Periodontal Screening and Recording: Use it, but don’t abuse

Originally published in the November/December 2016 issue of Dispatch

Early detection is the key to successful prevention and management of periodontal disease, which remains the leading cause of tooth loss in Canada. The Periodontal Screening and Recording (PSR) program can be a valuable tool for dentists, as an integral part of oral examinations. PSR is simple, quick and easy to record, because it does not require extensive charting. Many practitioners use this method to screen patients for periodontal disease. Unfortunately, too often, practitioners use PSR as a replacement for a comprehensive periodontal examination and charting; this is not its intended purpose.

PSR is designed as an efficient screening system to detect periodontal disease, determine if a comprehensive periodontal examination and charting is indicated, and assist communication between practitioners and patients. Each tooth is examined with a periodontal probe. The recommended probe has a 0.5 mm balled end and a coloured band, extending from 3.5 to 5.5 mm. Six areas of each tooth are examined (mesiofacial, midfacial, distofacial and corresponding lingual/palatal areas) and the depth of probe insertion is read against the coloured band and assigned a score from 0 to 4. The mouth is divided into sextants and for each, only the highest score (corresponding to the deepest probing depth) is recorded.

The management of patients according to their sextant scores requires clinical judgment on the part of the dentist; however, there are recommendations with treatment implications for each code, as described in the following table.

For those patients who have recently received treatment for periodontal disease and/or are in a maintenance phase following such therapy, a comprehensive full-mouth periodontal examination and charting should be performed.

PSR is an excellent screening system; however, it is not intended to replace or substitute for a comprehensive periodontal examination, when necessary. It is a valuable tool for early detection of periodontal disease and is designed to indicate when a comprehensive periodontal examination should be performed. Unfortunately, some practitioners ignore these recommendations and fail to perform a comprehensive periodontal examination of the affected sextant or full mouth, when it is clearly indicated. When this occurs, and especially if the patient’s periodontal disease progresses, it may lead to allegations of professional misconduct and/or malpractice for which there may be little or no defense.

If PSR is used, it should only be for the intended purpose: as a screening system for early detection of periodontal disease and indication for performing a comprehensive periodontal examination. If PSR is used without appropriate follow-up, when necessary, then the patient’s periodontal condition may be inadequately diagnosed and managed. This has implications for both the patient and the dentist, including dental and legal consequences.