Comparison of Community Periodontal Index of Treatment Needs and Bleeding on Probing in Partial- and Full-Mouth Examinations for Assessing Children’s Gingival Status: A Cross-Sectional Study

Abstract

Background: The asymptomatic progression of initial gingival inflammation in children often remains unnoticed or undiagnosed. Although full-mouth periodontal examination is considered the gold standard in diagnosing periodontal diseases, it is usually time-consuming and expensive. Therefore, the aim of this study was to assess gingival status using partial-mouth examination with the Community Periodontal Index of Treatment Needs (CPITN) and full-mouth examination with Bleeding on Probing (BOP) in the periodontal diagnosis of adolescents. Methods: This cross-sectional study was conducted in a sample of 457 Bulgarian children aged 11 to 14 years. Full-mouth examination was performed with the BOP index on all fully erupted permanent teeth, probing four gingival sites—three buccal and one oral. Partial-mouth examination was performed with CPITN, probing six representative teeth at six sites. Statistical analysis was conducted using Pearson’s chi-square test (χ²) and t-tests to compare relative proportions. Results: The BOP index identified significantly more healthy children compared to the CPITN (t = 1.90, p < 0.05). The CPITN has limitations in distinguishing between initial (BOP 10–30%) and advanced (BOP 30–60%) gingival inflammation. The comparative evaluation of the two indices by sextant showed that a healthy periodontium is most commonly observed in the posterior segments of both jaws in children, while gingival inflammation is localized predominantly in frontal areas. Conclusions: The CPITN has the advantage of providing a quick and easy method for recording gingival status in children, but it does not allow for the determination of the severity of gingival inflammation. Clinical Significance: Full-mouth examination using the BOP index is a more appropriate method for periodontal diagnosis in children, as it provides a detailed and comprehensive picture of the condition of the gingival tissues, especially when a clinical diagnosis is required to guide further treatment planning.

1. Introduction

In childhood and adolescence, gingival diseases are a common finding, and the asymptomatic progression of early forms of plaque-induced gingivitis often leads to these conditions remaining undiagnosed and, consequently, untreated for extended periods [1]. All of this creates conditions for the relatively rapid involvement of many components of the periodontal complex and serves as a prerequisite for the onset of inflammatory–destructive changes in the periodontium at an early age [1,2].

Children typically fail to recognize the early signs of gingival inflammation, and during puberty, oral hygiene often deteriorates due to behavioral and dietary factors. This increases the risk of developing periodontal disease [3,4,5,6]. Therefore, periodontal health assessments should be included in routine pediatric dental check-ups, with particular attention paid to modifiable risk factors [7,8]. Such assessments often rely on subjective clinical parameters like gingival color, contour, and swelling, which are visually evaluated by pediatric dentists [9,10].

Objective diagnostic evaluation is conducted using various gingival/periodontal indices—most notably through the detection of bleeding on probing (BOP) [11]. Though color and contour changes may appear earlier clinically, recent evidence suggests that provoked bleeding provides a more accurate reflection of gingival condition [12]. A growing number of studies now emphasize the importance of evaluating the extent of inflamed gingival tissue, recognizing that limited BOP (under 10%) is not sufficient to diagnose gingivitis but is a clear indication of the need for preventive periodontal measures [13].

In recent years, the assessment of the extent of inflammation-involved gingival structures in childhood has gained increasing importance. This is due to the understanding that the presence of a limited area of gingival inflammation (up to 10% provoked gingival bleeding) is still insufficient to classify the patient as having gingivitis but is a sufficient condition to initiate targeted periodontal prophylaxis [13].

Given the newly introduced category in the modern classification of periodontal diseases known as “periodontal health”, it is particularly important—especially in adolescents—to assess the condition of the gingival tissues through full-mouth examination [1,13]. The European Federation of Periodontology (EFP) and the American Academy of Periodontology (AAP) unanimously consider full-mouth periodontal examination to be the gold standard in diagnosing periodontal diseases. This includes evaluation of the gingival tissues around all fully erupted permanent teeth with a stabilized periodontium. To perform this evaluation objectively, the periodontal community recommends use of the Bleeding on Probing (BOP) index, applied at a minimum of four gingival sites per tooth [2,13].

