BPE Scoring Guide: Codes 0–4, the Asterisk (*), and What to Do Next

Last updated June 2026·9 min read

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Published by Nosht Limited

BPE Codes 0–4 and the Asterisk: Canonical Reference Table

The codes and thresholds below are taken from the BSP Basic Periodontal Examination (BPE) guidance (British Society of Periodontology, January 2019). The step-based treatment actions draw on the BSP UK implementation of the EFP S3-level treatment guidelines for stage I–III periodontitis (BSP, 2021).

BPE Code	Probe finding	What it means	BSP-recommended clinical action
0	Black band fully visible; no bleeding on probing; no calculus or plaque-retentive factors detected	Healthy periodontal tissues in this sextant	No periodontal treatment required; routine oral hygiene reinforcement (BSP, 2019)
1	Black band fully visible; bleeding on probing; no calculus; no pocket ≥3.5 mm	Gingival inflammation (gingivitis) without structural pocketing or calculus	Oral hygiene instruction (OHI) (BSP, 2019)
2	Black band fully visible; calculus (supra- or subgingival) and/or a plaque-retentive factor detected; pocket depth ≤3.5 mm	Calculus or restoration defect contributing to plaque retention, without significant pocketing	As for code 1, plus removal of plaque-retentive factors and all supra- and subgingival calculus (BSP, 2019)
3	Black band partially visible (lower edge subgingival, upper edge visible)	Pocket depth 3.5–5.5 mm (moderate pocketing, about 4–5 mm)	As for code 2, plus root surface debridement (RSD) if required. Radiographs for the sextant. After initial therapy, record a 6-point pocket chart in that sextant only — not the whole mouth (BSP, 2019)
4	Black band completely subgingival	Pocket depth >5.5 mm (a pocket of 6 mm or more; deep pocketing)	Record a 6-point pocket chart throughout the entire dentition; OHI and RSD; periapical radiographs to assess bone loss; assess the need for more complex treatment — specialist referral may be indicated (BSP, 2019)
*	Furcation involvement detected in a sextant	The probe tip can be inserted horizontally into the furcation of a multi-rooted tooth in this sextant	Record both the number AND the * for any sextant where furcation is detected (e.g. 3* or 4); the BSP does not restrict the to codes 3/4. Furcation worsens prognosis; treat according to the sextant code and consider specialist referral (BSP, 2019)

Record a full six-sextant BPE chart in the free BPE calculator →

Implants: do not use the BPE around implants; use 4- or 6-point pocket charting instead (BSP, 2019).

Clinical note on the asterisk: The asterisk (*) is written alongside the sextant’s code, not as a separate entry. A sextant scored as 4* has deep pocketing (>5.5 mm) AND furcation involvement. A sextant scored as 3* has moderate pocketing (3.5–5.5 mm) AND furcation involvement. The * is the BPE’s signal that the sextant has additional structural complexity that will affect treatment planning and prognosis.

What is BPE?

The Basic Periodontal Examination (BPE) is a rapid six-sextant screening tool used in UK dentistry to detect periodontal disease. Using a specific WHO/CPITN probe, each sextant scores 0–4 based on pocket depth and clinical findings, with an asterisk (*) added when furcation involvement is detected. The BSP Basic Periodontal Examination (BPE) guidance (British Society of Periodontology, 2019) recommends recording a BPE for all new patients and, for patients with codes 0–2, at every routine examination.

A BPE score is not a diagnosis of periodontal disease — it is a screening score that indicates what further examination and management is needed. A code 4 in any sextant means you must record a full-mouth periodontal chart before planning treatment.

The BPE probe: how it works

The BPE probe is a calibrated, round-ended (ball-tipped) instrument used to measure pocket depth and detect furcation involvement. The WHO/CPITN BPE probe has a ball-end of 0.5 mm diameter, which allows it to enter the base of a sulcus without penetrating the junctional epithelium under a light probing force of 20–25 g (BSP, 2019). The probe carries a distinctive black band between 3.5 mm and 5.5 mm. The position of this band relative to the gingival margin after probing determines the BPE code:

Black band fully visible above the gingival margin → pocket depth ≤3.5 mm → codes 0, 1, or 2
Black band partially subgingival → pocket depth 3.5–5.5 mm → code 3
Black band completely subgingival → pocket depth >5.5 mm → code 4

Six sextants are examined: upper right (UR7–UR4), upper anterior (UR3–UL3), upper left (UL4–UL7), lower right (LR7–LR4), lower anterior (LR3–LL3), and lower left (LL4–LL7). Third molars are not included unless the first and/or second molar is missing, and a sextant must contain at least two teeth to qualify for recording (BSP, 2019). Only the highest (worst) code per sextant is recorded.

