Periodontal Screening & Records

In the 1996 World Workshop in Periodontics, PSR (Periodontal Screening and Recording) was developed. It is a quick and cheap test performed at the first visit and then annually for patients. Different teeth are tested for adults and children. However, the recording method is the same and conducted using a WHO (World Health Organisation) probe. For adults, all six points on each tooth present are examined. For children, the adult teeth are measured and recorded. These include 16, 11, 26, 36, 41 and 46. If these teeth are missing, then the adjacent teeth are used.

• 0: no bleeding or calculus

• 1: bleeding

• 2: calculus or defective restoration margins

• 3: partially visible black band (3.5mm - 5.5mm)

• 4: black band disappears (>5.5mm)

* may be added to indicate furcation invasion, muco-gingival problems, gingival recession extending the black ring of the prober (>3.5mm) and mobility.

X is indicated for edentulous sextants or sextants with less than two teeth.

Method

Seating Positions for Probing

1. Lightly rinse and then dry the teeth.

2. Using the WHO probe, start on the distal surface of 17 and lightly bob towards the medial surface of 13. Use the walking probe technique for the lingual aspects.

3. Repeat the process for S2, S3, S4, S5 and S6.

4. Note that as long as the wisdom teeth are present - they are included in the indices.

5. At the end, there will be 6 codes in total.

6. Noe that a full periodontal chart will need to be used if there are two PSR code 3s or one code 4 is recorded. Periodontal charting of the sextant will be needed if it is a code 3.

Review Questions on PSR

Where do you perform PSR in children?

16, 11, 26, 36, 31, 46

4 reasons to put an asterix in PSR

Furcation, Mobility, recession >3.5mm, muccogingival problems

What is your treatment for each PSR code?

Purpose of PSR is to give initial assessment. Treatment options based on worst sextant:

Code 0 only→ Appropriate preventative care (e.g. professional prophylaxis and oral hygiene instruction)

Code 1 maximum→ Professional prophylaxis including Plaque removal and oral hygiene instructions

Code 2 maximum→ Professional prophylaxis including Calculus and plaque removal, correction of restoration margins, and oral hygiene instructions.

Code 3 record in 1 sextant→Comprehensive periodontal charting for that sextant and examination needed to determine care plan

Code 3 recorded in 2+ sextant OR Code 4 recorded in 1+ sextant→Comprehensive full mouth periodontal charting and examination needed to determine care plan

Differentiate between the different codes for PSR

What is the marking for edentulous in PSR?

X

What is the probing technique called for PSR?

Walking the probe

In what situation would you probe the distal of the 8's?

Only in PSR

What would you do once you got a Code 4? Would you finish the sextant?

You would complete a perio chart of the whole mouth. No you wouldn’t need to. Refer to senior clinics to get cleaned

You have done a PSR, you found a pocket of 6mm. What is the code?

Code 4

Charting you get to the 26 you find a furcation, and 5mm pocket depth. What is the code?

Code 3 with and asterix

What would you do if you had one Code 3 in the sextant?

Write down the code 3 and perform the next sextant. Unless you get 2 sextant with a code 3, then you have to complete a periochart of the whole mouth

What probe do you use to complete SBI, API, PSR?

WHO probe (World Health Organisation)

ball 0.5, next line is 3.5, end of black thickness is 5.5mm and the next line is 8.5mm