4 - Periodontal treatment in general practice

Question 1

Describe the assessment for periodontal disease.

Answer 1

• BPE (if interdental recession, there is perio despite BPE)
• bleeding, plaque, suppuration, mobility and furcation
• special investigations (likely radiographs, sensibility tests)

Question 2

Describe the risk assessment of a patient for periodontal disease.

Answer 2

• hx of tooth loss due to perio
• FH of tooth loss due to perio
• full medical history, smoking, medication for gingival hyperplasia, diabetes

Question 3

What treatment options should be discussed with the patient?

Answer 3

• what is available, and what timeframe
• risk factors influence on outcomes
• long appt with multiple sites vs multiple short appts
• cost of NHS v private

Question 4

Describe step 1.

Answer 4

• OHI, TIPPS
• MBPS
• PMPR up to 4mm pockets

Question 5

Describe step 2.

Answer 5

• reevaluate OH
• subgingival PMPR ± LA
• advise on potential side effects (sensitivity, recession, black triangles)

Question 6

Describe the reassessment after step 2.

Answer 6

• ask patient of their experience of treatment
• check MH and risk factors
• MBPS
• review pockets 4mm and more after 8 weeks for bleeding

Question 7

What are the long term options for periodontal care?

Answer 7

• if step 3, with persisting pockets despite good OH consider referral
• step 3, with poor response due to plaque levels consider palliative 3 month care
• step 4, with good response consider SPT

Question 8

What information should you give the patient prior to beginning treatment?

Answer 8

• written information about periodontal disease (eg BSP website)
• treatment plan including costs (if exempt from cost, still include treatment plan for indication of number of appointments)

Question 9

What information is vital to record in the notes?

Answer 9

• diagnosis
• radiograph reports
• BPE
• description of OH
• discussions had with patient (including referral offer/acceptance/denial)