What does the asterisk (*) mean in BPE? A closer look

The BPE asterisk signals furcation involvement — arguably the most clinically significant modifier in the BPE system, and a common source of confusion for students and newly qualified dentists. A furcation is the zone where the roots of a multi-rooted tooth diverge. Furcation involvement occurs when periodontal disease has progressed apically to the point that the probe tip can enter the space between the roots. Even in a sextant with a code 3 (moderate pocketing), furcation involvement dramatically changes the clinical picture: it increases the technical difficulty of root surface debridement and is associated with a less favourable long-term prognosis.

The asterisk does not replace the BPE code — it modifies it. You always record the code AND the asterisk: write the code number followed by * in the BPE chart box for that sextant. The BSP guidance instructs that both the number and the * should be recorded whenever a furcation is detected, and it does not restrict the asterisk to codes 3 or 4 — so furcation in a code 2 sextant would be recorded as 2* (BSP, 2019). The published BSP examples illustrate 3* and 4*, but the rule applies to whatever code the sextant scores.

What does "BPE 2b" or "3b" mean? (Bleeding notation)

The codes "2b", "3b" or a "b" suffix on any BPE code are not part of the standard BSP BPE coding system. In the standard BPE protocol, bleeding on probing is captured by code 1 and is not separately notated at higher codes.

You may encounter "b" suffix notation in some teaching hospital contexts, older practice software, or individual practice-level modifications where clinicians record bleeding on probing separately from the sextant’s worst finding. This is a non-standardised local modification and is not endorsed by the BSP, FGDP/CGDent, or GDC guidance. Confirmed against the source: the BSP 2019 BPE scoring system comprises only the codes 0, 1, 2, 3, 4 and the asterisk (*). No BSP, FGDP/CGDent or GDC publication defines a "b" (bleeding) suffix (BSP, 2019).

Why this matters medico-legally: If you use non-standard BPE notation in your clinical records, a different clinician reading the record (or an expert witness in a GDC complaint or negligence case) may be unable to interpret it. The GDC Standards for the Dental Team (2013, Standard 4.1) requires you to "make and keep contemporaneous, complete and accurate patient records." The correct approach is to record the standard BPE code (0–4, ± *) and, where clinically relevant, note bleeding as a separate finding in the free-text clinical notes. See our dental abbreviations guide for BPE charting notation.

When should you record a BPE?

A BPE should be recorded at every routine examination for adult patients — both at new patient examinations and at recall visits. The BSP 2019 guidance states that all new patients should have a BPE recorded, and that for patients with codes 0, 1 or 2 the BPE should be recorded at every routine examination. (For sextants scoring 3 or 4, more detailed periodontal charting replaces a simple repeat BPE.) (BSP, 2019)

New patient examinations — to establish a baseline for monitoring
Recall examinations — to detect changes from the previous BPE record
Not after periodontal treatment — the BPE cannot measure treatment response. Record a 6-point pocket chart before and after treatment, and full-mouth probing depths at least annually in maintenance (BSP, 2019)
Before oral surgery, implant placement, or restorative treatment — to document periodontal status prior to the planned procedure

A BPE cannot defensibly be omitted from an examination record simply because it is inconvenient or because the patient declined probing. If a patient declines the periodontal examination, document this explicitly, including the reason given and any advice provided.

BPE in children and young patients

The standard six-sextant BPE protocol is modified for children and young patients to account for the presence of primary and mixed dentition. The full six-sextant BPE is used from age 18; the simplified BPE (sBPE) applies to children and adolescents under 18, from around age 7 (BSP/BSPD, 2021).

