Periodontics
Periodontics tests screening, classification and staged management. New Zealand practice centres on the Basic Periodontal Examination, the 2017 world workshop classification, and non-surgical therapy before surgery.
Core rules
- Record BPE in six sextants with a WHO probe, walking around each tooth. Codes: 0 healthy, 1 bleeding, 2 calculus or plaque-retentive factors, 3 pocket 3.5-5.5 mm, 4 pocket 5.5 mm or more. Add an asterisk for furcation, mobility or mucogingival problems.
- A code 3, 4 or asterisk triggers full six-point charting with recession, probing depths, bleeding and plaque scores.
- Classify by stage (I-IV: severity, bone loss, tooth loss, complexity) and grade (A-C: progression rate, smoking, diabetes, bone loss divided by age).
- Deliver cause-related therapy: oral hygiene instruction, scaling and root surface debridement under local anaesthesia where needed, and risk factor control.
- Re-evaluate at 6-8 weeks before deciding on surgery; place stable patients on supportive periodontal therapy at 3-6 month intervals.
Worked example
A 48-year-old smoker has BPE 3, 4, 3, 2, 3, 3 with 7 mm pockets on 36 mesial and 46 distal, 30% bone loss and no tooth loss. Stage III, grade C (smoking plus rapid bone loss relative to age). Plan: full charting, smoking cessation advice, oral hygiene instruction, quadrant debridement with local anaesthesia, re-evaluation at 8 weeks, then consider surgery for residual pockets of 6 mm or more, and 3-monthly maintenance.
Traps
- Reporting BPE codes as a diagnosis rather than a screening tool.
- Prescribing antibiotics instead of mechanical debridement.
- Missing a combined endodontic-periodontal lesion or an occlusal trauma contribution.