How Gum Disease Is Diagnosed: Pocket Depths, Bleeding Scores and Staging
What BPE codes, pocket depths, bleeding scores, X-rays, staging and grading mean, and how change is tracked. In UK guidance the BPE is only a screen; a periodontitis diagnosis comes from a pocket chart, bleeding and X-rays, then staging and grading.
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Clinically reviewed by Dr Ibraheem Ijaz, dentist · GDC 301711
Medical disclaimer: This page is for general information only. It does not replace an examination or treatment by a dentist.
Dr Ibraheem Ijaz, GDC 301711, a General Dental Practitioner and the principal dentist at Deepcar Dental Care, reviewed this page. His qualifications include BDS, BSc (Hons) and MSc (Leeds).
Why does measuring gum disease matter?
Measuring the gums matters because gum disease often causes no pain, and early detection and treatment of periodontitis increase the likelihood of keeping teeth.
You can be unaware of active disease for many years, Leeds Teaching Hospitals NHS Trust notes. Delivering Better Oral Health (DBOH), the UK prevention toolkit, links early detection with keeping teeth and defines periodontal disease by measurement.
What does a periodontal probe measure?
A periodontal probe measures probing pocket depth, how deep the space between gum and tooth is, and shows whether the gum bleeds when gently probed.
For the basic periodontal examination (BPE), the British Society of Periodontology (BSP) specifies a probe with a 0.5 mm ball end and a black band from 3.5 to 5.5 mm. The highest score in each of six sections (sextants) is recorded.
A six-point pocket chart measures six sites per tooth, with bleeding recorded alongside (BSP). Clinical attachment loss shows as recession between the teeth, pocketing, or both, and is measured in millimetres from the cemento-enamel junction (CEJ), DBOH explains.
What does a BPE score mean?
BPE codes run from 0, healthy gums, to 4, a pocket of 6 mm or more; an asterisk marks furcation involvement.
| Code | What the probe shows (BSP, DBOH) | Usual next step in guidance |
|---|---|---|
| 0 | Pockets under 3.5 mm, no calculus or overhangs, no bleeding | No periodontal treatment |
| 1 | As 0, but bleeding on probing | Oral hygiene instruction |
| 2 | Pockets under 3.5 mm with calculus (tartar) or an overhanging restoration | As 1, plus removing these plaque-retentive factors |
| 3 | Black band partly hidden: a 4 to 5 mm pocket | X-rays; initial therapy with self-care advice, as 2 plus root surface debridement if needed; then a six-point chart of that sextant |
| 4 | Black band hidden: a pocket of 6 mm or more | Oral hygiene instruction, root surface debridement, a whole-mouth six-point chart, X-rays, staging and grading, assessing the need for more complex treatment; referral may be indicated |
| * | Furcation involvement, recorded with the number, such as 3* | Treated according to the number, assessing the need for more complex treatment; referral may be indicated |
What does each pocket depth mean?
After treatment, pockets of 4 mm or less without bleeding meet the European Federation of Periodontology (EFP) definition of pocket closure.
In periodontitis, any pocket of 5 mm or more meets the BSP flowchart's 'currently unstable' criterion. Pockets of 6 mm or more are the BPE code 4 range, and having no such deep pockets is one EFP endpoint of therapy.
What does a bleeding score show?
A bleeding score is the percentage of probed sites that bleed, a measure of gum inflammation.
With BPE codes 0 to 2 and no obvious recession between the teeth, the BSP flowchart reads under 10% of sites bleeding as clinical gingival health, 10 to 30% as localised gingivitis and over 30% as generalised gingivitis.
To ask about gum disease, book online or call 0114 288 2121.
Why are X-rays used to diagnose gum disease?
X-rays show the radiographic bone level, which UK staging uses to measure bone loss between the teeth.
The BSP says radiographs should be available for sextants scoring 3 or 4. Where X-rays are not clinically justified, or only bitewings are available, staging uses attachment loss or bone loss measured from the CEJ (BSP flowchart). Dental X-ray types and radiation safety have their own page.
How are gum disease stage and grade worked out?
In UK guidance, the stage records how much bone has been lost to periodontitis and the grade how fast, both at the worst-affected site.
UK guidance uses the BSP's adaptation of the 2017 World Workshop classification (DBOH):
| Stage | Bone loss between the teeth at the worst site |
|---|---|
| I (early or mild) | Under 15% of root length, or under 2 mm attachment loss from the CEJ |
| II (moderate) | Coronal third of the root |
| III (severe) | Middle third |
| IV (very severe) | Apical third |
For grade, the BSP flowchart divides the worst site's percentage of bone loss by the patient's age. A result below 0.5 is grade A (slow rate of progression), 0.5 to 1.0 grade B (moderate) and above 1.0 grade C (rapid). DBOH also records extent as localised (up to 30% of teeth), generalised or a molar-incisor pattern.
