Assessing plaque biofilm and bleeding

Assessing plaque biofilm and bleeding

Inflammation of the periodontal tissues occurs in response to the presence of dental plaque biofilm and results in bleeding. Bleeding from the gingival margin is mainly related to inadequate oral hygiene while bleeding from the base of the pocket may indicate that active periodontal disease is present.

The stepwise approach to treatment (see Planning periodontal treatment) advises regular and ongoing objective monitoring of plaque biofilm and marginal bleeding as an integral part of patient management. Charting plaque biofilm and marginal bleeding levels allows the clinician to understand the patient’s initial levels of plaque control and inflammation. It subsequently enables the response to treatment to be objectively monitored and, in addition, can be helpful for motivating patients.

Full mouth plaque assessment

A full mouth plaque assessment can be performed as part of the full periodontal examination (see Monitoring plaque and bleeding).

Plaque disclosing tablets or solutions can aid in the detection of plaque biofilm and act as a visual demonstration of plaque levels for patients. Plaque charts can be used to assist with oral hygiene instruction.

Abbreviated charts of index teeth

While a full mouth assessment is useful in specific circumstances, charting plaque biofilm and marginal bleeding indices for index teeth (e.g. Ramfjord teeth*) on a regular basis is more practical. However, be aware that partial mouth recording systems tend to underestimate disease and that an abbreviated bleeding score obtained from index teeth may underestimate the true bleeding score that would be obtained from a full mouth assessment.

Monitoring plaque biofilm and bleeding provides examples of abbreviated plaque biofilm and marginal bleeding charts and advice on how to record these. 

Ramfjord’s Teeth are six index teeth (16, 21, 24, 36, 41, 44) that are distributed to best reflect the condition of the whole mouth.