Although full-mouth periodontal examination is considered an objective and accurate diagnostic model, it also has certain drawbacks. Typically, such an examination takes between 20 and 30 min, depending on the number of teeth to be probed, which makes it difficult to apply in large-scale epidemiological studies. In cases where a larger number of individuals must be examined, partial-mouth indices for assessing periodontal status have been introduced to reduce examination time. The most commonly used partial-mouth indices in periodontal diagnostics include the Community Periodontal Index of Treatment Needs (CPITN), Periodontal Screening and Recording (PSR), and Basic Periodontal Examination (BPE). These indices involve assessing the condition of gingival tissues around a single representative tooth per sextant (typically 16, 11, 26, 36, 31, and 46) [14,15,16]. In 2011, the British Society of Periodontology (BSP) and the British Society of Paediatric Dentistry (BSPD) proposed a modification of the BPE screening index for pediatric dental practice—the simplified BPE (sBPE). The goal of these guidelines and the simplified BPE is to provide a quick and easy method for evaluating periodontal health in children under 18 years of age. The index teeth are selected based on the assumption that, if periodontal damage exists elsewhere, these teeth are also likely to be affected [17].

The literature also frequently references partial-mouth examinations based on various gingival indices applied to Ramfjord teeth (16, 21, 24, 36, 41, 44), which are considered to provide a more objective evaluation of gingival status, since they also include the premolar group [18]. While these partial-mouth indices save time and resources for both dental professionals and patients by assessing only selected sites or representative teeth, they also can lead to the underestimation of the gingival condition or, conversely, to overdiagnosis.

Gingival diseases as common diseases in children require regular monitoring. While the periodontal assessment indices mentioned previously are widely used, their comparability—especially between partial- and full-mouth methods—remains unclear. To date, no comparison of partial- and full-mouth indices has been conducted among children in our country. To address this gap, we formulated the specific aim of the study.

Aim:

The aim of the present study is to assess gingival status using partial-mouth examination with the CPITN and full-mouth examination with BOP in the periodontal diagnosis of adolescents and to determine the comparability of the two indices.

2. Materials and Methods

Study Design and Participants

This cross-sectional study was conducted in a sample of 457 children aged 11 to 14 years from the city of Sofia, Bulgaria. The research was approved by the Ethics Committee for Scientific Research at the Medical University of Sofia, under protocol number 12/14 May 2020. Participation in the study required signed informed consent from a parent or legal guardian.

This cross-sectional study was conducted between March and September 2021. The children were recruited from three public primary schools in Sofia. School selection was carried out based on a combination of random sampling and convenience related to their willingness to participate in the study. Examinations were carried out on school premises during scheduled visits by the dental research team. The inclusion criteria were general good health, the presence of all fully erupted permanent teeth (excluding third molars), no ongoing orthodontic treatment, and no systemic diseases or medication that could affect gingival health. Exclusion criteria included the recent use of antibiotics or anti-inflammatory drugs (within the last 3 months), the presence of acute oral infections, or incomplete dental eruption for age.

Clinical Protocol and Examiner Calibration

All examinations were conducted by two calibrated pediatric dentists under standardized conditions. Prior to the study, a calibration session was conducted during which two examiners independently assessed the periodontal status of 30 randomly selected children. Inter-examiner agreement was calculated using Cohen’s kappa statistic, yielding a value of 0.85 (95% CI: 0.78–0.92).

A disposable mouth mirror, an artificial light, and a WHO 621 periodontal probe (with a 0.5 mm ball tip and graduated markings at 3.5, 5.5, 8.5, and 11.5 mm) were used for all examinations [19]. Probing was performed with controlled pressure not exceeding 25 g, verified during calibration using a precision scale.

Diagnosis and Gingivitis Case Definitions

The diagnostic protocol for all children included performing a comprehensive periodontal examination, collecting anamnestic data regarding oral hygiene habits, and assessing oral and gingival status.

For the purposes of the study, the gingival status of all participants was recorded using two gingival indices: the Bleeding on Probing (BOP) index [13] and the Community Periodontal Index of Treatment Needs (CPITN) [14].

Bleeding on Probing (BOP)—Full-Mouth Examination

We initially assessed provoked gingival bleeding using the BOP index. The gingival sulcus around all fully erupted permanent teeth was probed at four gingival points—three buccal and one oral. We recorded the presence or absence of bleeding. The index was calculated as the relative share of gingival points exhibiting bleeding.

$$BOP={\displaystyle \frac{number \mathit{of} bleeding gingival points}{number of examined gingival points}}\times 100$$

According to the index values, and in line with the contemporary classification of periodontal diseases [1], the children were divided into three groups:

Group 1—Periodontal health: BOP up to 10%.