For children and adolescents under 18, the BSP and British Society of Paediatric Dentistry (BSPD) recommend a simplified BPE examining six index teeth: the four first permanent molars (UR6, UL6, LR6, LL6) plus UR1 and LL1 — i.e. FDI 16, 11, 26, 36, 31, 46 (BSP/BSPD, 2021). Only codes 0–2 are used in 7- to 11-year-olds, while the full range (0, 1, 2, 3, 4 and *) is used in 12- to 17-year-olds. Record the BPE code for each index tooth individually rather than per sextant.

BPE code 4: when to refer

A BPE code 4 in any sextant does not automatically require specialist periodontal referral— it requires a full-mouth (whole-dentition) 6-point pocket chart and active periodontal treatment starting with BSP Steps 1 and 2. However, specialist referral should be considered for code 4 cases in several circumstances. Referral decisions are governed by the BSP’s companion document, the Referral Policy and Parameters of Care (BSP, 2019):

The patient has residual deep pocketing (≥6 mm) after completion of Steps 1 and 2 that may require surgical management or referral at Step 3 (BSP S3-level treatment guidelines, 2021)
The case involves furcation involvement (code 4*) requiring surgical furcation therapy
The patient has a complex medical history (e.g. poorly controlled diabetes, immunosuppression) affecting periodontal prognosis
The treating clinician is not confident in managing a case of this complexity within their competence and experience

Documentation of the decision to refer — or not to refer — is as important as the referral itself. If you are managing a code 4 patient in primary care without specialist referral, record your clinical rationale. If you refer, document the date, the sextant(s) and clinical justification, and the outcome.

Documenting BPE in your clinical records

BPE must be recorded as part of every routine clinical examination. The GDC Standards for the Dental Team (2013, Standard 4.1) and the FGDP Clinical Examination and Record Keeping: Good Practice Guidelines (3rd edition, 2016; stewardship transferred to the College of General Dentistry in 2021, with no later edition published) both require that periodontal status is recorded at every examination. A defensible BPE record contains:

The date of the examination
Six individual sextant codes (one per sextant), not just a single "worst" code for the entire mouth
The asterisk noted in the relevant sextant box where furcation involvement was detected
The action taken as a consequence of the BPE
Consecutive BPE records at each recall to demonstrate monitoring over time

A record that simply states "BPE done", or records only a single number (e.g. "BPE 3") without specifying which sextant or the action taken, falls short of the FGDP/CGDent record-keeping standard: records should be clear, complete, reproducible and linked to the action taken. For broader documentation requirements, see our GDC dental records guide.

How Nosht supports BPE and periodontal documentation

Nosht provides structured clinical note templates for UK dental practices, including periodontal assessment templates that prompt BPE recording at the sextant level, link BPE codes to BSP-recommended actions, and include fields for periodontal charting and treatment planning. Unlike AI audio scribes, Nosht’s templates do not transcribe dictated speech— they provide structured, GDC-Standards-aligned prompts that ensure nothing is missed.

Try the free periodontal staging and grading calculator (for use after a full assessment) — no account needed — or document your BPE and periodontal findings alongside a BSP-aligned workflow. For how each BPE code maps onto the full classification, see the periodontal staging and grading reference.

Frequently asked questions

What are the BPE codes 0 to 4 in dentistry?

BPE codes 0–4 represent the worst periodontal finding in each of six mouth sextants, recorded using a WHO/CPITN probe. Code 0 means healthy tissues with no bleeding; code 1 means bleeding on probing without calculus or pockets; code 2 means calculus or a plaque-retentive factor; code 3 means a pocket depth of 3.5–5.5 mm (black band on the probe partially disappears); code 4 means a pocket depth greater than 5.5 mm (black band completely disappears). The asterisk (*) is added when furcation involvement is detected in any sextant.

What does the asterisk (*) mean in BPE?

In BPE recording, the asterisk (*) indicates furcation involvement — the point at which periodontal disease has progressed so that the probe tip can be inserted horizontally into the space between the roots of a multi-rooted tooth. The asterisk is written alongside the sextant’s numeric code (for example, 4* or 3*). It is not a separate BPE code; it modifies the existing code to signal additional structural complexity. Furcation involvement typically worsens the long-term prognosis for the affected tooth or teeth and may affect treatment planning and decisions about specialist referral.

