Proof of Prevention
This article should be read in conjunction with Prevention, Prevention. Proof will depend on clinical records and accurate documentation. This will be easier for colleagues caring for children from birth where no disease should develop. For adults the fundamental question is how to measure and record success or the worse case scenario where a prevention based philosophy is not working.
Cochrane principles ask us as professionals are we effective, does the treatment work, and are we efficient? The latter asks how well we carry out a given procedure. We know that when patients control their plaque well they can bring, with professional help, their periodontal disease under control. I believe we should apply the Cochrane principles to patients and their plaque control, are they effective and if not why not, are they efficient, do they carry out the task in a systematic manner and have they the right tools for the task in hand. While I prefer not to use a list of tick boxes when possible they provide an aide memoire of what to do and a space for a signature to confirm that the checks have been carried out. Follow up records are just as important as they enable comparisons with previous results to establish trends for the better or for the worse.
Group 1: Toothbrush Inspection
- Is it the correct size for the patient’s mouth?
- Is it the correct shape?
- Should the brush be changed and how often?
Group 2: Watching the Patient Brush Their Teeth
- Do they have a systematic approach ie move from tooth to tooth in a quadrant?
- Which areas of the mouth are they missing brushing?
- Are they spending enough time on brushing?
- Can you disclose any remaining plaque?
- Are you able to take photographs of the above for our records?
Group 3: The Basic Periodontal Examination
- Have you used the latest record as a teaching aid to improve plaque control?
- Have you compared this with the previous one and preferably two results?
- Have you printed out the last two results together with an explanation what the numbers mean and given it to your patient?
- If any quadrant score is 3 or more have you carried out a full mouth pocket chart?
Group 4: Full Mouth Periodontal Charting
- Have you printed this out for your patient and explained what it means?
- Have you decided at what follow up interval this chart should be repeated?
Group 5: Interproximal Brushing
- Does your patient need to use these brushes?
- Have you advised that there is no standard colour coding between manufacturers and your patient should use those you have prescribed?
- Have you prepared a Spacemark Dental customised chart for your patient rather than relying on two sizes fits all spaces?
- Have you printed the patient’s chart or let them take a photograph of your computer screen?
- If your patient reports that the size prescribed for an individual space is too small, have you upgraded their chart and given them a printout?
Group 6: Diabetics
- Have you liaised with your patient’s GP and obtained his/her HBA1c results?
- In the absence of general knowledge about the relationship between periodontal disease and diabetes have you talked to your local GP’s and advised them that diabetics are at greater risk of periodontal disease and would benefit from dental advice and if required treatment?
- Have you asked your professional associations to publicise (b) above?
Group 7: Recall Interval
- What is your policy for recalls of patients with active periodontal disease?
- What is your policy about increasing the recall time interval for patients who have either responded to advice/treatment or who are disease free?