Group 2—Localized gingivitis: BOP from 10% to 30%.

Group 3—Generalized gingivitis: BOP from 30% to 60%.

We selected 60% as the upper limit for provoked bleeding in this group because none of the children examined showed values above this threshold.

For the purposes of comparative analysis between the indices used in this study, children with BOP values between 10% and 30% are classified as presenting with initial gingivitis, and children with BOP values between 30% and 60% are classified as having advanced gingivitis.

Community Periodontal Index of Treatment Needs (CPITN)—Partial-Mouth Examination

To assess the gingival status using the CPITN, we probed the gingival sulcus of the representative teeth: 16, 11, 26, 36, 31, and 46. Probing was performed at six sites—three buccal and three oral [15]. The gingival status was recorded using a five-point scale, with the highest score observed at any of the six probing points taken as the score for that representative tooth. According to the recommendations of the British Society of Paediatric Dentistry, and due to the absence of any score higher than 2 among the children we examined, only scores 0 to 2 were registered in this study [16]. Based on the index value, the clinical findings and treatment needs are as follows:

Score 0—Periodontal health, with no bleeding present. No treatment required.

Score 1—Presence of provoked gingival bleeding, requiring detailed instructions for individual oral hygiene. For the purposes of this study, and in comparison with the BOP index, score 1 corresponds to initial gingivitis.

Score 2—Presence of provoked gingival bleeding along with additional plaque-accumulating factors (e.g., dental calculus, cavitated carious lesions, poorly adapted restorations, etc.), which required professional oral hygiene (scaling and polishing), along with instructions for individual oral hygiene. For the purposes of this study and comparative analysis with the BOP index, score 2 corresponds to advanced gingivitis [15].

Behavioral and Anamnestic Data

In addition to clinical data, information regarding participants’ oral hygiene habits (e.g., brushing frequency, floss use), dietary patterns, parental education level, and frequency of dental visits was collected using structured questionnaires completed by parents or guardians under supervision.

Data Quality Assurance

To ensure high data quality, all collected forms were double-checked for completeness and accuracy. A random 10% subsample of children was re-examined within 7 days to assess intra-examiner reproducibility, with kappa values ranging between 0.86 and 0.91 for the presence of bleeding.

Statistical Methods

Data processing was performed using the specialized software program IBM SPSS Statistics, version 19.0, and Microsoft Excel 2019.

The Kolmogorov–Smirnov test was used to check the frequency distribution, which showed a normal distribution.

To address the risk of Type I error associated with conducting multiple comparisons, the Bonferroni correction was applied. Specifically, the standard significance level (α = 0.05) was divided by the number of comparisons performed (α′ = 0.0167), ensuring that the overall probability of a false-positive finding remained below 5%.

To objectively assess the results of the conducted analyses, the following statistical methods were used:

• Pearson’s chi-square test (χ²)—used to test hypotheses regarding associations between categorical variables.
• Alternative analysis (t-test)—used to compare two relative proportions.

T-tests were used to compare relative proportions because the data were treated as continuous variables. This allowed for the comparison of mean differences between groups or conditions. The assumptions for using t-tests were met due to the large sample size, which helps ensure the robustness of parametric tests.

Cramér’s V was calculated as a measure of effect size to evaluate the strength of the association between the categorical variables. Values of Cramér’s V were interpreted using the following thresholds: 0.1 = small; 0.3 = medium; and 0.5 = large effect size.

3. Results

Overall Gingival Status in the Study Population (n = 457)

The study sample included 457 children aged 11 to 14 years, all of whom underwent comprehensive periodontal examination. The assessment of the gingival status of the children included in our study revealed the relative proportion of healthy subjects and those affected by gingivitis. The following charts illustrate the distribution of children according to the indices used to objectively assess their gingival status (Figure 1).

From the charts, it can be seen that, according to the BOP index, out of all 457 children, 36% had a healthy periodontium (BOP ≤ 10%), 40% showed initial gingivitis (BOP 10–30%), and 24% were found to have advanced gingivitis (BOP 30–60%) (χ² = 17.204; p < 0.05).

