in Greater Manchesterin Greater Manchester

GreaterGreater Manchester Manchester LocalGr Localeater Dental Dental Manchester Network Network Local Dental Network

Periodontal Management In Primary Dental Care Greater Manchester Local Dental Network

Quick Reference Guide

Second Edition I Spring 2019

Introduction

The quick reference guide has been designed to accompany the Healthy Gums DO Matter Toolkit. It includes all the relevant clinical information and tools a clinician would need quick access to, having read the Toolkit.

It has been designed to facilitate photocopying of the various documents, such as the patient agreement, consent form and pocket charts. The laminate finish has been designed to keep in the dental surgery as a quick reference booklet.

Contents

Modified Plaque and Bleeding Score Method Page 3

Modified Plaque and Bleeding Score Tables Page 4

Periodontal Pathway Diagrams Page 6

Clinical Notes Templates Page 15

Patient Leaflet and Consent Form Page 16

Patient Agreement Page 18

Pocket Chart Version 1 Page 19

Pocket Chart Version 2 Page 20

Pocket Chart Version 3 Page 21

BSP Flowchart Implementing 2017 Classification Page 22

2

Modified Bleeding Score

Ramfjord’s Teeth An Example of a Modified Bleeding Score Ramfjord’s teeth

16 21 24 16 21 24 UR6 UL1 UL4 UR6 UL1 UL4

B B B 0 0 1 D M M D 1M D 1 0 1 1 1 0 P P P 1 0 0

L L L 0 0 0 D M D M M D 1 0 1 1 1 0 B B B 0 1 0

LR4 LR1 LL6 LR4 LR1 LL6 44 41 36 44 41 36

Code Description Total Score = 11 0 Absence of bleeding on probing Bleeding Score: 1 Presence of bleeding on probing (marginal bleeding) 11 × 100 = 45.83 = 46% 24 Modified Bleeding Score = 46%

Modified Plaque Score

Ramfjord’s Teeth An Example of a Modified Plaque Score

16 21 24 16 21 24 UR6 UL1 UL4 UR6 UL1 UL4

B B B B B B B 1 B 1 B 0 DIP M MIP D 1MIP D D0 M M0 D 1M1 D P P P P P P P 2 P 1 P 2

L L L L L L L 2 L 0 L 1 DIP M DIP M MIP D D0 M D0 M M0 D B B B B B B B 1 B 1 B 2 LR4 LR1 LL6 LR4 LR1 LL6 44 41 36 44 41 36

Code Description Total Score = 15 0 No plaque visible, even when a probe is used Plaque Score: 1 Some plaque visible only when a probe was used to skim the tooth surface 15 2 Visible amount of plaque which can be seen without use of a probe × 100 = 41.66 = 42% 36 N No measurement could be made for this surface/tooth Modified Plaque Score = 42%

3 Modified Plaque Score Table

TotalT Scorotal eScore PlaquePlaque Scor eScore TotalT Scootalre Score PlaquePlaque Scor eScore

1 1 3% 3% 19 19 53%53%

2 2 5% 5% 20 20 56%56%

3 3 8% 8% 21 21 58%58%

4 4 11%11% 22 22 61%61%

5 5 14%14% 23 23 64%64%

6 6 17%17% 24 24 67%67%

7 7 19%19% 25 25 69%69%

8 8 22%22% 26 26 72%72%

9 9 25%25% 27 27 75%75%

10 10 28%28% 28 28 78%78%

11 11 30%30% 29 29 81%81%

12 12 33%33% 30 30 83%83%

13 13 36%36% 31 31 86%86%

14 14 39%39% 32 32 89%89%

15 15 42%42% 33 33 92%92%

16 16 44%44% 34 34 94%94%

17 17 47%47% 35 35 97%97%

18 18 50%50% 36 36 100%100%

4 Modified Bleeding Score Table

Total ScoreTotal Score Bleeding ScoBleedingre Score Total ScoreTotal Score Bleeding ScoBleedingre Score

