Plaque and Bleeding Score

Plaque and Bleeding Score

• Revise previous components of periodontal assessment
• Define disclosing & different types of toned disclosing solution and their modes of delivery
• Disclosing benefits both the patient and the clinician
• Demonstrate plaque score calculation using 4 and 6 point charting
• Interpret plaque score results and impacts on oral health messages
• Explain the relevance of bleeding score in relation to oral health practices, using immediate and delayed bleeding
• Interpret bleeding score results and impact on oral health messages

What is Disclosing?

• Disclosing agents change the color of dental biofilm to provide contrast with the tooth surface
• Biofilms can retain dye substances due to interaction
• Polarity difference between dye and biofilm: Electrostatic interactions (proteins) and hydrogen bonds (polysaccharides) bind particles
• Surfaces free of biofilm are easily rinsed off

Disclosing Solution Contents

• Contains a dye
• Typically a vegetable dye, such as Phloxine B
• Stains plaque a bright color (typically red or blue)

Disclosing Agent Properties

• Water soluble
• Has taste
• Ease of use
• Flavouring
• Colour contrast
• Duration
• Supports patient co-operation
• Ease to remove
• Non-allergenic

Types of Disclosing Solution

• Single tone
• Two tone
• Three tone 

Disclosing Delivery Methods

• Tablets
• Liquid
• Pre-loaded pellets

Why Disclose for the Patient?

• Provides motivation
• Provides education / re-education
• Allows for Personalised OH
• Facilitates Self-monitoring & evaluation

Why Disclose for the Clinician?

• Aids visualisation
• Provides direction for OH practices
• Provides Motivation
• Aids in Recording in patient notes
• Minimally invasive when used as a guide for removal

Required Equipment

• PPE
• Warning / consent / colour
• Vaseline
• Cotton wool / Pledget
• Disclosing solution
• Eyes
• Scribe
• Removal mechanism
• Dappins pot
• Microbrush
• Suction

Recording Plaque Scores

• 6 point plaque score
• 4 point plaque score

Plaque Index Calculation

• Strike off missing teeth
• Calculate total number of surfaces (teeth number x 4 or 6)
• Mark and add up number of areas with plaque
• Divide total number of surfaces covered in plaque by total number of surfaces
• Multiply by 100 to get percentage

Plaque Index Example

• Number of surfaces= 28 x 4 = 112
• Number of sites that had stained plaque = 6
• 6 ÷ 112 = 0.05
• 0. 05 x 100 = 5%
• Goals include understanding what message is being given to the patient and working towards a goal of having 5% plaque in the the patient's mouth or less

Bleeding Score: What bleeding represents

• Immediate
• Delayed

Taking a Bleeding Score

• Use a periodontal probe to gently probe along the gingival margin to assess bleeding

Immediate Bleeding

• As soon as the probe is inserted, the gingiva will bleed
• Tells you if the site is easy at access and cleansable

Delayed Bleeding

• Insertion of the prob to the base of the pocket, and bleeding happens a few seconds later
• Tells you if the site is easy at access and cleansable

Truths

• Bleeding score is an objective measure to determine if the patient's claims align with the clinical findings

BSP Top Tips

• Patients should be aware that self-performed plaque removal offers the largest treatment benefit
• Toothbrushing should be supplemented by the use of interdental brushes
• Individual patient's abilities, needs, preferences, and manual dexterity should be considered
• Refer to BSP website for further clarification and glossary of terms

Favourable vs Insufficient Improvement in Oral Hygiene

• Favourable Improvement in OH is indicated by ≥50% improvement in plaque and marginal bleeding scores OR Plaque levels <20% & bleeding levels ≤30% OR Patient has met targets outlined in their personal self-care plan as determined by their healthcare practitioner
• Insufficient improvement in OH is indicated by <50% improvement in plaque and marginal bleeding scores OR Plaque levels >20% & bleeding levels >30% OR Patient states preference to a palliative approach to periodontal care

Engaged vs. Non-Engaged Patients

• Engaged patients show improved OH, with plaque levels ≤ 20%
• Non-engaged patients may express a preference for palliative care