According to the CPITN, children with a healthy periodontium (score 0) accounted for about one-third of the entire sample, while children with initial gingivitis (score 1) were the most common, at 57% of the population. Those with advanced gingivitis (score 2) made up only 13% of the total (χ² = 139.554; p < 0.05).

The higher relative share of children with initial gingivitis (score 1) identified by the CPITN comes at the expense of a lower recorded percentage of children with either healthy periodontium (score 0) or advanced gingivitis (score 2). This indicates a limitation in the CPITN regarding its ability to differentiate the extent and severity of gingival inflammation. On the other hand, full-mouth examination using the BOP index considers the presence of provoked bleeding in a limited area of the gingival tissues (BOP ≤ 10%) as being indicative of periodontal health.

These findings suggest that the CPITN may overestimate mild inflammation and underestimate more severe forms when compared to the more sensitive BOP index.

Comparison of CPITN and BOP Indices (Cross-Tabulated Analysis)

The following table presents the relative proportions of children with different CPITN scores, distributed into three groups based on the severity of gingival inflammation according to the BOP index (

Table 1. Relative proportions of children with different CPITN scores, according to the severity of gingival inflammation.

	CPITN	Score 0 Periodontal Health		Score 1 Initial Gingivitis		Score 2 Advanced Gingivitis		t-Test
BOP		N	%	N	%	N	%
Up to 10% 1		102	63%	54	33%	7	4%	p < 0.05
Between10–30% 2		31	17%	130	71%	21	12%	p < 0.05 p0,2 > 0.05
Between 30–60% 3		2	2%	79	71%	31	27%	p < 0.05
t-test		t1,2 = 9.68 p < 0.05 t1,3 = 15.23 p < 0.05 t2,3 = 4.99 p < 0.05		t1,2 = 7.69 p < 0.05 t1,3 = 6.60 p < 0.05 t2,3 = 0.16 p > 0.05		t1,2 = 2.54 p < 0.05 t1,3 = 5.18 p < 0.05 t2,3 = 3.33 p < 0.05
95%CL		CPITN χ2 139.554 df = 2 V = 0.39				BOP χ2 107.204 df = 2 V = 0.34

CL—confidence interval; χ²—chi square; df—degrees of freedom; V—Cramér’s V association. ^{1, 2, 3} —Representation of groups with different BOP in order to be easy to track statistical tests between them.

).

From the table, it is evident that in 63% of the children, there is a match between CPITN score 0 and periodontal health as recorded by BOP (p < 0.05). Additionally, a CPITN score of 0 was registered for 17% of children in the BOP 10–30% group and 2% of children in the BOP 30–60% group.

A CPITN score of 1, which indicates the presence of provoked gingival bleeding, was recorded in 33% of children with healthy periodontium (BOP ≤ 10%) and in 71% of children with initial or advanced gingivitis (p < 0.05).

A CPITN score of 2 was registered for 27% of the children in the BOP 30–60% group (p < 0.05).

All comparisons were statistically significant (p < 0.05), as shown by the t-test results in the table. These results clearly demonstrate that the CPITN lacks the ability to determine the severity of gingival inflammation, in contrast to the BOP index, which provides more detailed and stratified information.

Gingival Inflammation by Sextant: Full-Mouth Examination

The following table and figure present the relative proportions of children with different degrees of severity of gingival inflammation, as assessed by BOP per sextant (

Table 2. Severity of gingival inflammation, as assessed by BOP per sextant.

		BOP Up to 10% 1 Periodontal Health		BOP 10–30% 2 Initial Gingivitis		BOP 30–60% 3 Advanced Gingivitis		t-Test
Sextant		N	%	N	%	N	%
Right 1	I sextant	367	80%	40	9%	50	11%	p1,2/1,3 < 0.05
	VI sextant	343	75%	81	18%	32	7%	p < 0.05
Front 2	II sextant	160	35%	100	22%	197	43%	p < 0.05
	V sextant	165	36%	89	20%	203	44%
Left 3	III sextant	369	81%	36	8%	52	11%	p1,2/1,3 < 0.05
	IV sextant	362	79%	67	15%	28	6%	p < 0.05
t-test		t1,2 = 15.59 p < 0.05 t2,3 = 15.09 p < 0.05 t1,3 = 0.17 p > 0.05		t1,2 = 4.71 p < 0.05 t2,3 = 5.18 p < 0.05 t1,3 = 1.26 p > 0.05		t1,2 = 11.75 p < 0.05 t2,3 = 11.53 p < 0.05 t1,3 = 0.53 p > 0.05
		95%CL		BOP χ2 164.168 df = 2 V = 0.42

CL—confidence interval; χ²—chi square; df—degrees of freedom; V—Cramér’s V association. ^{1, 2, 3} —Representation of groups with different BOP in order to be easy to track statistical tests between them.