1 1 4% 4% 13 13 54% 54%

2 2 8% 8% 14 14 58% 58%

3 3 13% 13% 15 15 63% 63%

4 4 17% 17% 16 16 67% 67%

5 5 21% 21% 17 17 71% 71%

6 6 25% 25% 18 18 75% 75%

7 7 29% 29% 19 19 79% 79%

8 8 33% 33% 20 20 83% 83%

9 9 38% 38% 21 21 88% 88%

10 10 42% 42% 22 22 92% 92%

11 11 46% 46% 23 23 96% 96%

12 12 50% 50% 24 24 100% 100%

5 ess) gime ettes, Nicotine gum r gime (e.g. mental illness, str re Brushing re fecting dexterity (e.g. Rheumatoid Arthritis) dental cleaning re YES Single tufted brus h stomia (e.g. drug-induced ) Yes - Stage, Grade, Risk Factors Inter SOCIAL HISTO RY BPE, Plaque and Calculus Level s Xe ro placement/use - E ciga Other relevant medical factors obacco use – Smoking or chewing fecting self ca MEDICAL HISTO RY Diabetes, immuno-compromised CLINICAL FINDINGS T INTERVENTION RECALL 9-12 MONTHS Stable periodontitis Pockets ≤ 4mm and no BoP at sites . Distribution - localised, generalised, molar/incisor Factors af History of periodontal disease – Clinical attachment loss Nicotine re Remove plaque retentive factors and scale. One Visit Bleeding – localised (<10-30%) or generalised (> 30%) Health on a reduced periodontium Stage, grade, risk assess. Reinfoce OHI, importance of daily ID cleaning & high levels of plaque control. Warn risk further Any disease or condition af periodontal destruction Pocket chart annually in maintenace phase PATHWAY C YES bone loss - historic periodontitis ) Interdental Recession/ Clinical Attachment Loss (Evidence of radiograhic interdental TION One Visit NO AL RISK periodontium INTERVENTION

non-periodontitis retentive factors – overhangs etc. Scale as needed / remove calculus Health on a reduce d Praise and Advice. Reinforce areas of ris k RECALL 12-24 MONTH S ASSESSMENT PATHWAY B CLINICAL EXAMINA Periodontal Health Pathway AND PERIODONT Evidence of Clinical Recession 1 1 1 2 NO 1 1 One Visit Health on an INTERVENTION retentive factors – overhangs etc. Scale as needed / remove calculus intact periodontium 0 0 RECALL 12-24 MONTHS Praise and Advice. Reinforce areas of risk 0 0 PATHWAY A 0 0 BPE

6

n 4mm with Bo P PATHWAY C ce OHI, importance RECALL - 6/12 Responsive patien t Stable periodontitis reduced periodontiu m BOP<10%. Health on a Brushing regime Single tufted brus h Reinfor Interdental cleaning regime SOCIAL HISTORY Xeostomia (e.g. drug-induced) Other relevant medical factors Yes - Stage, Grade, Risk Factors BPE, Plaque and Calculus Levels Diabetes, immuno-compromised MEDICAL HISTORY CLINICAL FINDINGS 4mm with Bo P Tobacco use – Smoking or chewing 4mm and no BoP at sites . ≤ 3 month recall INTERVENTION Distribution - localised, generalised, molar/incisor Factors affecting self care (e.g. mental illness, stress) Nicotine replacement/use - E cigarettes, gum History of periodontal disease – Clinical attachment los s Pockets YES Smoking cessation as indicated No pockets ≥ 3 Month Recall - VISIT 2 Bleeding – localised (<10-30% sites) or generalised (>30% Thorough supra and subgingival scale. Any disease or condition afffecting dexterity (e.g. Rheumatoid Arthritis) 4mm and no BoP at sites. No pockets ≥ ≤ of daily ID cleaning & high levels plaque control. Stage, grade, risk assess. Personalised preventive advic e Remove plaque retentive factors - scaling to facilitate OH Pocket chart. Warn of significant risk further periodontal destructio Supervised brushing, Demonstrate appropriate ID cleanin g Re-examination and reassement. Re-warn of significant risk further periodontal destruction Explain nature of Periodontal disease & main risk factor is plaque Pockets if no unstable site s Non-responsive patient on a reduced periodontium Periodontitis in remissio n RECALL - 3/12 and then 6/12 BOP>10%. Gingival inflamation bone loss - historic periodontitis ) Interdental Recession/ Clinical Attachment Loss (Evidence of radiograhic interdental YES & NO Non-periodontitis RECALL - 9/12 Responsive patien t reduced periodontiu m BOP<10%. Health on a 3 month recall INTERVENTION high levels of plaque control. Personalised preventive advice Smoking cessation as indicated Re-examination and reassement 3 Month Recall - VISIT 2 Thorough supra and subgingival scale. Reinforce OHI, importance of daily ID cleaning is plaque. Warn of risk periodontal destruction Remove plaque retentive factors - scaling to facilitate OH Reinforce messages and evaluate any improvement in OH Supervised brushing, Demonstrate appropriate ID cleaning Non-periodontitis PATHWAY B RECALL - 6/12 Explain nature of Periodontal disease and the main risk factor Evidence of reduced periodontiu m Non-responsive patient ASSESSMENT BOP>10%. Gingivitis on a Clinical Recession Periodontal Risk Pathway CLINICAL EXAMINATION AND PERIODONTAL RISK 2 2 & 2 2 NO BOP<10 % periodontium 2 2 ECALL - 9/12 R Responsive patien t Health on an intact 3 month recall

