Plaque and bleeding scores

Question 1

Why are plaque and bleeding scores useful

Answer 1

• assessing oral hygiene and patient compliance

Question 2

why are modified plaque and bleeding scores useful

Answer 2

• less time consuming than full mouth
• standardised and reproducible method to assess patient engagement

Question 3

what are Ramfjord’s teeth

Answer 3

• 16
• 21
• 24
• 36
• 41
• 44

Question 4

how are Ramfjord’s teeth used to do a modified plaque score

Answer 4

• each of the 6 Ramfjord teeth is split into 3 surfaces
  
  • interproximal
  • buccal
  • palatal/lingual
• for each surface there are 3 possible scores:
  
  • 2 = visible plaque without use of probe
  • 1 = no visible plaque but a probe skimmed over tooth surface reveals plaque
  • 0 = no plaque
• scores added to get a total

Question 5

what is the maximum score for the modified plaque score

Answer 5

36 (a score of 2 on all surfaces)

Question 6

how do you work out a modified plaque score as a %

Answer 6

score/36 x100

Question 7

what does the modified bleeding score measure

Answer 7

marginal bleeding rather than bleeding on probing from the base of the pocket

• reflects how well the patient is able to carry out effective plaque control daily, whilst bleeding on probing from the base of pockets indicates disease activity and periodontal breakdown

Question 8

how is the modified bleeding score assessed

Answer 8

each of the 6 Ramfjord’s teeth should have a periodontal probe run gently at 45 degrees around the gingival sulcus in a continuous sweep.

For up to 30 seconds after probing check for the presence or absence of bleeding

Question 9

how is the modified bleeding score recorded

Answer 9

• each of Ramfjord’s teeth split in 4 surfaces
  
  • mesial
  • distal
  • buccal
  • lingual/ palatal
• for each surface there are 2 possible scores
  
  • 1= bleeding
  • 0= no bleeding

Question 10

what is the maximum modified bleeding score

Answer 10

24

Question 11

what to do if one of Ramfjord’s teeth is missing

Answer 11

If there is an appropriate alternative tooth use that one, if not use code N (remember to adjust max plaque and bleeding score)

Question 12

when do you record scores

Answer 12

• not recorded at initial consultant clinic
• subsequently, record at every treatment and review visit

Question 13

what is the threshold plaque score for an ‘engaging’ patient

Answer 13

less than 30%

Question 14

what is the threshold bleeding score for an ‘engaging’ patient

Answer 14

less than 35%

Question 15

regardless of score, what is the threshold for an ‘engaging’ patient for plaque and bleeding scores

Answer 15

greater than 50% improvement in both

Question 16

what should an engaging patient recieve

Answer 16

site specific repeated root surface instrumentation, or more advanced treatment as necessary

Question 17

what treatment should a non-engaging patient recieve

Answer 17

• usually not suitable for site specific repeated root surface instrumentation, or more advanced treatment (communicate this to the patient)
• identify barriers to engagement
• consideration of further treatment options may include delay in further RSI until there is sufficient engagment
• they should continue to recieve ‘supportive care’ with further OHI, motivation and behaviour change

Question 18

how can we interpret these scores

Answer 18

• A plaque score only gives us a snap shot of the OH at that moment in time
• marginal bleeding will inform us how well the pt is brushing on a daily basis
• therefore bleeding more important determining factor when assessing non-smokers. Both bleeding and plaque should be interpreted together for smokers