CD0412

special _ practical periodontics I and a black band marked at 3.5–5.5 mm. The BPE is a simple and quick way of screening our patients for any underlying periodontal disease. Williams’ probes are also commonly used to assess the peri- odontal tissue (this probe has graduated markings at 1–2, 3–5, 7–8, 9–10 mm; Fig. 4). The BPE was developed by the British Society of Periodontology. It is a method of screening patients to determine the treatment required for the level of disease present. The BPE is an index for treat- mentneedanddoesnotestimatethelevelofdisease present. Rather, a loss of attachment chart is used to determine this. The BPE divides the mouth into sextants. All the teeth in a sextant are examined and scored accord- ingly (Table I). Recently, the British Society of Peri- odontology has made a slight change to the BPE scoring.Code*hasnowbeenchangedtodenotethe presence of a furcation only, whereas previously it was to denote the presence of a furcation or attachment loss of 7 mm or greater. The society has alsosaidthattheotherBPEcodesandCode*should be recorded for each sextant where a furcation is present. An example is shown in Table II. A furcation probe or Nabers’ probe is also an essential tool for assessing the degree of furca- tion involvement of a molar tooth. We can measure the amount of horizontal bone loss that has oc- curred within the furcation, classifying it as a Class 1, 2 or 3 furcation. The dark bands represent 3 mm markings (Fig. 5). A Class 1 furcation is noted when the furcation probe penetrates less than 3 mm into the furcation (Fig. 6). A Class 2 furcation is when the probe penetrates greater than 3 mm but does not go all the way through the furcation (Figs. 7 & 8). A Class 3 furcation is when the probe passesthroughthefurcationunimpeded(Figs.9&10). Radiographs are another important tool used to assessthebonelevelsaroundeachtooth,rootmor- phology and furcation involvement, and therefore the support present and long-term prognosis of the teeth (Fig. 8). Long-cone parallel radiographs or vertical bitewings are taken of sextants when the score is 3 or more (Fig. 11). _Risk factors The clinician should also be aware of risk factors that can exacerbate the existing periodontal dis- ease: diabetes, smoking and genetics. A combina- tion of these factors makes certain patients sus- ceptibletohigherrisksofperiodontaldisease.These cases may be treated in practice but referral to a specialist would be required if the disease is not stabilised. Recognition of risk factors includes: _BPE Codes 3, 4 or * in patients under 35 years old; _smoking ten or more cigarettes a day; _a medical condition directly affecting the peri- odontal tissues, for example diabetes, stress and certain types of medication; _arootmorphologythatadverselyaffectsprognosis; _rapidperiodontalbreakdown(>2mmattachment loss in any one year); _a high bleeding percentage with a low plaque score; and _a family history of early tooth loss due to perio- dontal disease. _Oral hygiene A high standard of oral hygiene is critical for successful periodontal therapy. There is a great deal Fig. 7_Class 1 buccal furcation in tooth 16. Fig. 8_Class 2 buccal furcation in tooth 17. Fig. 9_Class 2 lingual furcation in tooth 47. Fig. 10_Class 3 furcation in tooth 46. Fig. 11_Class 3 furcation in tooth 46. Fig. 12_Interdental brushes. Fig. 13_Interdental brush used to maintain a Class 2 buccal furcation. Fig. 14_Consultation visit. Fig. 15_Long-cone periapical radiograph of teeth #43 to 46. I 15cosmeticdentistry 4_2012 4 2 4* 3* 3 2 Table II_Example of BPE scoring and Code * for each sextant where a furcation is present. Fig. 12 Fig. 13 Fig. 14 Fig. 15 Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 11