How to record a BPE in dental notes

What the BPE is for

The Basic Periodontal Examination (BPE) is a screening tool. The British Society of Periodontology (BSP) is explicit that it should be used for screening only and should not be used for diagnosis. It tells you which sextants need a closer look, not what the periodontal diagnosis is.

All new patients should have a BPE recorded. For returning patients scoring 0, 1 or 2 in every sextant, the BPE should be recorded at every routine examination.

How to carry it out

1. Divide the dentition into six sextants: upper right (17 to 14), upper anterior (13 to 23), upper left (24 to 27), lower right (47 to 44), lower anterior (43 to 33), lower left (34 to 37).
2. Examine all teeth in each sextant, except third molars, unless the first or second molar in that sextant is missing.
3. A sextant needs at least two teeth to qualify for a score. A sextant with only one tooth left does not get its own score.
4. Use a WHO BPE probe: a 0.5mm ball end with a black band from 3.5mm to 5.5mm. Use a light probing force of 20 to 25 grams.
5. Walk the probe around the gingival margin of every tooth in the sextant, then record the highest score found in that sextant before moving to the next one. If a code 4 turns up, keep examining the rest of the sextant so no furcation involvement is missed.

The scoring codes

Record one score per sextant, the highest found in that sextant. Both the number and the asterisk are recorded together when a furcation is detected, for example 3* for a probing depth of 3.5mm to 5.5mm plus a furcation involvement in the same sextant.

What each code means for what happens next

Codes 0 to 2 do not call for more detailed periodontal charting on their own. Codes 3 and 4 do, and BSP guidance is specific about what each one needs.

• Code 3: initial therapy, including self-care advice such as oral hygiene instruction and risk factor control. A six-point pocket chart for that sextant only is then recorded after initial therapy, at review.
• Code 4: if any sextant scores 4, a six-point pocket chart is recorded across the whole dentition, not just that sextant.
• Radiographs should be available for every code 3 and code 4 sextant, showing crestal bone levels. The BSP notes that many clinicians regard periapical views as essential for code 4 sextants, to assess bone loss as a percentage of root length.
• A BPE score cannot be used to monitor how treatment is going, because it does not show how individual sites within a sextant have changed. A six-point pocket chart recorded before and after treatment is used for that instead.
• For a patient who has had initial periodontal therapy and is now in the maintenance phase, full probing depths across the whole dentition should be recorded at least once a year.
• When a six-point pocket chart is indicated, only sites of 4mm and above need recording, though all six sites per tooth should be measured. Bleeding on probing should always be recorded alongside a six-point chart.
• BPE should not be used around implants. Use four-point or six-point pocket charting there instead.

Under-18s

The adult BPE above is not used for children and adolescents under 18. The BSP and British Society of Paediatric Dentistry set out a separate simplified BPE (sBPE) for periodontal screening in this age group.

sBPE assesses six index teeth rather than full sextants, to avoid false pockets: all four first permanent molars, plus the upper right central incisor and the lower left central incisor. Codes 0 to 2 are used for 7 to 11 year olds. The full range, codes 0, 1, 2, 3, 4 and the asterisk, can be used from 12 to 17. See the BSP/BSPD sBPE guidance for the full detail.

What to write in the notes

GDC Standard 4.1 requires you to make and keep contemporaneous, complete and accurate patient records. The guidance under it says records should be clear, legible and readily understood by others, should show the name or initials of the treating clinician, and that any later amendment should be clearly marked and dated.

• The six sextant scores, in a consistent grid: upper right, upper anterior, upper left on one row, lower right, lower anterior, lower left below it.
• Any asterisk for furcation involvement, against the sextant it applies to.
• Bleeding on probing and plaque, where these were recorded as part of the examination.
• What was discussed with the patient, including any findings explained to them.
• The plan: whether a six-point pocket chart is needed and when, radiographs, hygiene care, review interval, or referral.

HelpDental Assist can draft this part of the note from what is said during the appointment, for the dentist to check before it is saved, but the dentist still carries out the probing, decides the score and signs off the plan.

Two worked examples

Common recording mistakes

• Not recording a BPE for a new patient at all.
• Treating a code 3 as needing a six-point chart on the same visit. BSP guidance calls for initial therapy first, with the chart recorded after, at review.
• Scoring a sextant that has fewer than two remaining teeth, when it does not qualify for its own score.
• Recording a six-point chart without bleeding on probing alongside it.
• Writing down the score grid but not what was discussed with the patient or the plan that follows from it.
• Using the adult BPE codes and sextants on a patient under 18, rather than the six index teeth of the sBPE.
• Scoring a BPE around an implant, instead of four-point or six-point charting.

Common questions.

Sources.

• BSP, Basic Periodontal Examination (BPE) guidelines, 2019
• BSP/BSPD, Simplified BPE (sBPE) for Under 18s, updated 2021
• GDC, Standards for the Dental Team, Standard 4.1
• GDC, Standards for the Dental Team (printer-friendly PDF)
• CGDent, Clinical Examination and Record-Keeping
• SDCEP, Periodontal care: record-keeping
• SDCEP, Periodontal care: BPE screening of adults

Assist writes the note while you work.

It records the appointment and drafts the note for you to review and sign off, then copies into your practice system.

Related.