This is not a comprehensive review of periodontology, but some tips at the interface with other aspects of restorative dental care. I always found that patients who had surgery and their plaque control failed again were very much worse than if no surgery had been undertaken. Secondly, if calculus can be removed and patients encouraged to control their plaque effectively on a daily basis, then for the vast majority, this was all the treatment required, coupled of course with regular reviews at intervals dictated by each patient’s own response.
I make no excuses for placing this first. If patients cannot control their plaque, or better, be taught the correct techniques, then they, and we, are on a slippery downwards slope. Prevention is far better than cure. This section is limited to basic periodontal care only, that can improve the dental health of the majority of the population. Tips for specialist periodontal care are outside the remit of this section.
There are important relationships between crown margins and gingivae, and it can be very difficult to obtain accurate impressions for crown and bridgework if the gingivae bleed.
As the inventor of colour coded pocket probes over 40 years ago, I am pleased that the Basic periodontal examination (CPITN) has been an NHS requirement for nearly 20 years. However recording the scores is only part of the story. They need to be compared with previous scores, better, no change, or even better then worse. They really should be communicated to patients as an educational and support tool. Remember patients have an absolute right to see their records following the Access to Medical Records Acts of 1991 and 1998. As an example of what not to do, my cousin’s wife, who is a diabetic, has her BPE scores recorded six monthly. When prompted by me to ask for her records, she was told ‘They are alright’. In my opinion this is not the standard of care required for the 21st century and information age.
Whenever I give courses I am asked routinely what handouts will there be. So, what handouts do you have for your patients with periodontal disease?
This is particularly true in relation to advice about interspace brushing which is now the norm for many patients instead of flossing. All to often I hear of patients told to use just one or two small brushes, on the grounds that is all they could be expected to remember. But what if the spaces are larger than the brush size used? This will not control plaque, and may generate a false sense of patient care. The correct brush size needs to be checked in the mouth for each interspace and recorded in a way that is acceptable to both dental professionals and patients, which requires a reverse image for the latter when compared with our usual charting conventions.
The Spacemark Dental system achieves those results. See www.spacemark-d.com.
It has been tried and tested, and it may surprise you to learn that the impetus for its development arose directly from my patients’ needs and requests and a complaint.