When a dentist or hygienist calls out a number like “four” during a check-up, they are using the Periodontal Screening and Recording (PSR) system to quickly assess gum health. This standardized method is a rapid, initial tool to identify patients who may have gum disease and require a more detailed evaluation. The PSR system divides the mouth into six sections, known as sextants, and assigns a single code based on the deepest measurement found in each area. Hearing a score of 4 flags that a significant change has occurred in the gum tissue, signaling the need for a comprehensive periodontal assessment.
Understanding the Periodontal Screening System
The PSR system is a globally recognized method for screening gum health. It uses a specialized instrument called a periodontal probe, which has a small, colored band on its tip to gauge the depth of the gum pockets. The probe is gently inserted into the space between the tooth and the gum tissue, and the resulting measurement is the pocket depth.
The codes progress from 0 to 4, representing increasing severity of gum change. A Code 0 indicates a healthy state, with no bleeding or hardened plaque (calculus) and shallow pockets of 3 millimeters (mm) or less. Codes 1 and 2 represent mild changes, typically involving bleeding or calculus, but still with shallow pocket depths. A Code 3 is assigned when the colored band is only partially visible, indicating a pocket depth between 3.5 mm and 5.5 mm, which suggests moderate gum disease. The score of 4 represents the most severe finding in this initial screening process.
What a Code 4 Score Specifically Indicates
A Code 4 is assigned when the colored band on the periodontal probe completely disappears into the gum pocket. This lack of visibility means the deepest pocket in that section measures 6 millimeters (mm) or more. This depth is a direct physical manifestation of significant tissue destruction caused by long-term bacterial infection.
Healthy gum tissue attaches tightly to the tooth, creating a shallow pocket typically 3 mm or less. When bacteria accumulate and inflammation persists, the immune response breaks down the connective tissue and underlying bone supporting the tooth. This destruction deepens the pocket, creating a larger space where bacteria thrive, which the Code 4 measurement reflects.
A measurement of 6 mm or more indicates that a considerable amount of the attachment apparatus holding the tooth has been lost. This loss is a strong indicator of advanced periodontal disease, often referred to as periodontitis.
Diagnosis and Necessary Follow-Up
A Code 4 signals a moderate to advanced case of periodontitis in that area. Since the PSR is a screening tool, this score immediately mandates a comprehensive periodontal examination of the entire mouth to accurately map the full extent of the disease.
The comprehensive examination involves full-mouth probing, where the depth of every pocket around every tooth is measured and meticulously charted, along with recording any bleeding. Additionally, diagnostic imaging, specifically a full series of dental X-rays, is required to visualize the bone loss beneath the gums. X-rays allow the dental professional to determine the pattern and severity of bone destruction, which is necessary to assign a formal diagnosis and stage the disease.
Detailed charting also looks for other signs of advanced disease, such as tooth mobility and involvement of the furcation, the area between the roots of multi-rooted teeth. The combination of probing data, clinical observations, and radiographic evidence provides a complete picture, allowing the dentist to create a specific, personalized treatment plan.
Treatment Options for Advanced Periodontitis
The primary non-surgical treatment for the advanced infection indicated by a Code 4 score is Scaling and Root Planing (SRP), commonly known as a deep cleaning. This procedure is performed under local anesthesia and goes beyond a standard cleaning to remove hardened plaque and calculus from the deep periodontal pockets. The goal is to eliminate the source of the infection by thoroughly cleaning the tooth root surfaces.
During root planing, the tooth roots are smoothed to remove bacterial toxins and create a clean surface. This makes it more difficult for bacteria to reattach and allows the gum tissue to heal and reattach more firmly. After SRP, pocket depths are expected to reduce as inflammation subsides and the gums tighten around the teeth. In some cases, localized antibiotic delivery systems may be placed into the deep pockets to aid in eliminating remaining bacteria.