INTERVENTION high levels of plaque control. Personalised preventive advice Smoking cessation as indicated Re-examination and reassement 3 Month Recall - VISIT 2 Thorough supra and subgingival scale. Reinforce OHI, importance of daily ID cleaning is plaque. Warn of risk periodontal destruction BOP>10 % 1 1 periodontium Remove plaque retentive factors - scaling to facilitate OH Reinforce messages and evaluate any improvement in OH Supervised brushing, Demonstrate appropriate ID cleaning RECALL - 6/12 Explain nature of Periodontal disease and the main risk factor PATHWAY A Gingivitis on an intac t 1 2 Non-responsive patient 1 1 BPE

7 4mm & no BoP ≤ Recall 6/12

Maintenance If no unstable sites Stable periodontitis at 4mm sites, BoP >10% at 4mm sites, BoP <10%

Recall 3/12 and then 6/12 POCKETS m POCKETS ≤ 4mm & no BoP Periodontitis in remission ≥ 6m Grade C to plaque levels. Rapid destruction Inconsistant destruction in relation POCKETS reinforce prevention Unstable periodontitis Level 2 Referral POCKETS ≥ 6mm prevention and education Re-motivate and reinforce Continue with root surface 3 MONTH RECALL Re-root surface debridement 9 MONTHS FROM BASELINE Re APE / 6 Point Pocket chart Exam, plaque/bleeding scores debridement. Re-motivate & Good OH GOOD OH relevant sextant (Marginal BoP) > 50% Improvement

Plaque Score <30% Reinforce prevention Bleeding Score <35% OR Root surface debridment APE/ 6 Point Pocket Chart in Recall 3/12 greater with BoP Unstable periodontitis prevention and education Re-motivate and reinforce Residual pockets 4mm or POCKETS ≥ 4mm WITH BoP Re-root surface debridement etion Good OH RECALL GOOD OH RECALL BASELINE (Marginal BoP) 3 MONTH > 50% Improvement relevant sextant

Plaque Score <30% 3 MONTH Bleeding Score <35% Clinical Discr TIENT PROGRESS REVIE W OR BoP >10% PA APE/ 6 Point Pocket Chart in 6 MONTHS FROM BASELINE at 4mm sites no unstable sites. Re-debride supra and Periodontitis in remission. subgingivally as indicated POCKETS ≤ 4mm & no BoP then 6/12 if no unstable sites Increased risk. Recall 3/12 and No pockets ≥ 4mm with BoP - Reinforce OHE & behaviour change, ID cleaning, radiographs, Exam, stage, grade, risk assess, Modified Plaque & Bleeding score, supra & subgingival scaling - remove and calculus VISIT 2 - 4 VISIT 1 - patient agreement, leaflet & consent form, prevention, motivation Periodontal Disease Pathway 3 3 BoP <10% 3 3 Recall 6/12 Maintenance Stable periodontitis

3 3 POOR OH POOR OH (Marginal BoP) (Marginal BoP) < 50% Improvement < 50% Improvement Plaque Score >30% Plaque Score >30% Remove Supra and subgingival calculus Remove Supra and subgingival calculus Re-motivate patient Re-motivate patient Reinforce prevention Bleeding Score >35% Reinforce prevention Bleeding Score >35% OR OR Re-establish pt agreement Re-establish pt agreement Supra and subgingival scaling Supra and subgingival scaling 3 1 1 1 1 1 BPE

