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Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

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Page 1: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Prevention and

Treatment of Periodontal Diseases in

Primary CareDental Clinical Guidance

Published June 2014

Page 2: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

What is SDCEP?

• The Scottish Dental Clinical Effectiveness Programme (SDCEP) is part of the Dental Directorate within NHS Education for Scotland

• SDCEP develops guidance on priority topics for oral health care that aims to be evidence-based, practical and user friendly to support quality care

• SDCEP guidance informs under-graduate and post-graduate education and training as well as daily dental practice in Scotland and beyond

• SDCEP is also involved in implementation research to understand how to bring about changes in practice

Page 3: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Background to the Guidance

• Periodontal disease is prevalent in a large proportion of the Scottish population

• One of the most frequent dental procedures carried out in Scotland is the simple supra-gingival scale and polish

• <10% of patients receive the more intensive categories of care designated for managing patients with moderate to severe disease

• Medico-legal defense unions report that an increasing number of claims relate to alleged failure to diagnose and treat periodontitis

Page 4: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

How was the guidance produced?

• A Guidance Development Group (GDGD), comprising a group of dental professionals with a particular interest in periodontal diseases plus a patient representative, was convened to write the guidance

• GDG formulated a list of 20 key clinical questions

• SDCEP Research Lead facilitated evidence search and appraisal

• Recommendations based on considered judgement of the evidence

• Full public consultation and peer review before publication

Page 5: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Format

• The guidance provides evidence-based recommendations in the following areas:Assessment and Diagnosis Maintaining

Dental ImplantsChanging Patient Behaviour ReferralProviding Treatment Record KeepingLong Term Maintenance

• Key recommendations are highlighted at the beginning of each section with brief summaries of the evidence underpinning the guidance recommendations throughout the text.

• A more in-depth discussion of the evidence is provided in a separate Evidence into Practice section.

Page 6: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Key Messages - Assessment and

Diagnosis• Assess and explain risk

factors for periodontal diseases to patients

• Screen all patients for periodontal diseases at every routine examination

• Carry out a full periodontal examination for patients with BPE scores 3, 4 and *

Page 7: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Key Messages – Changing Patient

Behaviour• Use the Oral Hygiene

TIPPS behaviour change strategy to address inadequate plaque removal

• Raise the issue of smoking cessation where appropriate

• Encourage patients to modify other lifestyle factors that may impact on their oral health

Page 8: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Oral Hygiene TIPPS

• Oral Hygiene TIPPS aims to help clinicians improve their patients’ plaque removal by: – increasing the patient’s confidence in

their ability to perform effective plaque removal.

– helping them plan how and when they will look after their teeth and gums.

• Includes a ‘hands-on’ demonstration of plaque removal techniques and an opportunity for the patient to practice in front of the clinician

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Page 9: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Key Messages – Providing Treatment

• Ensure the patient is able to perform optimal plaque removal

• Gingivitis: remove supra-gingival plaque, calculus and stain and sub-gingival deposits and, if possible, correct any local plaque retentive factors

• Periodontitis: treat as above plus carry out root surface instrumentation at sites ≥4 mm probing depth where sub-gingival deposits are present or which bleed on probing

• Do not use antimicrobial medication to treat chronic periodontitis

Page 10: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Key Messages – Long Term Maintenance

• For all patients, carry out an oral examination and use Oral Hygiene TIPPS to address inadequate plaque removal

• Dental prophylaxis: remove supra-gingival plaque, calculus and stain and sub-gingival deposits if necessary

• Supportive periodontal therapy: carry out root surface instrumentation at sites ≥4 mm probing depth where sub-gingival deposits are present or which bleed on probing

– Ensure that full mouth periodontal charting is performed annually in these patients

• Assign an individual risk level to inform recall frequency

Page 11: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Key Messages – Maintaining Dental

Implants• Ensure the patient is able to

perform optimal plaque removal around the dental implant(s)

• Examine peri-implant tissues for signs of inflammation and bleeding on probing and/or suppuration

• Remove supra- and sub-mucosal plaque and calculus deposits and excess residual cement

• Perform radiographic examination only where clinically indicated

Page 12: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Key Messages - Referral

• Consult any locally produced referral guidelines and the BSP ‘Referral Policy and Parameters of Care’ to determine if the patient is a suitable candidate for referral

• Prior to referral, carry out initial therapy to address inadequate plaque removal, smoking status (if applicable) and to remove supra- and sub-gingival deposits

• Provide supportive periodontal therapy and monitoring for patients who have been discharged from specialist or secondary care

Page 13: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Key Messages – Record Keeping

• Record the results of the periodontal examinations (basic and/or full) carried out and the current standard of oral hygiene

• Record the diagnosis, suggested treatment plan and details of costs

• Document any discussions you have with the patient e.g. regarding treatment options, risks and benefits of treatment, oral hygiene advice, smoking cessation, alcohol consumption and/or other lifestyle factors

Page 14: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

Supporting Tools

• Guidance in Brief – a summary of the main recommendations for the busy practitioner

• Video showing Oral Hygiene TIPPS in action

• Oral Hygiene TIPPS visual aid

• Patient leaflets – a general leaflet and one aimed at patients with diabetes

• Accessible versions

Page 15: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

Quality Education for a Healthier Scotland

More Information

• The full guidance, Guidance in Brief and Supporting Tools are available via the SDCEP website

www.sdcep.org.uk

• For further information contact SDCEP at

[email protected]

Other SDCEP guidance publications are also available via the SDCEP website