Previously Undx Periodontal Disease

Question 1

What special tests are required if see significant bone loss?

Answer 1

Either full mouth PAs or OPT

Question 2

What is dose difference between PAs and OPT

Answer 2

OPT 0.014 mSv
PA 0.004 mSv

Question 3

How explain chronic periodontal disease to pt?

Answer 3

Explain they have gum disease which has been caused by bacteria in the mouth. Explain if the bacteria are not removed effectively with brushing and flossing they can irritate your gums causing bleeding and pain. Unfortunately if left it can damage the gums and bone irreversibly reducing support for the teeth making them become wobbly.
Explained infection and bleeding is reversible but damage to bone isn’t
Explain want to work together to prevent more damage and further bone loss
Be releasing in terms of prognosis and don’t hide this information from pt

Question 4

What is a structure which can be used to break bad news?

Answer 4

SPIKES
Setting - ensure privacy
Perception - assess the patients understanding
Invitation - ask pt how they would like to be given information and how much detail they would like
Knowledge - warn pt bad news in coming
Empathetic response
Summary - inc a clear plan

Question 5

Pt asks why periodontal disease hasn’t been picked up before - how respond?

Answer 5

Apologise to patient and advise tx can be started as soon as possible to help prevent any further destruction
Give a clear plan inc timescale for pt
Reassure will look into why this wasn’t picked up sooner

Question 6

What to do if pt wishes to complain?

Answer 6

Direct towards local complaints procedure

Question 7

Pt w/ periodontal disease ask about tx options and how to save teeth - what would advice?

Answer 7

Discuss importance of OH inc smoking cessation
Emphasise tx success is dependent on compliance
Ensure no MH factors inc poorly controlled diabetes
Explain extraction poor prognosis teeth may improve OH
Discuss non-surgical tx and review
Discuss possible referral
Discuss risks oft x inc gingival recession and sensitivity

Question 8

After pt leaves, how should situation be managed?

Answer 8

Discuss concerns directly w/ colleague
Discuss how they can prevent happening - CPD to improve clinical practice
Work to identify any other unpotential untreated pt
Consider escalating to practice manager
Report to GDC as last call or significant pt safety concerns