quality education for a healthier scotland prevention and treatment of periodontal diseases in...
TRANSCRIPT
![Page 1: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/1.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/2.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/3.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/4.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/5.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/6.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/7.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/8.jpg)
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
Phot
ogra
phs:
ww
w.a
ngus
brem
ner.c
om
![Page 9: Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/9.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/10.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/11.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/12.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/13.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/14.jpg)
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](https://reader037.vdocuments.site/reader037/viewer/2022110320/56649c9b5503460f94959c7a/html5/thumbnails/15.jpg)
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
Other SDCEP guidance publications are also available via the SDCEP website