8

m mm 6

≥ 6m Grade C ≥ to plaque levels. Rapid destructio n Inconsistant destruction in relation POCKETS reinforce prevention Unstable periodontitis Level 2 Referral POCKETS prevention and education Re-motivate and reinforce Continue with root surface 3 MONTH RECALL Re-root surface debridement 9 MONTHS FROM BASELIN E Exam, plaque/bleeding scores Re APE / 6 Point Pocket chart debridement. Re-motivate & Good OH GOOD OH Pocket Chart (Marginal BoP) > 50% Improvement

Plaque Score <30% Reinforce prevention Bleeding Score <35% OR Full mouth APE/ 6 Point Root surface debridment Recall 3/12 greater with BoP Unstable periodontitis prevention and education Re-motivate and reinforce Residual pockets 4mm or POCKETS ≥ 4mm WITH BOP Re-root surface debridement Good OH RECALL GOOD OH Pocket Chart BASELINE RECALL (Marginal BoP) 3 MONTH > 50% Improvement

Plaque Score <30% 3 MONTH Bleeding Score <35% Clinical Discretion OR Full mouth APE/ 6 Point BoP >10% at 4mm sites PATIENT PROGRESS REVIE W 6 MONTHS FROM BASELINE no unstable sites. Re-debride supra and subgingivally as indicated Periodontitis in remission. POCKETS ≤ 4mm & no BoP No pockets ≥ 4mm with BoP - then 6/12 if no unstable sites Increased risk. Recall 3/12 and Reinforce OHE & behaviour change, ID cleaning, radiographs, Exam, stage, grade, risk assess, Modified Plaque & Bleeding score, supra & subgingival scaling - remove and calculus VISIT 2 - 4 VISIT 1 - patient agreement, leaflet & consent form, prevention, motivation Advanced Periodontal Disease Pathway 4/4* 4/4* BoP <10% Recall 6/12 Maintenance 4 4 Stable periodontitis

POOR OH POOR OH Advanced Periodontal Disease Pathway 4/4* 4/4* 4/4 * (Marginal BoP) (Marginal BoP) < 50% Improvement < 50% Improvement Plaque Score >30% Plaque Score >30% Remove Supra and subgingival calculus Re-motivate patient Remove Supra and subgingival calculus Re-motivate patient Reinforce prevention Bleeding Score >35% Reinforce prevention Bleeding Score >35% OR OR Re-establish pt agreement Re-establish pt agreement Supra and subgingival scaling Supra and subgingival scaling 4/4* 11 1 1 1 BPE

9 RECALL 3 MONTHS Examination, and risk assessment Modified Plaque & Bleeding Scores Patient agreement & patient leaflet consent form Oral health education and behaviour change Prevention and motivation Radiographs and report - stage grade Diagnosis & finalise treatment plan Supra and Subgingival scaling to remove supra & subgingival calculus to facilitate oral hygiene Reinforce OHE, behaviour change and motivation VISIT 1 VISIT 2-4 Baseline - First Examination & Assessment Year 1, Month 1 Year Baseline – Course 1

10 4mm & no BoP ≤ Recall 6/12 Maintenance If no unstable sites Stable periodontitis at 4mm sites, BoP >10% at 4mm sites, BoP <10% Recall 3/12 and then 6/12 POCKETS POCKETS ≤ 4mm & no BoP Periodontitis in remission Good OH GOOD OH RECALL (Marginal BoP) > 50% Improvement

Plaque Score <30% 3 MONTHS Reinforce Prevention Bleeding Score <35% OR Root Surface Debridment *APE/ 6 Point Pocket Chart e e Plaque Scor Bleeding Scor

POOR OH RECALL (Marginal BoP ) Remove Calculus < 50% Improvement Plaque Score >30% Re Motivate Patient 3 MONTHS Reinforce Prevention Bleeding Score >35% OR Re-establish Pt Agreement Supra and Subginival scaling 3 Month Recall - Re-examine & Reassess Advanced Disease Pathway (BPE code 4) full mouth APE/DPC, pre-treatment pocket chart Disease Pathway (BPE code 3) APE/DPC in the relevant sextant post initial therapy pocket chart * Year 1, Month 3 Year 3/12 Re-examination and reassessment

