Periodontal health
Managing patients with a diagnosis of periodontal health
Periodontal health is defined in the 2018 Classification of Periodontal Diseases as <10% of sites with bleeding on probing and all sites with probing pocket depths of ≤3 mm and no clinical attachment loss due to periodontitis.8
Key recommendation
For patients with a diagnosis of periodontal health, prioritise personalised oral hygiene instruction over professional mechanical plaque removal (PMPR) to encourage effective oral self-care.
(Strong recommendation; high certainty evidence)
In patients with a diagnosis of periodontal health, the priority is to support the patient to maintain their healthy status.
The Delivering Better Oral Health toolkit (DBOH)7 notes the importance of daily, effective plaque removal and the 11th European Workshop in Periodontology consensus report Principles in prevention of periodontal diseases90 recommends repeated and individually tailored oral hygiene instruction (OHI), with the addition of professional mechanical plaque removal (PMPR) both supragingivally and submarginally, where required, to allow good self-performed oral hygiene.
A systematic review assessed studies investigating the provision of periodontal “standard care” (i.e. 6-monthly review appointments, where the focus was on calculus removal) conducted in general dental practice in regularly attending adults without severe periodontitis compared to less frequent care.57, 58 The review found that providing calculus removal on a less frequent basis was as effective as “standard care” when assessing plaque biofilm (low certainty evidence due to risk of bias and indirectness) and gingival bleeding (high certainty evidence) levels over two to three years follow-up.
Periodontal health is dependent on the patient controlling, and eliminating where possible, risk factors for disease and consistently performing adequate home care. Support from the dental team, such as providing information about risk factors, support for skills development in oral hygiene and removal of plaque retentive factors will help the patient achieve this. For some patients, calculus removal will be required as part of the process of supporting periodontal health to enable adequate home care.
Further details on the development of the recommendations in this guidance can be found in Methodology.
For patients with a diagnosis of periodontal health:
Explain that healthy periodontal tissues are important to retain teeth, that disease may develop in the presence of risk factors and that the dental team will regularly check the status of the patient’s periodontal health.
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 knowledge base on the value of good self-care routines (see Oral hygiene).
Where applicable, give information regarding personal risk factors and modifying them, for example, smoking cessation advice and diabetes control (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.
Continue to check the patient’s risk profile (see Assigning patient risk) and their periodontal health status regularly.