).

From the table, it can be seen that the absence of gingival inflammation was most frequently observed in the posterior segments of both jaws (p < 0.05), with around 80% showing limited gingival bleeding (BOP ≤ 10%; p > 0.05).

Initial gingivitis (BOP 10–30%) was significantly more frequent in the anterior segments of both dental arches, at 20–22% (p < 0.05). We also found that the relative proportion of gingival tissues affected by initial gingivitis in the mandible was similar to that in the anterior region, at 15–18% (sextants IV and VI) (p > 0.05).

Advanced gingivitis (BOP 30–60%) was also most commonly recorded in the anterior regions of both jaws (p < 0.05).

The assessment of gingival status using the BOP index showed that healthy sextants predominated among the children we examined (Figure 2). Localized initial and generalized advanced gingivitis were found to be primarily concentrated in the anterior regions of dentition. This localization pattern reinforces the hypothesis that anterior teeth are more prone to plaque accumulation and inflammation in children.

Gingival Inflammation by Sextant: Partial-Mouth Examination

The following table and chart present the relative proportions of children with different registered CPITN scores by sextant (

Table 3. CPITN scores by sextant.

		Score 0 Periodontal Health		Score 1 Initial Gingivitis		Score 2 Advanced Gingivitis		t-Test
Sextant		N	%	N	%	N	%
Right 1	I sextant	399	87%	38	8%	20	4%	p < 0.05
	VI sextant	372	81%	76	17%	9	2%
Front 2	II sextant	258	57%	199	43%	-	-	p < 0.05
	V sextant	225	49%	210	46%	22	5%	p0,1/0,2 < 0.05
Left 3	III sextant	381	83%	50	11%	26	6%	p < 0.05
	IV sextant	370	81%	78	17%	9	2%
t-test		t1,2 = 9.28 p < 0.05 t2,3 = 10.67 p < 0.05 t1,3 = 1.49 p > 0.05		t1,2 = 9.28 p < 0.05 t2,3 = 9.09 p < 0.05 t1,3 = 1.35 p > 0.05		t1,2 = 0.32 p > 0.05 t2,3 = 0.59 p > 0.05 t1,3 = 0.91 p > 0.05

^{1, 2, 3}—Representation of groups with different BOP in order to be easy to track statistical tests between them.

).

When recording gingival status using the CPITN, a score of 0 was most frequently registered in the posterior sextants of both jaws, with over 80% of these showing no provoked gingival bleeding (p < 0.05).

Initial gingivitis (score 1) was significantly more frequent in the anterior segments of both dental arches compared to the other sextants (p < 0.05). Regardless of location, advanced gingivitis (score 2) was the least frequently recorded, and the observed differences between sextants were not statistically significant (p > 0.05).

The assessment of gingival status using the CPITN showed that, among the children we examined, sextants with score 0 (healthy periodontium) predominated (Figure 3). Score 1 was mainly registered in the anterior segments of both dental arches, while score 2 was recorded very rarely in isolated sextants.

The analysis of the results by sextant with the two indices we used showed that, regarding the localization of gingival inflammation, the results from both indices are comparable. However, a more detailed assessment of the severity of the existing inflammation was obtained with the BOP index.

These findings suggest that, while both indices localize inflammation similarly, only BOP provides a nuanced view of severity.

Overall Comparison and Interpretation

Although the localization trends between the two indices aligned, the BOP index allowed a clearer distinction between initial and advanced gingivitis, making it a more appropriate diagnostic tool in the epidemiological screening of pediatric populations.

4. Discussion

Clinical periodontal examination should be an essential part of the routine dental check-up in children and adolescents. The initial assessment of periodontal structures includes recording any changes in the soft and hard periodontal tissues. According to AAP/EFP, an easy and accurate method to objectively assess gingival status is the evaluation of Bleeding on Probing (BOP) [13]. In our study, BOP was recorded at four sites per tooth (mesiobuccal, buccal, distobuccal, and lingual), while CPITN assessed six representative teeth (16, 11, 26, 36, 31, 46). The aim of our study was to assess gingival status using partial-mouth examination with the CPITN and full-mouth examination with BOP in the periodontal diagnosis of adolescents and to determine the comparability of the two indices.

