staging & grading and BPE code treatments Flashcards
what does the staging show us?
how many stages are there?
what are they?
how severe the disease is.
there are 4 stages
STAGE I - early/ mild
borderline betweeen gingivitis and periodontitis
< 15% bone loss from CEJ.
STAGE II - moderate
established periodontitis
Bone loss coronal third of root
STAGE III - severe -
Bone loss mid third of root
Patient at risk of tooth loss
STAGE IV - very severe -
Bone loss in apical third of the root.
Hypermobility, occlusal trauma, drifting Loss of aesthetics and function
what does the grading show us?
how many grades are there and what do they mean?
how fast the bone loss and disease is progressing
GRADE A- SLOW bone loss
GRADE B- MODERATE bone loss
GRADE C- SEVERE bone loss
Risks for developing periodontal disease?
Smoking
Poor oral hygiene
Dry mouth
Cannabis use
Alcohol intake
Poor Glycaemic control
Obesity
Poor Diet
BPE of 1
what is this?
what is the treatment?
no pockets below 3.5mm
bleeding on probing
black band completely visible
OHI instruction
BPE of 2
what is this?
what is the treatment?
no pockets below 3.5mm
Bleeding gums with calculus present
black band completely visible
OHI instruction, removal of all plaque retentive factors, supra or sub gingival calculus
BPE of 3
what is this?
what is the treatment?
pockets measuring between 3.5mm-5.5mm
black band partially visible
OHI, RSD (root surface cleaning), (6PPC only in GDH)
BPE of 4
what is this?
what is the treatment?
Pockets measuring deeper than 5.5mm
black band completely gone
OHI, RSD (root surface cleaning), 6PPC
What happens if a patient declines treatment or is not-engaging at all?
These patients can be entered into ‘palliative care’ for their gum disease with step 1 repeated regularly. It is also important that we do not write patients off, you never know when a patient may change their behaviour and engage.
What is the difference between PMPR in step 1 and PMPR in step 2? In Step 1, it mentions Supra and Subgingival PMPR of the clinical crown. I thought we did not go subgingival in Step 1
In Step 1, PMPR includes the removal of plaque and calculus supra and subgingivally. This acknowledges that at this step you are not attempting to do any root surface management but are looking to remove visible or detectable subgingival deposits located on the crown of the tooth, part of which may be subgingival either due to false pocketing or the disease being mild. Essentially you are creating an environment for the patient to clean better. In Step 2, you are carrying out subgingival instrumentation (root surface debridement or PMPR) on the root surface. The quality of the instrumentation is important.
Engaged and Non-engaged patients if a patient fails to hit the required scores to be classed as an engaged patient, can we withhold Step 1 forever?
A non-engaging patient could be held at step 1 and not move to step 2 until they are demonstrating that they can improve their plaque control. as long as we have followed the steps and are documenting the patient’s oral hygiene routines, the treatment carried out and the reasons why they are not able to move to step 2. Having an objective way of measuring our patient’s plaque control using a plaque score is a great way of demonstrating this.
Is it important that every patient has step 4 (supportive periodontal care)?
should be encouraged strongly to all patients. . Oral hygiene is not a one-off event in Step 1, it needs to be practiced throughout all the steps. Maintenance is a crucial part of periodontal therapy and it is the most cost-effective thing patients can do to keep their teeth!
Where would you start staging from?
The worst affected bone loss site
