This screen asks for measurements based on the condition of the patient’s mouth on the date of the exam.

Click on the appropriate perio measurement for pocket depths and radiographic bone height from the CEJ for each specific sextant as indicated on the illustration. For each sextant, check the corresponding box to indicate if there is any bleeding on probing in that sextant.

Note that a Risk Assessment requires at least one pocket depth value other than "No Teeth" and at least one radiographic bone height value other than "No Teeth" and "No X-ray."

As you click the numerical answer, a colour will appear on that corresponding sextant in the tooth diagram, indicating the extent of disease:

• Green indicates a generally healthy sextant
• Yellow indicates a generally less healthy sextant
• Red indicates a generally unhealthy sextant
• Grey indicates missing teeth

Deepest Pocket Per Sextant:

(Also called probing depth or sulcus depth). Only the deepest pocket in the sextant should be used to determine your response for each input value.

The mainstay of periodontal screening in the UK, as recommended by the British Society of Periodontology, is the BPE and therefore detailed pocket depth measures are not recorded unless a sextant scores a code 4 at baseline (or code 3 and 4 at the post-therapy review. Therefore we recommend the following:

• For code 0, 1, 2 & 3 BPEs, chart as "less than 5mm"
• For code 4 BPEs, chart as either "5-7mm" or ">7mm"

This means that where a code 4 is registered, rather than moving to the next sextant, probe the remainder of the code 4 sextant and simply record the deepest pocket depth in that sextant.

Note: If the patient has implants, the implant should not be considered as a tooth when indicating the greatest pocket depth per sextant. Pocket depths around implants should NOT be considered.

Bleeding on Probing:

Under each sextant in the pocket depths section is a box labelled "Bleeding." Check that box if there is bleeding anywhere in that sextant when probing to measure pocket depth during the exam.

X-ray: Distance from CEJ to bone crest:

This can also be described as the radiographic bone height from the CEJ. The greatest distance in each sextant from the CEJ to the radiographic bone crest is used.

Choose the single greatest measurement of bone height from the CEJ per sextant (do not take an average of all measurements in that sextant).

Note that in the case where there is a is a vertical bone lesion, the greatest distance is at the base or apical extent of the bone lesion, which might not be interpreted as the bone crest. In any case, you should indicate the greatest distance in each sextant from the CEJ to the most apical level of bone that is evident on the radiograph.

It is acceptable to use radiographs that have been taken within 5 years of the examination. This is marginally adequate since bone height generally does not change enough in 5 years to affect the risk score.

However, the most accurate assessment requires radiographs taken the day of the assessment, which can be accomplished with as few as four bitewing radiographs. The use of only four posterior bitewing radiographs will not permit the bone height measurement for the upper anterior or lower anterior, and hence the risk and periodontal health scores could be inaccurate. This is unlikely to be significant for the patient whose diagnosis is health, gingivitis or beginning periodontitis, indicated by Periodontal Disease state<=10 (less than or equal to 10). Radiographs of all teeth are indicated for patients with severe periodontitis, indicated by Periodontal Disease state >=37 (greater than or equal to 37) to calculate accurate risk scores and disease states.

Restorations and crowns may obscure the CEJ. In this situation, the clinician should use previous records and his or her best judgment to determine the radiographic bone height from the CEJ.

Note that a Risk Assessment requires at least one radiographic bone height value other than "No Teeth" and "No X-ray."

A pragmatic approach......

The distance from the CEJ to the alveolar crest in health is about 1.5mm. Therefore the <2mm score implies no bone loss other than perhaps the loss of the crestal lamina dura.

The 2-4mm bone loss value implies very mild to moderate bone loss and is an estimate by visual inspection (do not worry about using a ruler!).

The >4mm value indicates severe bone loss.

The "no teeth" obviously means no teeth in that sextant.

 

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To move on from this page:

Clicking the Previous button saves the field values you have entered, and loads the Dental Info screen.

Clicking the Next button saves all the values you have entered for this Risk Assessment, and loads the Reports Settings screen.

Note: You can leave some required fields blank at this point if you will be saving the Risk Assessment as Unfinished and completing it later. The system allows you to move among the various components of a Risk Assessment without forcing you to complete all required fields. The system will check and enforce that all required values have been entered when you click “Finish” on the final screen at the point where data is transmitted to PreViser for calculation.