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.