1. Quality Education for a Healthier Scotland Prevention and Treatment of Periodontal Diseases in Primary Care Dental Clinical Guidance Published June 2014

2. 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

3. 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

4. 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

5. Quality Education for a Healthier Scotland Format The guidance provides evidence-based recommendations in the following areas: Assessment and DiagnosisMaintaining Dental Implants Changing Patient BehaviourReferral Providing TreatmentRecord Keeping Long 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.

6. 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 *

7. 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

8. 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 Photographs: www.angusbremner.com

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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 scottishdental.cep@nes.scot.nhs.uk Other SDCEP guidance publications are also available via the SDCEP website