11 pathway Good OH GOOD OH (Marginal BoP) > 50% improvement Patient goes into

engaging patient Plaque Score <30% Bleeding Score <35% OR etio n Clinical Discr e assess POOR OH (Marginal BoP) Plaque Scor < 50% Improvement remove calculus Plaque Score >30% Bleeding Sco re Re-motivate patient Reinforce prevention Bleeding Score >35% OR Re-establish pt agreement RECALL 3 MONTHS Supra and subginival scaling Re-examine & re

3 monthly cycle 6 Month Recall - Non-Engaging Patient Non-Engaging - Recall Month 6 Year 1 // Month 6 – Non-engaging patient pathway way Year 6/12 Re-examination and reassessment

12 m 6m ≥ POCKETS Unstable periodontitis prevention and education Re-motivate and reinforce RECALL 3 MONTHS Re-root surface debridement e assess Post therapy GOOD OH 50% improvement Plaque Scor (Marginal BoP) > Bleeding Sco re

greater with BoP Plaque Score <30% Bleeding Score <35% prevention and education Unstable periodontitis OR Re motivate and Reinforce Residual pockets 4mm or *APE/ 6 Point Pocket Chart Re-root surface debridement RECALL 3 MONTHS POCKETS ≥ 4mm WITH BoP Re-examine & re

6 Month Recall - Engaging Patient BoP >10% unstable sites Periodontitis in remission. and then 6/12 if no then 6/12 if no unstable sites Increased risk. Recall 3/12 and RECALL 3 MONTHS at 4mm sites no unstable sites. Re-debride supra and subgingivally as indicated POCKETS ≤ 4mm & no BoP No pockets ≥ 4mm with BoP - BoP <10% Stable periodontitis Maintenance Recall 6/12 Advanced Disease Pathway (BPE code 4) full mouth APE/DPC, post-treatment pocket chart Disease Pathway (BPE code 3) APE/DPC in the relevant sextant post-treatment pocket chart RECALL 6 MONTHS * Year 1 // Month 6 – Engaging patient pathway Year – post treatment 3/12 Re-examination and reassessment the baseline) Course 3 (6 months from

13 m 6m ≥

POCKETS Level 2 Referral 3 Monthly Cycle Unstable periodontitis Continue with 3/12 recall debridement. Re-motivate & Continue with re-root surface reinforce prevention/education e e assess GOOD OH 50% improvement Plaque Scor (Marginal BoP ) greater with BoP > Bleeding Scor

Post re-treatment Plaque Score <30% Bleeding Score <35 % Unstable periodontitis OR prevention and education Residual pockets 4mm or Re motivate and Reinforc e *APE/ 6 Point Pocket Chart RECALL 3 MONTHS POCKETS ≥ 4mm WITH BoP Re-root surface debridemen t Re-examine & re and

9 Month Recall - Engaging Patient BoP >10% unstable sites and then 6/12 if no Periodontitis in remission. RECALL 3 MONTHS then 6/12 if no unstable sites Increased risk. Recall 3/12 at 4mm sites no unstable sites. Re-debride supra and

subgingivally as indicated POCKETS ≤ 4mm & no BoP No pockets ≥ 4mm with BoP - BoP <10% Stable periodontitis Maintenance Recall 6/12 Advanced Disease Pathway (BPE code 4) full mouth APE/DPC, post re-treatment pocket chart Disease Pathway (BPE code 3) APE/DPC in the relevant sextant post re-treatment pocket chart RECALL 6 MONTHS * Year 1 // Month 9 – Engaging patient pathway Year – post re-treatment 3/12 Re-examination and reassessment the baseline) Course 4 (9 months from

