Starting Fresh!
With the NHS suspending routine dental appointments, many of our patients found themselves without their regular oral health inspection. This led to many patients being without access to dental care for a period between 8 - 18 months.
Unfortunately, the absence of supervision from dental professionals has caused a number of clinical conditions to go undetected and in some situations cause serious and lasting damage.
Periodontal disease is a condition where the bone surrounding and holding a tooth in the jaw bone becomes infected and dissolves. The gum covering the tooth can either become inflamed or recede and sometimes without any signs such as bleeding gums.
Periodontal disease can be genetic - and to those people susceptible, simple home care is not enough. It can also be environmental - stemming from poor cleaning habits, medical conditions such as diabetes, and social habits like smoking and high alcohol intake.
Whatever the reason, it is important to identify the condition and timely treatment is key to limiting the harm caused by this. Unfortunately too often we see patients attending their first appointment with us and not being aware of the bone loss that has occurred throughout their life. Healthy teeth can be lost due to unhealthy gums.
During the enforced national lockdown, dental hygiene therapy became a treatment that was a low priority by the greater medical community due to the concern of the coronavirus and the need to limit aerosol-generating procedures such as dental cleanings that involved ultrasonic scalers.
One of the biggest challenges we will be facing when we can resume a normal appointment schedule is how to combat the advancement in periodontal disease for patients who are susceptible. Whilst asymptomatic for many until the end of the disease cycle, it is very dangerous when left untreated and unfortunately very debilitating when multiple teeth need to be removed.
The lockdown allowed us time to refocus on the nature of periodontal disease and how we as clinicians treat this disease. Periodontal therapy is not curative - as long as individual remains susceptible, their risk will always be there, but the treatment of the condition has to be lifelong - or as long as they have natural teeth.
One of the best weapons in the fight against periodontal disease is the Dental Hygienist or Dental Therapist. Both are highly skilled clinicians who provide very effective treatment and advice against the disease.
The correct implementation of an oral hygiene regime will involve the careful assessment of the initial condition measuring the firmness of the gums and general oral health care patterns, as well as using supporting evidence from x-rays to determine the amount of bone present. Your dentist will normally perform a basic periodontal examination at your check-up appointment and you may remember them giving your gums a score between 0 - 4. This simple but effective scoring system quickly identifies your oral health and allows signposting to a treatment pathway.
What does Each Score mean?
0 - No periodontal concerns detected and no bleeding of gums on probing.
1 - The gums bleed on gentle probing. They should not normally bleed and be resistant to light pressure.
2 - The presence of calculus either above or below the gum \ The presence of a plaque retentive factor such as a broken tooth.
3 - The presence of a periodontal pocket greater than 3.5mm but less than 5.5mm
4 - The presence of a periodontal pocket greater than 6mm
* - The presence of a furcation. This is when the gum has receded past the point multi-rooted tooth roots diverge.
Based on the scoring given, your dentist, hygienist or therapist will advise you on the reason for the condition and how best to manage it. If the condition is particularly severe, you may be offered a referral to see a periodontal specialist.
Once the appropriate investigations have been carried out, we will recommend either maintenance and preventative appointments OR treatment based appointments.
We previously followed appointments - regardless of if treatment or maintenance using a time ie 30-minute appointments and expected the clinician to provide the necessary care possible. This approach was historical in the profession and simplistic in the treatment.
As we continue to understand periodontal disease and how it impacts patients, it became important to understand that both treatment and maintenance appointments cannot and should not be the same. Patients with active periodontal disease do require more treatment and given that periodontal disease can spread across teeth, it is important to spend the appropriate time treating the condition, rather than downing tools when the session finishes.
We have therefore in conjunction with and to support our hygienist and therapist team introduced a few changes that are focused on improving oral care.
To modernize the delivery of the service and also provide care that is in keeping with current regulations, we are introducing dental nurse support to our hygiene appointments. The availability of a dental nurse to the clinician allows them to focus on the therapy and also the patient experience more comfortable.
The second important change is the appointment time required. Appointment times will now be based on your periodontal scoring, and depending on the score you are given at your examination, we will recommend appointments based on this.
Patients with basic periodontal exam scores or 0 & 1 will be 30-minute appointments focused on preventative, maintenance, and cosmetic care of their teeth and gums.
Patients with basic periodontal exam scores of 2 - depending on the severity of calculus, plaque, and tartar build-up will be assessed for 30 minute - 60-minute appointments.
Patients with basic periodontal exam scores of 3 or 4 will require longer appointments of 60 minutes with the focus being on treating the periodontal disease.
It is additionally important to understand that the treatment may require multiple appointments. Periodontal disease can cause sensitivity of teeth, and the effective cleaning of the roots of teeth may require the administration of local anaesthetic. It may not be possible or practical to administer anaesthetic to the whole mouth during a single appointment. Furthermore, the treatment required may involve a period of healing where severely inflamed gums need to settle before further treatment can be performed.
Finally - last but certainly not least, the treatment and advice offered in surgery should not be the sole treatment. Home care is an essential and fundamental part of oral health, and the treatment provided will only be sustainable if the right care is performed at home on a regular and daily basis.
Your next visit to our hygienist team may be different - starting with the new team members joining us. You can read more about our hygienist team on the team page of our website.