Presented by Dr.

Lai Su Min
Klinik Pergigian Ayer Molek
12.04.2023

SOP for
MoH Dental Clinics –
Management of
Periodontal Conditions
in Primary Oral
Healthcare Clinics
 Table of Content

Introduction Objectives Scope

Implementation Training
 • 2 significant global burden of oral diseases:
• Dental caries
• Periodontal disease
Introduction
• Severe periodontitis is recognised as the sixth
most prevalent oral disease.
 • 94.0% of adults according to NOHSA 2010
Periodontal • Almost 50% of adults have periodontal pockets
Disease in • 90% of adults need OHI, scaling and prophylaxis
Malaysia • 3x increase in need for complex periodontal care
(1990 vs 2010)
Risk Factors Associated
With Periodontal Disease
• Unhealthy lifestyles
• Tobacco use
• Poor nutrition
• Stress
• Diabetes mellitus
• Genetics
• Drugs
 This SOP will be used to screen adults aged 18
years and above attending primary oral
healthcare clinics.

SCOPE
Not in this SOP (2018):
BPE needs to be recorded in
patients as young as 15 y/o
 General Objective
To address the high burden of periodontal disease
among Malaysian adults aged 18 years and above

Specific Objectives

OBJECTIVES 1. To determine BPE score of patients attending

primary oral healthcare clinics.
2. To refer complex periodontal disease to
Periodontist as early as possible.
3. To increase the accessibility to periodontal care
at primary oral healthcare clinics.
 IMPLEMENTATION
___________________ • A simple and rapid screening tool that is used
to detect periodontal disease
FUNCTION
OF BPE • BPE does not provide a diagnosis of
periodontal disease but indicates for further
assessment and treatment required
Probes used for BPE
• WHO CPITN probe

• If there is no WHO CPITN probe, use:

• Williams probe
• Michigan ‘O’
• Marquis
• UNC-15
Alternative: Williams Probe
 IMPLEMENTATION
___________________
1. Briefly explain to patient
2. Divide dentition into 6 sextants
SCREENING
METHOD
3. Examine all teeth except 8’s
• For a sextant to qualify for recording,
it must contain at least 2 teeth.
• If only 1 tooth is present in a sextant,
the score for that tooth is included in
the recording of the adjoining sextant.
• A WHO CPITN probe should be
“walked around” the sulcus/pockets
in each sextant.
• Light probing force of 20-25g.
• Once a code 4 is detected in a sextant,
move directly on to the next sextant.
BPE Scoring Codes
Calculus (supra/ sub-gingival) Restoration overhang
 IMPLEMENTATION
___________________ • The BPE score for each sextant gives an
indication of the periodontal care
required.
EARLY
TREATMENT • The BPE score should be considered
together with other factors when making
decision for referral.
 IMPLEMENTATION
___________________

EARLY
TREATMENT
 For BPE 1, 2 and 3
IMPLEMENTATION • Review every 2-4 months to assist
___________________ maintenance of oral health
• Review medical and drug history
• BPE charting
REVIEW & • OHI
ASSESSMENT • Dietary Counselling
• Smoking Cessation Advice
• Scaling if necessary
• Involvement of Klinik Pergigian Mesra
Promosi
 • BPE score 0,1,2,3 with periodontal problems
such as mucogingival defect and gingival
hyperplasia

• BPE score 3 with underlying medical problems

such as major organ transplants, diabetes,
REFERRAL TO immunosuppression, history of infective
PERIODONTIST endocarditis and patients on warfarin

• BPE score 3 not responding to treatment after

2 visits

• BPE score 4
Remember
• All patients for referral must be provided with basic dental treatment
e.g. filling, scaling and extraction
• Operators must always adhere to the latest Periodontal Referral
Protocol
 • All patients are under the responsibility of
Dental Officers at the Primary Oral
Healthcare Clinics

RESPONSIBILITY • Dental Therapists will assist in providing

OHI, Smoking Cessation Advice and
Dietary Counselling under supervision of
Dental Officers
 Training

Centralised training Localised training

of trainers (state level)

- Echo training of DOs &

- DOs (UG48 & above)
DTs in each state
represent state
- Involves help from
- 3 days lecture
Periodontists