14 Example of Notes for Clinical Records

Patient advised of mild/moderate/severe/ very severe / rapidly Advised patient of importance of daily ID cleaning to progressing (aggressive) periodontal disease (periodontitis) stabilise PD which is localised affecting less than 30% of teeth / generalised Patient advised to make sure sung fit for ID brushes so are affecting more than 30% of teeth and progressing at a slow/ effective moderate/rapid rate and is currently stable/ in remission/ unstable Patient shown correct technique for ID cleaning and how to work ID brush to ensure effective cleaning Patient warned of tooth mobility and tooth loss related to periodontal disease Demo given in the mouth with ID brush and patient shown how to insert at correct angle and avoid trauma to the gingivae Patient advised that they are at risk of developing destructive and clean effectively against both teeth and interdentally periodontal disease – periodontitis Patient shown in the mouth how to use interdental brushes Patient advised the main risk factor for periodontal disease and shown how to access upper post quadrants form palatal is plaque and to prevent further bone destruction and aspect and lower posterior quadrants from the lingual aspect. advancement of periodontal disease leading to tooth mobility Patient advised to do this daily as well and tooth loss, they must maintain high standards of oral hygiene and low plaque levels Patient advised to use single tufted brush as well and to concentrate marginally and interproximally. Demonstrated to Patient advised of diabetes related to periodontal disease and the patient how to use the single-tufted brush using a pen grip increased risk of developing periodontal disease of finger grip for better control. with poorly controlled blood sugar levels and poorer response to periodontal therapy. Patient advised well controlled Patient’s brushing technique examined and patient shown the diabetics have similar risk to non-diabetic patients. Patient areas being missed advised stabilising periodontal disease will be influenced by how well controlled their glycaemic levels are Tooth brushing demo given to patient – patient shown Bass technique and modified Stillman technique Patient advised of smoking related to periodontal disease – increased risk factor (3-7 times) for periodontitis and Patient advised if periodontal disease progresses it will poorer response to periodontal therapy and increased risk eventually result in tooth mobility leading to tooth loss of treatment failure and tooth loss. Patient advised smokers Discussed with patient referral to periodontal specialist for receiving treatment for periodontitis are twice as likely to lose periodontal therapy and treatment teeth compared with non-smokers. Patient advised stopping smoking will help to improve the outcome of periodontal Patient advised of self-care responsibilities to prevent further disease destructive periodontal disease leading to tooth loss and tooth mobility. These include brushing effectively twice daily as Discussed with patient about Electronic Cigarettes / vaping shown and once daily interdental cleaning with appropriate and oral nicotine – still a risk factor for periodontal disease as interdental cleaning aids as has been demonstrated. nicotine is a vasoconstrictor – encouraged patient to try and reduce and stop and to use it as part of a plan to stop smoking APE done - Full mouth 6-point pocket chart carried out and all and using nicotine pockets 4mm and over with and without bleeding recorded on pockets chart and maximum attachment loss per tooth. Patient advised that oral hygiene is not adequate to support Mobility and furcation involvement recorded. formal periodontal therapy. Patient advised needs to improve oral hygiene and plaque levels to support periodontal therapy. Supra and subgingival scaling and root surface debridement Patient advised that formal periodontal therapy with pocket carried out on all pockets identified on pocket chart (under charting and root surface debridement to be delayed until LA – type, dose, amount, location given, batch number, expiry oral hygiene supportive. Patient advised that we will carry out date) with ultrasonic/cavitron machine and/or hand instruments gross supra and sub-gingival scaling and debridement to help Full mouth ultrasonic disinfection carried out with/without LA facilitate improvement in oral hygiene and plaque levels. (type, dose, amount, location given, batch number, expiry date) Patient advised the best outcome after treatment will be Patient does not want periodontal treatment or scaling. when they have low plaque levels, excellent oral hygiene, stop Patient warned of further progression of periodontal disease smoking and blood sugar related to diabetes is under good and further tissue and bone destruction leading to tooth control mobility and eventual tooth loss. Advised that periodontal Reinforced patient agreement and self-care plan and their treatment will delay this process and if it is supported by responsibilities to maintain good plaque control high standards of plaque control and oral hygiene then it will stabilise the periodontal disease. Patient still decided not to Patient warned of post operative sensitivity, gingival recession, have periodontal treatment and refuses treatment and accepts tooth mobility and black triangle appearance due to loss of the risks. Patient information gone through and patient signed interdental papillae after periodontal therapy informed refusal for periodontal treatment Patient shown in mirror all the areas they are missing and the Patient advised periodontal treatment will not be successful plaque build up on the teeth and interdentally. and stabilise unless supported with high levels of plaque Patient advised of the importance of interdental cleaning to control and oral hygiene remove interdental plaque and prevent periodontal disease Patient agreement re—established and re-outlined patient’s Patient shown how to use Interdental brushes properly and responsibilities for self-care as in the patient agreement advised sizes. Patient advised to make sure sung fit for ID brushes so they are effective

