2 x Pocket Chart

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A: Obviously, we are not able to give precise advice on a patient by patient basis and this would be driven by your judgement or that of the practitioner prescribing care. Frequency for supportive/maintenance therapy is determined based on an individualised risk assessment for the patient taking into account local as well as systemic factors and of course a history of previous periodontitis. The papers below would tend to reflect the current consensus view that this would ideally be between 3 and 5 or 6 months to maintain peri-implant health, most likely influenced by the factors mentioned above, as well as the potential impact of peri-implant disease on the surrounding tissue, need for and consequences of treatment and outlook for any prostheses. A: No, Staging and Grading is based on the worst affected tooth with periodontal disease. Whilst a diagnostic statement might give the feeling that a case is severe, but on examination it turns out to be based on one very badly affected tooth, as clinicians we interpret our clinical findings and treat accordingly. The new system, like the previous system, does not dictate treatment based on a specific diagnosis and it is for the clinician to decide on the most appropriate treatment for each case. Why is it that this part of step 2 would not be conducted in step one? Is that because you want to make sure the patient is engaged with good homecare/plaque control first, and if that is followed you should see a reduction in PPDs and BOP anyway without subgingival scaling? Ergo, perio prognosis following subgingival root surface debridement is going to be much improved?

Gingival recession is the condition seen when the gingival margin is located apically to the cemento-enamel junction. The value noted as the gingival margin 1 should be recorded as a negative value. If the patient’s oral hygiene is poor, bearing the above discussion in mind and with consideration of the BSP guidelines, it is reasonable to claim a band 2 course of initial periodontal therapy without conducting a 6PPC. A: You have effectively asked and answered the first question yourself. The main reason for not including sub gingival instrumentation or root surface management in step 1 is that we want the patient to take responsibility for their disease and its management. As you know, no amount of perio treatment will work in the absence of good home care and this approach ensures that we do not waste time and resources trying to treat this disease in a patient who is not engaged and where there will be little or no benefit. We have practiced like this for many years and the additional benefits that from thisapproach are: Furcations of all molars and first premolars of the upper jaw should be assessed with a furcation probe. The horizontal component of probing is graded (0 - 3) according to the following criteria: While the evidence supporting the use of high volume suction to reduce the risk associated with dental AGPs is very low certainty, the use of suction does have other benefits (e.g. saliva/debris removal, airway protection) and is standard practice in dentistry. ..... Therefore, an individual risk assessment to identify such patients may be necessary. High volume suction has a number of variables and is both equipment and operator sensitive. While suction is available in all dental practices, there may be practices where the existing ‘high volume suction’ does not meet the required standard and additional costs may be involved in upgrading facilities to meet these. There are also ongoing costs associated with assessing and calibrating the level of suction, and servicing of the suction equipment, although these costs are unlikely to be additional as use of suction is standard practice. Following consideration of these factors, the Working Group reached an agreed position:A: Whist the BSP have produced their implementation of the 2017 World Workshop, this is ultimately a global shift in the way we classify periodontal disease together with a change in the language we use when formulating a diagnostic statement. As such, using an out of date system and terminology is not appropriate once you understand the new system. Imagine if we still used the term pyorrhea! This fun game of true or false works as a challenging math center for kids. Set out two columns, true and false. Underneath, mix up some simple math problems with answers. Students need to then work out whether to place the problem in the true or false column! Your patients sees the impact their changes have on their inflammation, they cannot attribute it to you.

Should there be a need to re-X-ray a patient i.e. due to a relapse in the patients periodontal status, then you should produce a new diagnostic statement based on the new radiographs that you have taken. A:BPE guidelines state: “Radiographs should be available for all Code 3 and Code 4 sextants. The type of radiograph used is a matter of clinical judgement but crestal bone levels should be visible. Many clinicians would regard periapical views as essential for Code 4 sextants to allow assessment of bone loss as a percentage of root length and visualisation of the periapical tissues”. A: Patients who have been identified as potential periodontal patients by their BPE scores, should have appropriate radiographs and special sets done to allow a diagnosis to be made prior to treatment. As the staging and grading requires knowledge of bone levels, it is not possible to produce an accurate diagnostic statement without radiographs and we should not treat patients without a formal diagnosis. In this situation, radiographs should be obtained. British Society of Periodontology good practitioner’s guide 2016 https://www.bsperio.org.uk/publications/good_practitioners_guide_2016.pdf?v=3Cons: The style is not for everyone. In addition, some had trouble getting this product to lie flat and found that it had a permanent crease. Q: I was wondering if you could clarify whether High Volume Aspiration is still required when carrying out a hand scale? We have tried to search this information in Public Health Info as well as the updated NHS CDO but they have not specified. The above scenario is probably the most common in day to daypractice. There may be situations where a patient presented with historical disease that is reasonably well managed and you chose to do a DCP at that stage to make onward decisions about Step 1/2 or 4. That is where clinical judgement supersedes guidelines. This double-sided chart folds flat for easy storage and has dry-erase cards so you can use it over and over again. A: No, Staging and grading and your diagnostic statement is based on the radiographs that you take when you first meet a patient. At your review, following treatment, the only thing that can realistically change is the element of the diagnostic statement that relates to disease activity i.e. stable, in remission, unstable, as you will not be taking more radiographs at this stage. You should reflect on this in your notes when you reassess your patient and are deciding on the need for more treatment or progressing to supportive care.

Following 8-12 weeks and improved oral hygiene/compliance, if code 3’s remain, a second band 2 claim of root debridement and a 6PPC may be done. Q: If the only bone loss is on the distal of lower second molars and we know there has previously been impacted third molars, do we need to stage and grade that patient? Q: If one tooth has advanced disease and the rest of the mouth is not too bad, do we re-stage and grade the case if we extract the worst affected tooth or teeth?

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We have had a very positive response to the BSP implementation of the 2017 Classification and the flowchart to help practitioners has been an overwhelming success.

Use of high volume suction might contribute to a reduction in fallow time following a Group A dental procedure”.If you have dry mouth, use a mouthwash that doesn’t contain alcohol. You can also try chewing sugar-free gum, sipping water, and avoiding caffeine. Implant Disease Risk Assessment IDRA–a tool for preventing peri-implant disease (Lisa J. A. Heitz-Mayfield | Fritz Heitz | Niklaus P. Lang)