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References

In: Mosedale RF, Floyd PD, Smales FC London: British Society of Periodontology; 1986
: The Stationery Office Limited;
Butterworth M, Sheiham A Changes in the Community Periodontal Index of Treatment needs (CPITN) after periodontal treatment in a general dental practice. Br Dent J. 1991; 171:363-366
Grace M Effective periodontal control. Dent Update. 1992; 19:339-344
Needleman I Periodontal treatment in practice. Dent Practice. 1993; 31:(10)1-5

BPE guidelines: british society of periodontology revision 2016

From Volume 43, Issue 5, June 2016 | Pages 406-408

Authors

Philip Ower

MSc, BDS, MGDS RCS

Specialist in Periodontics, The Periodontal Practice, 21 Devonshire Place, London, and The Briars Dental Centre, Newbury

Articles by Philip Ower

Article

In 1985 the Fédération Dentaire Internationale (FDI) developed a simplified periodontal screening examination for dental practice, based on the World Health Organization (WHO) Community Periodontal Index for Treatment Needs (CPITN) index that was then used to assess levels of periodontal diseases for epidemiological purposes. This was quickly adopted by many countries as a fast and reliable screening tool for general practitioners and, in the UK, it was developed by the British Society of Periodontology as the The Basic Periodontal Examination (BPE). The BSP published their first set of guidelines on the use of BPE in 1986. Since then the guidelines have become accepted by academic, teaching, practice and legal bodies as the basic standard for initial periodontal assessment of all patients receiving general examinations. Following the original 1986 publication, which was widely discussed in the dental press,1,2,3,4,5 the guidelines have undergone periodic revisions in 1994, 2000, 2011 and now in 2016.

For the latest revision a working group consisting of academics, specialist and general practitioners was established. Not surprisingly a variety of differing views were expressed about which aspects of the 2011 guidelines required revision. The 2016 document represents a consensus view on which the working group was able to agree. Most of the revisions had almost unanimous agreement and there was also strong agreement that the revision should not be radically different from the existing guidelines, to avoid confusion. It was also agreed that the document should remain short (covering 2 sides of A4 at the most) so that it remained easily downloadable and printable, and therefore of practical use in a general practice setting. Much of the document is unchanged but it has been rewritten to make it more user-friendly.

As expected, the revision that created the most discussion and the widest variety of views was code 3. In many ways code 3 is a crucial part of the BPE system as it has the potential to identify periodontal disease at a very early stage when it is easier to manage. At the same time, however, while a code 3 could indeed be mild and/or early disease, it could also be gingivitis without attachment loss. Discussion revolved around the management of a code 3 and whether a full mouth 6 point chart (6PPC) was required for this code; it was recognized that there was a risk that practitioners might under record BPE to avoid the need for a 6PPC in that sextant. Views surrounding this code varied from only doing a 6PPC if bone loss was apparent on a radiograph (given that the recommendation for radiographs in all code 3 and 4 sextants remains) to leaving the recommendation that all code 3 sextants should receive a 6PPC. In the end it was agreed that code 3 sextants need not receive a 6PPC at the outset but that this should be done to assess the response to initial therapy to control marginal inflammation.

Many of the 2011 guidelines remain unchanged, such as a full mouth 6PPC if any sextant scores code 4, the need to radiograph all code 3 and 4 sextants and not using BPE for monitoring. The main differences between the 2011 and 2016 guidelines are:

  • Code 3 – initial therapy followed by a 6PPC;
  • Bleeding on probing should always be recorded with 6PPC;
  • Only record 4 mm and above when doing a 6PPC.

    • The 2016 BPE Guidelines are published here in their entirety. They can also be downloaded from www.bsperio.org.uk/publications/downloads. The BSP is keen to receive comments from users on the new guidelines – use the Contact Us section of the BSP website.