The stage cannot go down, because the bone loss is largely irreversible, but it may go up, DBOH explains. Whether gum disease can be reversed and periodontitis have their own pages.
How is change tracked over time?
In BSP guidance, change is tracked by repeating six-point pocket charts, showing how each site responds to treatment.
The BSP advises a chart before and after treatment, and full probing depths at least annually in the maintenance phase after initial therapy for periodontitis. The EFP advises assessing the response to cleaning below the gum once the gums have healed (periodontal re-evaluation). The BSP flowchart gives three statuses:
| Periodontitis status | BSP definition |
|---|---|
| Currently stable | Bleeding under 10%, pockets 4 mm or less, no bleeding at 4 mm sites |
| Currently in remission | Bleeding 10% or more, pockets 4 mm or less, no bleeding at 4 mm sites |
| Currently unstable | Pockets of 5 mm or more, or 4 mm or more with bleeding |
Treated, stable periodontitis patients with healthy gums remain at increased risk of it returning and must be closely monitored, the 2017 World Workshop consensus states. Success after deep cleaning treatment below the gum line has its own page.
How do you read your own gum chart?
A gum chart records what dental professionals measured; BSP formats for its main parts are:
- BPE grid: six boxes, each with a sextant's highest code, such as 4, 3 or 3*.
- Pocket chart: only sites of 4 mm and above need recording, with bleeding recorded alongside.
- Diagnosis statement: extent, stage, grade, current status and risk factors, as in the BSP example of generalised periodontitis, stage 3, grade B, currently unstable, in a smoker of 15 cigarettes a day.
What are the limits of these measurements?
The BPE is for screening only, not diagnosis, and cannot monitor the response to treatment, the BSP says.
- Gums bleed less readily in smokers (Leeds Teaching Hospitals); why gums bleed when you brush covers smoking's effect.
- The EFP guideline notes the endpoints of therapy may not be achievable in all teeth in severe stage III periodontitis.
When should you see a dentist about your gums?
NHS guidance gives these actions; if you do not have a dentist or cannot get an emergency appointment, call 111 or visit 111 online:
- Gums that bleed when you brush your teeth or eat hard foods, gums that are painful and swollen, bad breath, or a child with sore, bleeding gums: see a dentist.
- Gum disease, in you or your child, with other symptoms such as very sore and swollen gums, teeth becoming loose or falling out, ulcers or red patches in your mouth, or a lump in your mouth or on your lip: ask for an urgent dentist appointment.
- Toothache that lasts more than 2 days, does not go away with painkillers, or comes with a high temperature, pain when you bite, red gums, a bad taste or a swollen cheek or jaw: see a dentist.
- Toothache with swelling around your eye or neck, or swelling in your mouth or neck that makes it difficult to breathe, swallow or speak: go to A&E, but do not drive; ask someone to drive you or call 999 and ask for an ambulance.
How much does gum treatment cost?
Non-surgical periodontal therapy, treatment of advanced gum disease, gum surgery, gum grafting and regenerative gum treatment have no line on the current fee list. Neither do BPE screening, full six-point periodontal charting or smoking cessation advice.
Frequently asked questions
What is a 4 mm pocket?
A 4 mm pocket is a site where the probe goes 4 mm below the gum edge. It scores BPE code 3, the 4 to 5 mm band. Without bleeding after treatment, it fits the European Federation of Periodontology's definition of pocket closure; if it bleeds, it meets the British Society of Periodontology's criterion for currently unstable periodontitis.
Can you have periodontitis with low BPE scores?
Sometimes. UK guidance (DBOH) gives the example of a previously treated, stable periodontitis patient with attachment loss between the teeth but BPE codes of only 0, 1 and 2, staged from attachment loss measured from the CEJ when X-rays are not available or justifiable. The BSP flowchart sends obvious recession between the teeth to full assessment.
Can pocket depths improve after treatment?
They can. Leeds Teaching Hospitals says successful treatment will reduce bleeding and the depth of pockets but is not generally able to reverse bone loss. UK guidance (DBOH) notes that pockets do not always reduce, even in successful treatment, which is one reason the BPE cannot assess the response.
Can you measure your own gum pockets at home?
No. Pocket depths are measured with a periodontal probe and bone levels with X-rays, by dental professionals. Leeds Teaching Hospitals says a reliable diagnosis can only be made by a dental clinician, and the BSP asks clinicians to interpret BPE scores taking into account factors that may be unique to each patient.
What gum care is available at Deepcar Dental Care?
Gum care at Deepcar Dental Care includes BPE screening at every examination, full six-point periodontal charting, non-surgical periodontal therapy and smoking cessation advice. Treatment of advanced gum disease is done in house, as are gum surgery, gum grafting and regenerative gum treatment.
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Deepcar Dental Care is at 334 Manchester Road, Deepcar, Sheffield, S36 2RH, with free parking directly outside. See hygiene appointments and patient reviews.
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