Periodontal Examination

The periodontium is the tissue that supports and surrounds the teeth and includes gum tissue, ligaments, cementum, and the bones that hold the teeth in place. A periodontal examination is a specialized dental examination that specifically focuses on identifying and diagnosing disease or potential disease in these tissues. There are different approaches to the periodontal examination, depending on the region where the dental practice is, but the goals are the same. In 1982, data collected and provided by the World Health Organization led to the development of an classification system, called the Community Periodontal Index of Treatment Needs (CPITN), and they also developed a probe that was created specifically to help dental health practitioners meet the goals specific to the periodontal examination. This probe, called WHO 621, has a small ball at the end and colored bands placed intermittently at specific measurements along its shaft. This allows dental health practitioners to measure the depth of periodontal pockets, and, combined with the CPITN, was designed to help create a global standard for clinical practice. While the WHO 621 probe is used in nearly all periodontal examinations, the commonly used systems for classification vary from country to country. In the United States, Canada, and Brazil, the most frequently used classification system is called Periodontal Screening and Recording, or PSR; in the United Kingdom and New Zealand, the Basic Periodontal Examination, or BPE, is most commonly used; and in Australia, the Primary Essential Periodontal Examination, or PEPE, is used.

In the United States, the PSR system was simplified and adopted in 1992, intending to encourage the prevention and early treatment of periodontal diseases. The PSR is a screening tool that can be easily incorporated into every oral examination, and, since 1992, the American Dental Association has encouraged clinicians to use it in every dental examination, both to diagnose periodontal pathologies and to educate the public about periodontal health. It is important to note that the PSR does not replace the more comprehensive periodontal examinations that clinicians conduct after diagnosis and when planning treatment; instead, it is a screening tool that helps determine whether a more thorough periodontal examination is necessary. The PSR divides the mouth into six separate regions and includes multiple measurements from each individual tooth within these sextants. During the examination, the WHO 621 probe is inserted into the gingival sulcus, which is the crescent-shaped crevice in the gums at the base of each tooth, and walked around the base of each tooth. The relationship between the colored bands on the WHO 621 probe and the location of the gum tissue helps determine whether any pathologies are present in that specific tooth or its root, or in the mucous membranes and tissues that surround the tooth. Each sextant is coded based on the least healthy tooth in that sextant, and, when an entire sextant is missing teeth, that sextant isn’t coded at all and is instead marked with an X. Based on the coded number of each sextant, clinicians can then make recommendations for further treatment. The coding system takes into consideration such factors as probing depths, attachment levels or gingival recession levels, mobility, bleeding on probing, and whether the roots or gums and mucous membranes are compromised. Radiographic imaging may also be used to assess damage beneath the gum line and in the bones themselves.