene homecare
• Patient compliance should be recorded.
This should include oral hygiene,
attendance. Added to this where Suggested treatment plan:
appropriate smoking cessation advice Oral Hygiene instructions.
discussed should be noted. Non-
compliance to advice and instructions Relevant Smoking Cessation advice.
should also be noted. Course of gum treatment with Dentist/Hygienist.
• All periodontal assessments should be Referral to Specialist Periodontist for assessment and treatment.
written in notes. In particular probing
Referral to Teaching Hospital.
depths, bleeding sites, comment on
plaque levels, and mobility should be
recorded. I have provided you with:
• Maintenance therapy should be Smoking cessation leaflet.
scheduled at appropriate time intervals.
Detailed oral hygiene instructions
The British Society of Periodontology Leaflet regarding Gum Disease/Gingivitis
[Link]) has a very detailed Informed you how best to proceed in addressing
outline of referral policy and parameters of your dental condition.
care.
Many colleagues inform patients of the Answered all questions that you wished to ask and
diagnosis of periodontal disease verbally but given you the opportunity to return to discuss
unfortunately may not write this in their your condition
notes.
Added to this it is essential that
any verbal advice is supported with
Patient Name
information leaflets. Ideally a written form Patient Signature Date
countersigned by the patient that they have Clinician Signature Date
been informed of the diagnosis and all
options discussed, should be filled in the
notes; attached as an example.
It is very likely that the above will also There is no doubt that treating periodontal disease is
generate necessary and ethical hygiene
treatment sessions for hygienists and
challenging but can also be very rewarding. Careful
dentists. assessment, treatment and monitoring of patients will
Reference:
The British Society of Periodontology,
aid all clinicians and patients.
[Link]
PerioAcademy template version

[Link] \\ APRIL 2017 51