The results from our study showed that the BOP index identified significantly more healthy children compared to the CPITN (t = 1.90, p < 0.05). Specifically, BOP detected 45% healthy children, whereas CPITN recorded only 30% as healthy, highlighting its tendency to overestimate gingival inflammation. The reason for this finding is that the CPITN classifies the presence of provoked gingival bleeding as pathological, even if it occurs on only one of the representative teeth examined. This approach does not allow for the differentiation of the “limited fields” of gingival inflammation (gingivitis site) from an actual case of gingivitis [13].

The CPITN allows for the relatively quick assessment of the gingival status of adolescents, combined with specific therapeutic recommendations based on the findings. In this study, we found that the CPITN has limitations in distinguishing between initial (BOP 10–30%) and advanced (BOP 30–60%) gingival inflammation, or more precisely, between localized and generalized gingivitis. For example, cases classified as CPITN score 1 often corresponded to localized BOP of 15–25%, while score 2 sometimes matched generalized BOP above 40%. Therefore, we would recommend using the CPITN as a suitable index for easily identifying the presence of gingival inflammation, but not for determining its severity, especially when it is necessary to develop a targeted treatment plan.

The comparative evaluation of the two indices by sextant showed that a healthy periodontium is most commonly observed in the posterior segments of both jaws in children, with comparable results between the two indices.

The BOP index indicated that gingival inflammation is found mainly in the anterior segments of both dental arches, with generalized forms even predominating in these areas. In contrast, the CPITN recorded almost equal relative proportions of health and initial gingival inflammation (score 1) in the anterior regions, while more advanced forms (score 2) were rarely detected using this index. The reason for these differences lies in the fact that the CPITN assesses only the two central incisors in the anterior region. These teeth are not always affected by provoked bleeding, and additionally, at this age and in this specific location, the presence of plaque-accumulating factors is a rare finding [20].

The results from our study support the conclusion that the CPITN has the advantage of providing a quick and easy method for recording gingival status in children, but that it does not enable determination of the severity of gingival inflammation. In contrast, full-mouth examination using the BOP index, although more time-consuming, offers a significantly more detailed picture of the gingival status in adolescents.

Numerous scientific studies have compared the use of partial-mouth examination versus full-mouth examination in periodontal diagnosis [20,21,22,23,24,25,26,27]. The reason for this interest lies in the search for a faster and simpler approach that saves resources (time, cost, etc.) for both the patient and the dental professional during the diagnostic process. Several authors propose half-mouth examinations (using randomly selected diagonal quadrants) as a valid alternative to full-mouth probing, providing high agreement (ICCs > 0.90) in detecting key parameters such as plaque index, probing depth, and attachment loss [27].

Nonetheless, these approaches have primarily been validated in adult populations with advanced periodontal destruction. Eke et al. [27] showed that although half-mouth methods yield reliable results in adults, Ramfjord tooth assessments consistently underestimate disease prevalence. This discrepancy is particularly relevant when considering early inflammatory changes in younger populations, such as adolescents, where localized inflammation is predominant.

In recent years, even non-invasive methods for assessing gingival status have been developed, in which representative teeth are not probed, and the condition of the gingival tissues is instead evaluated visually using a custom-developed scale [21].

Machado et al. conducted a study similar to ours, examining 1134 12-year-old children. For the purposes of their research, the authors compared BOP scores obtained through full-mouth examination with three types of partial-mouth examinations. The first type involved probing all teeth at six sites in two diagonal quadrants. The second type assessed only three sites per tooth (mesiobuccal, buccal, distolingual) in quadrants 1 and 2 or 3 and 4. The third type used representative teeth based on the CPITN methodology. The authors concluded that the second type of partial periodontal examination most closely approximated the results of the full-mouth examination [22].

Ahmadi et al. suggest that partial-mouth examination can be used as an alternative to full-mouth examination. The authors studied 80 patients with periodontal pathology of varying severity and extent, comparing full-mouth examination with several types of partial-mouth assessments: (1) all teeth in the upper right and lower left quadrants; (2) upper and lower right quadrants; (3) upper and lower left quadrants; (4) the Ramfjord teeth (16, 21, 24, 36, 41, 44). A statistically significant correlation was found between partial periodontal assessment in the upper right and lower left quadrants and the results of the full-mouth examination [23].

