Periodontal Assessment 3 PDF

Periodontal Assessment 3 Plaque and Bleeding Score Foundations of Clinical Skills and Practice Sarah Balian Intended Learning Outcomes By the end of the session students should be able to: Revise previous components of periodontal assessment. Define the process of disclosing and discuss dif...

Periodontal Assessment 3 Plaque and Bleeding Score Foundations of Clinical Skills and Practice Sarah Balian Intended Learning Outcomes By the end of the session students should be able to: Revise previous components of periodontal assessment. Define the process of disclosing and discuss different types of toned disclosing solution and their modes of delivery. Discuss the benefits of disclosing in relation to the patient and the clinician. Demonstrate the calculation of the plaque score using 4 point and 6 point charting Interpret the results of the plaque score and impact on oral health messages. Explain the relevance of the bleeding score in relation to oral health practices – using immediate and delayed bleeding. Interpret the results of the bleeding score and impact on oral health messages. Useful Videos https://www.youtube.com/watch?v=n2T3n8olEmw https://www.youtube.com/watch?v=bZ61Quba5Rk Recap How will you show them the current state, explain the target & set the target? How will you assess if they met the target? How will you measure ‘engagement’?  How will you monitor? Create necessary changes? Anything specific required? How will you monitor? Maintain status quo? Improvements? Coaching? Personal Trainer?  Engaged Non-Engaged OH Improved No or not enough OH By ≥ 50% or more in improvement plaque & marginal By ≤50% or more in plaque & bleeding scores marginal bleeding scores Plaque levels ≤20% or ↓ Plaque levels ≥20% or ↓ Bleeding scores ≤20% ↓ Bleeding scores ≥20% ↓ Met targets designed by Not met targets designed by clinician from the the clinician from the previous previous appt appt Says want ‘palliative care’ Plaque Score Foundations of Clinical Skills and Practice Sarah Balian What is disclosing? Disclosing agents work by changing the colour of dental biofilm in order to provide a contrast with the tooth surface. Biofilms have the capacity to retain large no. of dye substances due to the interaction. The polarity difference between the components of the dye and biofilm. Electrostatic interactions (proteins) and hydrogen bonds (polysaccharides) bind the particles together. Surfaces which are biofilm free can easily be rinsed off. What is in disclosing solution? Contain a dye Typically a vegetable dye, such as (Phloxine B) Stains plaque a bright colour (typically red or blue) Properties of a disclosing agent? Water Taste soluble Non- Ease of allergenic use Ease to Flavouring? remove Support patient Colour – co- contrast? operation Duration? See nothing to seeing something Types of disclosing solution Single tone Two tone Three tone Types of disclosing solution Tablets Liquid Pre-loaded pellets Why disclose for the patient? Education / Re- Self-monitoring & Motivation Personalised OH education evaluation See Why disclose for the clinician? Direction for OH Recording in patient notes Visualisation Motivation for you practices – progression/prediction Minimally invasive if using as guide to remove Equipment needed PPE Warning / consent / colour Vaseline Cotton wool / Pledget Disclosing solution Eyes Scribe Removal mechanism Dappins pot Microbrush Suction  Record my score Recording plaque scores 6 point plaque score 4 point plaque score 192 128 Plaque Index Calculation 1. Strike off teeth missing 2. Total number of surfaces (teeth number x 4 or 6) 3. Mark & add up the number of areas with plaque 4. Divide the total number of surfaces covered in plaque by total number of surfaces 5. Multiply by 100 to get % Plaque Index Example Number of surfaces= 28 x 4 112 Number of sites that had stained plaque 6 6 ÷ 112 = 0·05 ·05 x 100 = 5% What message are you giving the patient? You have 5% of plaque in your mouth – what is the goal? Goals Plaque present 5% Plaque free 95% Goals Plaque present 78% Plaque free 22% Buccal, Lingual or Interproximal? Communication with team members Clear Indicate start point State when crossing midline If in doubt – ask! Bleeding Score Foundations of Clinical Skills and Practice Sarah Balian What does bleeding represent? Immediate Delayed How do you take a bleeding score? Immediate bleeding Look at the image As soon as you insert the probe gingiva will bleed What does this tell you? Is this site easy at access and cleansable? Delayed bleeding You insert the probe to the base of the pocket and bleeding happens a few seconds later? What does this tell you? Is this site easy at access and cleansable? Where is the patient cleaning? Truths – patient attends and claims they are brushing twice a day and using interdental brushes daily Troubleshooting Recommended Reading Effect of visual method vs plaque disclosure in enhancing oral hygiene in adolescents and young adults: a single-blind randomized controlled trial, Peng Y et al, American Journal of Orthodontics and Dentofacial Orthopedics 2014, 145(3) A comparison of bacterial plaque disclosants in periodontal disease. Cohen et al 1972. J Periodontal 43(6):333-338 The effect of a preventive programme on dental plaque, gingivitis and caries in schoolchildren. Results after one and two years. Axelsson, P, & Lindhe, J Journal of Clinical Periodontology, 1974(1):126-138 Dental plaque – classification, formation, and identification , Viorica chetru et al, International Journal of Medical Dentistry, volume 3, issue 2 April/June 2013, pp. 139-143 Image references https://www.alibaba.com/product-detail/ACID-RED-97-ACID-SCARLET-BA_62008462382.html https://www.thetoothandgumshop.com.au/shop/cleaning-aids-accessories/caredent-disclotabs-plaque-disclosing-tablets-copy/ https://nwpd.com.au/helping-children-brush-better/ https://www.amazon.co.uk/Disclosing-Tablets-Plaqsearch-Chews-Plaque/dp/B01E4AER00 https://www.ebay.co.uk/itm/153543073314?chn=ps&norover=1&mkevt=1&mkrid= https://www.primeum.com/en/blog/motivation-of-commercial-people-boosting-effectiveness https://www.teachhub.com/classroom-activities/2009/05/top-12-pioneers-in-education/ https://www.cam.ac.uk/research/news/genes-influence-ability-to-read-a-persons-mind-from-their-eyes https://www.lawcomm.co.uk/blog/new-government-guidance-issued-to-home-movers-during-the-covid-19-outbreak https://en.wikipedia.org/wiki/Accolade https://www.pittsburghparent.com/the-tooth-is-connected-to-the-everything-%E2%80%A8/ https://www.sharrockinsurance.co.uk/are-your-tools-insured/ https://www.amazon.co.uk/Sticker-Solutions-Reward-Chart-Stickers/dp/B00V4BQIWS/ref=asc_df_B00V4BQIWS/?tag=googshopuk- 21&linkCode=df0&hvadid=255488099025&hvpos=&hvnetw=g&hvrand=17321884733143004539&hvpone=&hvptwo=&hvqmt=&hvdev=c&hvd vcmdl=&hvlocint=&hvlocphy=9045917&hvtargid=pla-421911591970&psc=1