Anatomy and Basic Periodontal Examination
- Enamel
- Dentin
- Junctional epithelium
- Connective tissue
- Alveolar bone
- Division of dentition into six sextants
- Use of World Health Organization (WHO) Probe
- Running the probe around gingival pockets
- Scoring codes range from 0 to 4
- More detailed charting for BPE scores of codes 3 and 4
- Sextant division: Upper Right, Upper Anterior, Upper Left, Lower Right, Lower Anterior, Lower Left
- Recording the highest score in each sextant
- Radiographs for teeth or sextants with BPE codes 3 or 4

Timing of Examination
- BPE recorded for all new patients
- BPE recorded for patients with code 0, 1, and 2 at least once annually

Guidance on Interpretation of BPE Scores
- Score 0: No need for periodontal treatment
- Score 1: Provide patient with oral hygiene instruction (OHI)
- Score 2: Provide patient with OHI and remove plaque retentive factors
- Score 3: Provide patient with OHI and root surface debridement (RSD)
- Score 4: Provide patient with OHI, RSD, and evaluate for more complex treatment

Microbiology
- The environment of the gingival sulcus is unique within the mouth.
- The gingival sulcus becomes a periodontal pocket in the presence of periodontal disease.
- Gingival crevicular fluid (GCF) increases significantly during gingivitis and periodontitis.
- Gingival crevicular fluid provides defense mechanisms against microbial insult.
- Bacterial metabolism in the gingival sulcus is supported by proteins and glycoproteins present in GCF.

Pathology
- Chronic excess of sulcular depth can lead to inadequate cleansing and accumulation of food debris and microbes.
- Dental biofilm can form in the sulcus, posing a danger to periodontal ligament fibers.
- If microbes remain undisturbed, they can penetrate and destroy soft tissue and periodontal attachment fibers.
- Untreated periodontal disease may result in deepening of the sulcus, recession, and tooth loss.
- A periodontal pocket indicates an abnormally deepened gingival sulcus.