Tanik and Gul evaluated the validity of partial CPITN (PCPITN) and full-mouth CPITN (FCPITN) indexes derived from CPITN for the diagnosis of periodontal disease in the study included 1000 patients over the age of 20. For gingivitis, the sensitivity of PCPITN was 68.88%, specificity was 85.94%, and the area under the receiver operating characteristic (ROC) curve was 0.6893. For periodontitis, FCPITN sensitivity was 89.28%, specificity was 96.56%, and the area under the ROC curve was 0.931. Although FCPITN and PCPITN demonstrated moderate effectiveness in diagnosing gingivitis, they were more effective in identifying periodontitis [27].

Overall, the main advantages of CPITN include simplicity, speed, and international standardization, which has led to its widespread use, with results included in over 500 publications [15,28]. In this context, suggest that CPITN remains suitable for large-scale epidemiological studies or as a rapid screening tool for at-risk populations, even though BOP provides superior precision for detailed clinical assessment and treatment planning.

However, it is notable that studies supporting partial-mouth or quadrant-based assessments tend to compare isolated probing values rather than evaluating the patient’s overall periodontal condition [29]. In contrast, the pediatric population requires diagnostic approaches that are sensitive to early-stage, reversible gingival inflammation, which is typically asymptomatic and site-specific. This aligns with our findings, showing that BOP detected early localized gingivitis that CPITN missed in several cases [4,6,12].

Additionally, early diagnosis is critical, considering that gingival inflammation in children is significantly associated with poor oral hygiene, plaque accumulation, and systemic factors such as cardiovascular disease [10]. Recent studies have confirmed the higher prevalence and bacterial diversity of periodontal pathogens, such as T. denticola and T. forsythia, in children with systemic comorbidities [10]. The presence of these microorganisms correlates with increased gingival inflammation and suggests the need for comprehensive periodontal evaluations.

Moreover, there is increasing recognition of the broader health implications of undiagnosed or underestimated gingival inflammation. Periodontal inflammation in adolescents may serve as a marker for other modifiable health risks such as poor diet, obesity, and vitamin D deficiency. According to recent reports, the early detection of PD could serve as an opportunity to initiate lifestyle changes that prevent future adverse health outcomes [3,4].

Despite the accumulating evidence, there is still a lack of standardized, age-appropriate diagnostic and treatment protocols in pediatric periodontal care. A recent narrative review by Cosola et al. [6] emphasized that most conventional diagnostic indices, including the CPITN, were designed for adults and fail to capture the subtleties of early-stage periodontal conditions in children. New longitudinal and epidemiological studies are needed to better tailor risk assessment models and treatment strategies to younger populations.

In conclusion, the comparative analysis of the CPITN and BOP revealed that although the CPITN offers a rapid screening tool, its limitations in detecting the severity and extent of gingival inflammation render it insufficient for comprehensive periodontal assessment in adolescents. Full-mouth examination with BOP remains the more sensitive method, particularly for detecting early or localized inflammation, and should be prioritized in pediatric dental diagnosis. Given the increasing awareness of the systemic relevance of periodontal health, particularly in children and adolescents, dental professionals should adopt diagnostic protocols that reflect both precision and preventive value.

5. Conclusions

Partial-mouth examination using the CPITN can be successfully employed for a quick and easy assessment of gingival status in children but is not suitable for determining the severity of gingival inflammation. For this purpose, full-mouth examination using the BOP index is more appropriate, as it provides a detailed and comprehensive picture of the condition of the gingival tissues, especially when clinical diagnosis is required to guide further treatment planning.

6. Research Limitations

This study has several limitations that should be considered when interpreting the findings. First, the sample was drawn from a limited geographic area and included only children attending public primary schools, which may restrict the generalizability of the results to broader populations. Second, the cross-sectional design captures data at a single point in time and does not allow for the evaluation of changes in periodontal status over time or causality. Third, the school-based setting, while practical for screening purposes, may not fully reflect the conditions of a clinical environment.

7. Future Considerations

Future research should aim to validate the findings of this study in larger, more diverse pediatric populations, including different age groups and socioeconomic backgrounds. Longitudinal studies are also needed to assess the predictive value of BOP and CPITN for long-term periodontal health.