quality education for a healthier scotland prevention and treatment of periodontal diseases in...
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Quality Education for a Healthier Scotland
Prevention and
Treatment of Periodontal Diseases in
Primary CareDental 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
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
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
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.
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 *
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
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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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
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
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
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
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
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
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