Periodontal Care in General Practice: 20 Important FAQs – Part One
Does Periodontitis Affect Quality of Life?
Periodontitis negatively impacts oral health-related quality of life.
Severe cases have a greater impact.
Address psychological concerns, halitosis, pain, and poor aesthetics in treatment plans.
Oral disorders ranked highest in age-standardised prevalence of 'years lived with disease' in 1990 and 2017.
Periodontal disease rates increased between 2007 and 2017.
What’s the Latest on the Role of Diabetes in Periodontitis?
Suboptimally controlled diabetes is a significant risk factor for periodontitis.
Patients with hyperglycaemia are three times more likely to develop periodontitis.
Diabetes increases the severity of periodontitis.
Dentists should gather a careful history, including HbA1C results.
Preventive care and regular monitoring are needed for diabetic patients without periodontitis; those with periodontitis need treatment with emphasis on good glycaemic control.
Risk assessment for type 2 diabetes in dental practice is supported.
Guidelines from the European Federation of Periodontology and the International Diabetes Federation aim to improve early diagnosis, prevention, and management.
What do I Need to Bear in Mind When Treating Smokers and Vapers?
Smoking increases susceptibility, severity, and progression of periodontitis.
Smokers are four times as likely to have periodontitis.
Smoking's effect is dose-dependent and more pronounced in younger individuals.
Clinicians should advise smokers to enroll in cessation programs.
Patients who continue to smoke should be warned about less predictable outcomes and increased recurrence rates.
E-cigarettes may be safer than smoking for general health but their effects on periodontal health are undetermined.
Inquire about e-cigarette use and include vaping cessation in the treatment plan.
What do I Need to be Aware of When Treating Pregnant Patients?
Elevated hormone levels in pregnancy exacerbate gingival inflammation.
Existing gingivitis or periodontitis typically worsens during pregnancy.
Treat periodontitis during pregnancy but avoid elective periodontal surgery.
Provide oral health education and emphasize that non-surgical periodontal therapy is safe and effective.
Maintain frequent monitoring throughout pregnancy.
What is the Link Between Periodontitis and General Health?
Severe periodontitis is associated with premature mortality and cardiovascular disease.
There is a direct relationship between periodontitis severity and diabetes complications.
Periodontal therapy is associated with HbA1C reduction.
Periodontitis is independently associated with cardiovascular diseases.
Increase awareness about periodontal health for general health and wellbeing.
What were the Key Changes Made to the BPE Guidelines in 2016?
Examine all sites in a sextant with code 4.
Perform initial therapy for code 3 before six-point pocket charting.
Do not use BPE around implants; use four- or six-point pocket charting.
Take radiographs for all code 3 and code 4 sextants.
Record sites of 4 mm and above when a six-point pocket chart is indicated.
Record bleeding on probing with a six-point pocket chart.
Where Can I Find Out More About the New Classification?
The 2017 World Workshop Classification system considers advances in biological and clinical research.
It defines clinical health and distinguishes between intact and reduced periodontium.
‘Aggressive periodontitis’ is replaced by a staging and grading system.
The BSP has an implementation group to guide adoption of the new classification.
Resources are available on the BSP website.
What Language Can I Use With My Patients to Convince Them of the Importance of Treating Periodontitis?
Explain benefits in patient-friendly language, such as keeping teeth longer, avoiding bad breath, and improving quality of life.
Discuss associations between periodontitis and general health.
How Do I Provide Effective Oral Hygiene Instructions in the Limited Time Given?
Orientate: Introduce oral anatomy.
Disclose: Use disclosing agents to highlight missed areas.
Demonstrate: Show toothbrushing and interdental cleaning.
Lingual/palatal: Advise starting in these areas.
Overzealous brushers: Advise a pen-grip and wrist-action.
Promote power brushes.
Emphasise interdental cleaning.
GPS (Goal setting, Planning, Self-monitoring): Use this approach for habit change.
Risk assessment tools: Employ tools to predict disease progression.
Keep it simple and reinforce advice.
Emphasize patient responsibility.
When Carrying Out Non-Surgical Periodontal Therapy, is There One Approach That is Superior to Another, Specifically When Considering the Number of Visits and Instruments/Equipment Used?
Non-surgical periodontal therapy is effective for motivated patients with good plaque control and pockets >5 mm or 4 mm with bleeding.
Vigorous removal of cementum/root structure is no longer recommended.
No single technique or regime is superior; decisions depend on disease severity, patient anxiety, and plaque control.
Quality of debridement is more important than the technique.
Full-mouth debridement may cause systemic insult.
A blended approach using both ultrasonic and hand scaling is ideal.
Evidence on lasers is conflicting.