Periodontal Screening

The newest in periodontal screening

This form has been adapted from the Community Periodontal Index of Treatment Needs (CPITN) developed by the Oral Health Unit of the World Health Organization (WHO).

This screening satisfies dental-legal requirements for monitoring and record keeping for periodontal conditions. The scoring is quick and easy. 

The mouth is divided into sextants. A perio screening probe, available from most instrument suppliers, with a darkened band from 3.5mm to 5.5 mm is used. Scoring depends on how much of the darkened band is visible. (See explanation key on form). If a Code 0, 1 or 2 is found in all sextants, a comprehensive periodontal examination may be needed. A Code 3 or 4 indicates the need for a localized or full mouth comprehensive exam. Use our form C-103R Comprehensive Periodontal Examination. Order the form separately from STARTER KIT.

  • Accepted format for perio screening
  • Patient can participate visually using mirror or intra-oral camera
  • A Code 3 or 4 indicates the need for a comprehensive perio exam.
C-203R Periodontal Screening
$18.00 / 200 $34.00 / 400
$64.00 / 800 $120.00 / 1600



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