Introduction

A complete periodontal assessment includes a thorough review of the patient's medical and dental histories, as well as the recording of gingival findings including probing depths, clinical attachment levels, tooth mobility and position, furcation involvement, bleeding on probing, occlusal relationships, and bone levels.

It is important the dentist or dental hygienist monitor and evaluate a patient's periodontal status on a regular basis. The American Dental Association estimates 42% of adults in the United States over the age of 30 have periodontal disease.¹ Periodontal disease is found worldwide, but most common in older populations. Bleeding upon probing was found to differ among low-, middle- and high-income countries.¹⁶ The Centers for Disease Control and Prevention reports 47.2% of adults in the United States have a form of periodontal disease. The rate increases to 70.1% for those Americans age 65 and older.⁹ While there is no true way to know if periodontal disease is increasing or decreasing among the population in the United States, it can be assumed that since Americans are living longer with their natural teeth, and since periodontal disease is common in the older population, there are more people living with periodontal disease.¹⁰ Every oral examination should include an evaluation of the periodontium. The ultimate goal of the periodontal assessment is to identify and classify periodontal disease.³ Although the Periodontal Screening and Recording^® (PSR) is not intended to replace a full mouth probing and recording of findings, it is a rapid method of screening patients to decide if a more comprehensive assessment is necessary. The dentist or dental hygienist must decide, upon completion and documentation of their patient’s PSR scores, whether the patient should receive a full periodontal examination. This would result in the patient’s classification of periodontal disease characterized by the staging and grading system as recommended by the American Academy of Periodontology (AAP).¹⁵ The severity of periodontal disease is classified by four Stages (I – IV) where the focus is on attachment and bone loss. The dental professional then determines one of three Grades (A, B, or C) which indicates disease progression and outcome.¹⁷

Gingivitis and periodontitis fall into the category of periodontal diseases. Both are microbial infections of the periodontium, where the microorganisms operate in conjunction with a person’s host response.⁷ The dental hygienist is most often the person in the professional dental setting who screens patients and assesses periodontal health or disease. The most commonly used screening method for the measurement of depth of the gingival sulcus and the clinical attachment level is periodontal probing.⁶ The clinician, by measuring probing depths, can make assumptions of the state of health of the periodontium. Early detection and diagnosis are significant components in the prevention of periodontal disease. The American Academy of Periodontology (AAP) recommends every dental patient should receive a comprehensive periodontology evaluation annually.¹¹ The Periodontal Screening and Recording^® (PSR) system is one example of a diagnostic aid used to assess the periodontal health of patients. The PSR system has been used to study the relationship in overweight and obese patients who smoke as well as a way to estimate the periodontal health statuses of a representative military population.^2,8 A study by Khocht et al found the PSR to be an effective tool in the screening of periodontal diseases.⁴ The PSR has been used to detect the periodontal status of individuals with immunoglobulin A deficiency.¹² Overall, there are a limited number of studies involving use of the PSR.

Background

In 1982, the World Health Organization (WHO) created the Community Periodontal Index of Treatment Needs (CPITN). This method of evaluation estimated the periodontal disease prevalence and severity based on the probing depths and condition of the periodontium. In 1992, the AAP modified the Simplified Periodontal Examination (SPE), used in New Zealand, and developed the PSR system for use in North America (journal article). With the corporate sponsorship of the Procter & Gamble Company, the AAP and the American Dental Association (ADA) adopted the PSR system.³

The PSR system was designed to initiate the promotion, prevention, and early treatment of periodontal diseases by:

• Introducing a simplified screening method that met legal dental recording requirements.

• Encouraging dentists to incorporate the PSR system into every oral examination.

• Educating members of the public to value periodontal health and to request a periodontal screening from dentists (PSR Training Program, 1992).