08


• Clinical risk reduction


AVOIDING PERIO PITFALLS


Dr Madeleine Murray highlights common risk areas when managing patients with periodontitis


P


RACTITIONERS often struggle with periodontics in general practice. Good disease control depends largely on patient buy-in, as well as having sufficient time to treat. Achieving these can be challenging but risks can be minimised through careful diagnosis, treatment and crucially good communication and record keeping. Clear advice about basic standards of diagnosis, referral,


treatment and follow-up can be found in both the Scottish Dental Clinical Effectiveness Programme (SDCEP) guidelines and documents produced by the British Society of Periodontology.


Diagnosis Failure to make one. Follow-up by the clinician of either reported clinical symptoms or BPE scores of 4 is crucial. Major causes of under diagnosis of periodontitis include failure to: • recognise symptoms of disease until the late stages


• carry out comprehensive assessment when BPE scores of 4 are recorded, or


• report incidental findings of periodontal bone loss on radiographs. Failure to document the diagnosis. Accurately recording


conversations relating to periodontal problems and findings of full chartings or radiographs is essential. Good clinical records can help support a practitioner who has discussed periodontal problems and offered treatment or referral, even if that was not taken up. Failure to advise the patient of the situation. In many cases the


practitioner recognises that there are periodontal problems, however the patient either hasn’t been told or can’t remember being told that is the case. If we accept that periodontitis is a chronic, debilitating, multifactorial condition with a strong basis in disordered immune and inflammatory mechanisms, like diabetes or rheumatoid arthritis, then it


becomes easier to explain to patients why they are at risk and why they have developed the disease. Periodontitis is not anyone’s fault and diagnosing it does not imply blame or failure, rather it is a complex disease for which timely diagnosis and management present an opportunity to improve not only the patient’s dental prognosis but their general health. Failure to refer. Specialists now expect to save teeth which in the


past would have been removed. Together with their teams they can help maintain teeth for many years, and this is especially true if referral is done at an early stage. Despite the challenges of long waiting times and limited access to NHS specialist periodontists, referral should at least be discussed as an option and followed up if the patient accepts it. Guidelines for when to consider referral can be used to make a case for access to specialist level treatment.


Treatment Treatment schedules. Periodontal disease requires periodontal treatment, rather than periodontal maintenance. Initial treatment involves control of risk factors for disease progression, followed by in-surgery management of the tooth and periodontal tissues; oral hygiene instruction scaling, root debridement and subsequent follow-up. All of those aspects comprise treatment and depend on each other for successful ongoing management. Providing routine three-monthly scaling may control tissues where there is minimal disease but won’t correct problems in those with established or more severe conditions. Controlling risks. In patients who cannot be encouraged to reduce their


general systemic risk (e.g. by stopping smoking) or who cannot be encouraged to clean their mouth at home, disease control will always be problematic. It is this stage of disease management that requires the dentist or hygienist to communicate convincingly. Documenting conversations about risk and risk reduction along with understanding objective measures


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16