If SRP does not sufficiently reduce the pocket depths, or if the pockets are too deep to be effectively cleaned non-surgically, surgical options may be necessary. These procedures, such as osseous or flap surgery, involve temporarily lifting the gum tissue to gain direct access to the deeper infection and bone defects. Bone grafting procedures may be performed in advanced cases to encourage the regeneration of lost bone structure. These interventions are followed by a strict regimen of ongoing periodontal maintenance appointments to prevent the disease from recurring.
Understanding the Periodontal Screening System
The PSR system is a globally recognized method for screening gum health. It utilizes a specialized periodontal probe with a colored band on its tip to gauge the depth of the gum pockets. The probe is inserted between the tooth and the gum tissue, and the resulting measurement is the pocket depth.
The codes progress from 0 to 4, representing increasing severity of gum change. Code 0 indicates a healthy state, with no bleeding or calculus, and shallow pockets of 3 millimeters (mm) or less. Codes 1 and 2 represent mild changes, involving bleeding or calculus, but maintaining shallow pocket depths. A Code 3 is assigned when the colored band is only partially visible, indicating a pocket depth between 3.5 mm and 5.5 mm, which suggests moderate changes. The score of 4 represents the most severe finding in this initial screening process.
What a Code 4 Score Specifically Indicates
A Code 4 is assigned when the colored band on the periodontal probe completely disappears into the gum pocket. This means the deepest pocket measures 6 millimeters (mm) or more. This depth is a physical manifestation of significant tissue destruction caused by long-term bacterial infection.
Healthy gum tissue attaches tightly to the tooth, creating a shallow pocket typically 3 mm or less. When bacteria accumulate, inflammation persists, and the immune response breaks down the connective tissue and underlying bone. This destruction deepens the pocket, creating a larger space where bacteria thrive, which the Code 4 measurement reflects.
A measurement of 6 mm or more is a strong indicator of advanced periodontal disease (chronic periodontitis). This depth signifies that a considerable amount of the attachment apparatus holding the tooth has been lost, actively compromising the stability of the tooth in that area.
Diagnosis and Necessary Follow-Up
A Code 4 signals a moderate to advanced case of periodontitis, immediately mandating a comprehensive periodontal examination of the entire mouth. This in-depth assessment is necessary to accurately map the full extent of the disease.
The examination involves full-mouth probing, where the depth of every pocket is measured and meticulously charted, along with recording any bleeding. Diagnostic imaging, specifically a full series of dental X-rays, is required to visualize bone loss beneath the gums. X-rays allow the professional to determine the pattern and severity of bone destruction, providing information to assign a formal diagnosis and stage the disease.
Detailed charting also looks for other signs of advanced disease, such as tooth mobility and involvement of the furcation (the area between the roots of multi-rooted teeth). The combination of probing data, clinical observations, and radiographic evidence provides a complete picture for creating a specific, personalized treatment plan.
Treatment Options for Advanced Periodontitis
The primary non-surgical treatment for the advanced infection indicated by a Code 4 score is Scaling and Root Planing (SRP), commonly referred to as a deep cleaning. This procedure is performed under local anesthesia and goes beyond a standard cleaning to remove hardened plaque and calculus from the deep periodontal pockets. The goal is to eliminate the source of the infection by thoroughly cleaning the tooth root surfaces.
During root planing, the tooth roots are smoothed to remove bacterial toxins and create a clean surface, allowing the gum tissue to heal and reattach more firmly. After SRP, the pocket depths are expected to reduce as inflammation subsides and the gums tighten around the teeth. Localized antibiotic delivery systems may be placed into the deep pockets to aid in eliminating remaining bacteria.
If SRP does not sufficiently reduce the pocket depths, surgical options may be necessary. These procedures, such as osseous or flap surgery, involve temporarily lifting the gum tissue to gain direct access to the deeper infection and bone defects. Bone grafting procedures may also be performed in advanced cases to encourage the regeneration of lost bone structure. These interventions are followed by ongoing periodontal maintenance appointments to prevent recurrence.