How do we measure and monitor gum health? How do we know if your periodontal (gum) condition is good or bad? And how do we know if your gum health is improving or deteriorating?

Each time we sit down to do a "dental" examination, we check a number of things, not just whether your teeth are decayed. One of the major parts of the examination is your gum (Periodontal) condition. Some gums in poor condition are so obvious that even the untrained eye can spot them a mile off - indeed, if they're poor enough the untrained nose can spot them a mile off too!

But most unhealthy gum isn't obvious, so a more scientific approach is needed. For this reason the World Health Organisation developed the CPITN - the Community Periodontal Index of Treatment Needs - used as the BPE - the Basic Periodontal Examination.

The CPITN uses a specially designed probe which has a ball on the end. This stops it being sharp and also helps us to feel hardened debris (called tartar or calculus) or rough edges on restorations. The CPITN probe also has a contrasting black band to help show how far the probe can be slid into the edge of the gum. The first band is 3.5 to 5.5 mm from the end of the probe.

The mouth is divided up into six chunks (sextants) consisting of the upper six front teeth, lower six front teeth and the four back corners. The probe is "walked" gently around the crevice where the tooth joins the gum and the depth it slides into the crevice is observed. Whatever the worst score for that particular sextant is, then that's the score assigned to the whole sextant. So, if the whole sextant were perfect apart from one spot then the whole sextant gets the score of the worst spot. The scores point to the treatment to be carried out.

 

These are the possible scores - you'll see them recorded in a grid that forms six boxes. As with everything else we do, it is displayed as though we were looking at the patient from the front. So the left is on the right and vice versa.

0 - All is fine in that sextant.

 

1 - An area of gum bleeds when gently probed - a sign of inflammation.

Getting the patient's cleaning technique correct should reverse this.

 

2 - The ball at the end of the CPITN probe can feel roughness due to either calculus (tartar)or due to an edge on a restoration. The rough calculus, which harbours bacteria needs cleaning away (or the restoration needs altering) and again the patient's cleaning technique.

 

3 - The CPITN probe has gone in far enough to reach the start of the black band (over 3.5mm). This "periodontal pocket" is too deep for the patient to get into thoroughly with normal cleaning. At this point we need to add detail and then (depending on who does the measurements) the pocket depth is measured in millimetres at either 4 or 6 points around the tooth.The periodontal pocket can be caused by the gum swelling up but still being attached at the original level - this is called a false pocket. Or the gum attachment can pull away from the tooth and create a true pocket. Very thorough professional scaling and alteration of technique will often turn a 3 back into a zero. More than one visit is needed so that progress can be monitored.

4 - The CPITN probe has gone in beyond the end of the first black band back onto the silver area (over 5.5mm) Full pocket charting is appropriate and therapy starts with professional scaling, often with local anaesthetic and modification of technique. This continues over several visits.

 

* - Added if the CPITN probe will slide into the area between the roots. Usually tied to a score of 4. This is called furcation involvement. Furcation involvements are very difficult to eliminate.

The Basic Periodontal Examination is a simple system designed for wholesale screening of the population. But it does translate very well to use for periodontal screening in general dental practice. The BPE scores lead treatment planning but they're also useful as an easy guide for patients to watch their own progress. The simple way is to tot up the points and generate a total. So if the six scores add up to 12 , then we'd say the patient has lost 12 out a possible of 24 (6 x 4). It's a simple but useful way to give a patient a score to try to drive down. Obviously the aim is to lose no points at all, so that all the sextants are in excellent condition. The pedants in dentistry don't like this approach, but as a practical tool it works.

BPE is actually very blunt as a tool. It doesn't pick up the subtleties of change. That's why our hygienists record bleeding sites in the mouth and amounts of plaque present when the patient presents for treatment. All in all, the idea is to generate numbers so that we don't write down things like "I think the patient's gums are better"

© Hesslewood Lodge Dental Practice, 16th Nov 2015

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