15

Patient Name: Patient Number: DOB: Date

Mob/Furc Recession Pocket Depth B B UR8 UR7 UR6 UR5 UR4 UR3 UR2 UR1 UL1 UL2 UL3 UL4 UL5 UL6 UL7 UL8 Upper P P Pocket Depth Recession

Recession Pocket Depth L L Lower LR8 LR7 LR6 LR5 LR4 LR3 LR2 LR1 LL1 LL2 LL3 LL4 LL5 LL6 LL7 LL8 B B Pocket Depth Recession Mob/Furc

Review Date Mob/Furc Recession Pocket Depth B B UR8 UR7 UR6 UR5 UR4 UR3 UR2 UR1 UL1 UL2 UL3 UL4 UL5 UL6 UL7 UL8 Upper P P Pocket Depth Recession

Recession Pocket Depth L L Lower LR8 LR7 LR6 LR5 LR4 LR3 LR2 LR1 LL1 LL2 LL3 LL4 LL5 LL6 LL7 LL8 B B Pocket Depth Recession Mob/Furc Patient Name: Patient Number: DOB: Date

Mob/Furc Recession Pocket Depth B B UR8 UR7 UR6 UR5 UR4 UR3 UR2 UR1 UL1 UL2 UL3 UL4 UL5 UL6 UL7 UL8 Upper P P Pocket Depth Recession

Recession Pocket Depth L L Lower LR8 LR7 LR6 LR5 LR4 LR3 LR2 LR1 LL1 LL2 LL3 LL4 LL5 LL6 LL7 LL8 B B Pocket Depth Recession Mob/Furc

Modified Plaque Score Modified Bleeding Score

16 21 24 16 21 24 UR6 UL1 UL4 UR6 UL1 UL4 B B B B B B B DIP M B B MIP D 11MIP D D M M D M D P P P P P P P P P

L L L L L L L L L DIP M DIP M MIP D D M D M M D B B B B B B B B B LR4 LR1 LL6 LR4 LR1 LL6 44 41 36 44 41 36

Total Score = Modified Plaque Score =% Total Score = Modified Bleeding Score =% Patient Name: Patient Number: DOB: Date

12 10 8 6 4 Buccal 2

12 10 8 6 Palatal 4 2 R L Mob/Fur c Recession B B Pocket Depth 8 776 5 4 3 2211 3 4 5 6 8 Upper

P Pocket Depth P Recession L L Recession Pocket Depth

8 7 67564 3423121 5 8 Lower

B B Pocket Depth Mob/FurRecessionc

2 4 6 8 10 12 Lingual

2 4 6 8 10 Buccal 12

www.bsperio.org.uk

www.bsperio.org.uk

in Greaterin ManchesterGreater Manchester

Author Greater ManchesterGreater Manchester Local Dental Local Network Dental Network Shazad Saleem

Contributions from: Martin Ashley Prof Iain Chapple Colette Bridgman Elaine Hawthorn Gill Davies

Greater Manchester Local Dental Network (LDN) Healthy Gums DO Matter

LDN Perio Steering Group: Shazad Saleem - (Chair and Clinical lead), Colette Bridgman, Martin Ashley, Elaine Hawthorn, Rose Pealing & Prof Iain Chapple.

LDN Perio Working Group and additional input from: Shazad Saleem, Martin Ashley, Elaine Hawthorn, Colette Bridgman, Rose Pealing, Prof Iain Chapple, Paul Weston, Prof Ian Needleman, Ian Sproat, Tasmia Khan, Serena Rochford, James Darcey, Kirsten Sedgwick, Imran Asghar, Ravi Singh, Diane Hunter, Mohsan Ahmad, Claire Scott, Razvana Bashir, Ann Brady.

Supported By Greater Manchester Area Team – Ben Squires, Lindsey Bowes Public Health England, Greater Manchester Centre

Medico - Legal Advice Andrew Bridgman, St Johns Buildings Barrister’s Chambers Philip R. Greene, Specialist in Periodontics, Dental Expert Witness

Greater Manchester Health & Social Care Partnership Greater Manchester Local Dental Network, GM Area Team, 3 Piccadilly Place, Manchester M1 3BN Email: [email protected] Second Edition I Spring 2019