What does "BPE 3b" or "2b" mean?

The "b" suffix on a BPE code (e.g. "2b" or "3b") is NOT a standard BSP BPE notation. In the formally published BPE system, bleeding on probing is already captured by code 1 and is not separately notated at higher codes. If you encounter this notation in a clinical record, it is likely a non-standard practice-level modification in which "b" has been added to denote bleeding on probing alongside the worst-finding code. If you use non-standard notation in your records, you should maintain a practice-level glossary, as records must be interpretable by any registered dental professional under GDC Standard 4.1. The BSP 2019 BPE system uses only codes 0–4 and the asterisk; no BSP, FGDP/CGDent or GDC publication defines a "b" suffix (BSP, 2019).

When should a BPE be recorded?

A BPE should be recorded at every routine clinical examination for adult patients, including new patient examinations and recall visits. The BSP (2019) describes the BPE as a minimum standard of care for initial periodontal assessment and recommends recording it for all new patients and, for patients with codes 0–2, at every routine examination. It should also be recorded before surgical procedures, implant placement, or major restorative treatment to document the pre-treatment periodontal status. In medico-legal terms, an examination record without a BPE is an incomplete record and may not adequately document the patient’s periodontal health at the time of the appointment.

Does a BPE code 4 mean I must refer to a periodontist?

A BPE code 4 does not automatically require specialist referral — it requires a full-mouth periodontal chart and active periodontal treatment following the BSP’s four-step pathway. However, specialist referral should be seriously considered where the patient has deep residual pocketing after completion of Steps 1 and 2, where furcation involvement is present (code 4*), or where the complexity of the case exceeds the treating clinician’s experience. The decision to refer or manage in-house must be documented, including the clinical rationale. Referral decisions are governed by the BSP Referral Policy and Parameters of Care (BSP, 2019).

How is BPE different from full periodontal charting?

BPE is a rapid sextant-based screening tool that records the worst finding per sextant, not individual pocket depths at each tooth surface. Full periodontal charting records pocket depth (usually at six sites per tooth), recession, bleeding on probing, plaque/BOP indices, furcation involvement grade, and clinical attachment level for every tooth. Full charting is required when BPE scores 3 or 4 are recorded, as the sextant-level BPE is insufficient to plan active periodontal treatment.

Is BPE mandatory for every adult patient in UK dentistry?

The BSP recommends recording a BPE for all new patients and, for those with codes 0–2, at every routine examination (BSP, 2019). Under the FGDP/CGDent Clinical Examination and Record Keeping guidelines (3rd edition, 2016), the absence of a BPE from an adult examination record constitutes a record-keeping deficiency. In an NHS setting, omission of BPE from patient records may be identified as a concern during BSA dental audit. In a CQC inspection or GDC complaint, a pattern of missing BPE records would likely be flagged as indicative of a systemic failure in clinical examination standards.

Can a dental hygienist or therapist record a BPE?

Yes. Dental hygienists and therapists are trained in periodontal assessment and are competent to carry out and record BPE as part of their clinical scope. When working under direct access (introduced on 1 May 2013 in the UK), a hygienist or therapist is responsible for their own periodontal assessment, including BPE recording, without requiring a prior examination by a dentist. The same documentation standards apply to BPE records made by hygienists and therapists as to those made by dentists — the record must include the date, all six sextant scores, the asterisk where applicable, and the clinical action taken.

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Sources

GDC Standards for the Dental Team, Principle 4: Maintain and protect patients’ information (accessed 18 October 2026)
CGDent: Clinical Examination and Record-Keeping, Good Practice Guidelines (3rd edition) (accessed 18 October 2026)
BSP: The Basic Periodontal Examination (BPE), 2019 (accessed 18 October 2026)
BSP: Implementing the 2018 Classification of Periodontal Diseases to Reach a Diagnosis in Clinical Practice (accessed 18 October 2026)
West N, et al. BSP implementation of European S3-level evidence-based treatment guidelines for stage I–III periodontitis in UK clinical practice. J Dent 2021 (accessed 18 October 2026)
Sanz M, et al. Treatment of stage I–III periodontitis: the EFP S3 level clinical practice guideline. J Clin Periodontol 2020 (accessed 18 October 2026)