Periodontal health
Patients with a diagnosis of periodontal health
Long-term care for patients with a diagnosis of periodontal health aims to prevent the development of primary disease. It includes aspects of both prevention and treatment, with emphasis on regular re-enforcement of effective oral hygiene and management of modifiable risk factors (e.g. smoking status, diabetes control).
Care is likely to be delivered less frequently and less intensively for these patients than that provided to patients with a diagnosis of periodontitis. The presence or absence of specific factors related to an increased risk of disease onset (e.g. inadequate oral hygiene, smoking, diabetes, a family history of early tooth loss) will determine the interval for this risk-based recall.
In patients who have no history of periodontitis and who do not currently have gingivitis, each recall appointment should comprise assessment and, if appropriate, treatment as follows.
Update the patient’s medical and social history and assess the patient’s control of modifiable risk factors (e.g. plaque control, smoking status, HbA1c levels).
Carry out an oral examination, including periodontal screening (including BPE) and assessment of plaque and bleeding levels.
Provide personalised oral hygiene advice and instruction, where required, to assist and encourage the patient to improve their oral hygiene skills as well as their understanding of the value of good self-care routines (see Oral hygiene).
Where applicable, give advice on control of modifiable risk factors (see Smoking cessation and Control of diabetes).
Assess whether professional mechanical plaque removal (PMPR) is required, for example at sites where calculus or other plaque retentive factors are present, and provide as necessary.
Correct local plaque retentive factors - for example, remove overhanging restorations or alter denture design.
Assess and assign an individual periodontal risk level (see Assigning patient risk and Risk assessment tool) based on the patient’s medical history, known risk factors, current oral health status and levels of plaque control. Explain to the patient what this means for them and use the risk level to inform the future recall interval.