A Probing Report with Hatem Algraffee BDS, MSc, M.Clin.Dent., MRD RCS, MFDS RCS  Specialist Periodontist

Numerous reports have been published by UK dental defence societies outlining that one of the current highest litigation costs are from undiagnosed and untreated periodontal disease. Added to this it has also been suggested that simple careful thorough documentation and treatment planning will reduce such cases.

The key aspects are assessment, diagnosis, monitoring and documentation by the clinician. Recording Basic Periodontal Examination (BPE) is paramount and is seen as the initial screening tool and seen as a minimal standard of care for initial periodontal assessment. The BPE guideline was slightly modified in March 2016 and is outlined below.

Basic Periodontal Examination
This is an essential means of screening all new patients and recall examinations. Added to this each category will provide the clinician with treatment suggestions. It provides a clear written documentation of your continued periodontal screening.

Below are the six categories that need to be remembered and treatment needs implemented:

Essential recommendations:
• Code 3: initial therapy including OHI, Initial therapy of scaling. Then review patient several months later with a record a 6-point pocket chart in that sextant only

• BPE should not be used around implants. A full detailed periodontal chart is recommended.

• Radiographs should be available for all Code 3 and Code 4 sextants. The crestal bone levels should be visible.

• Bleeding on probing should always be recorded in conjunction with a 6--point pocket chart

There is no doubt that treating periodontal disease is challenging but can also be very rewarding. Careful assessment, treatment and monitoring of patients will aid all clinicians and patients.

Parameters of Care:
• It is the responsibility of the clinician to monitor and screen all patients for the presence of periodontal disease.

• Patient compliance should be recorded. This should include oral hygiene, attendance. Added to this where appropriate smoking cessation advice discussed should be noted. Non-compliance to advice and instructions should also be noted.

• All periodontal assessments should be written in notes. In particular probing depths, bleeding sites, comment on plaque levels, and mobility should be recorded.

• Maintenance therapy should be scheduled at appropriate time intervals.

The British Society of Periodontology (www.bsperio.org.uk) has a very detailed outline of referral policy and parameters of care.

Many colleagues inform patients of the diagnosis of periodontal disease verbally but unfortunately may not write this in their notes.

Added to this it is essential that any verbal advice is supported with information leaflets. Ideally a written form countersigned by the patient that they have been informed of the diagnosis and all options discussed, should be filled in the notes; attached as an example.

It is very likely that the above will also generate necessary and ethical hygiene treatment sessions for hygienists and dentists.

References
The British Society of Periodontology, PerioAcademy template version

Hatem Algraffee qualified as a dentist from the Royal London Hospital. He then worked in an oral and maxillo-facial surgery department, followed by several positions for various health authorities and general practice. He completed four years full time specialist training in Periodontology at Guys London Hospital. Hatem dedicates his time to co-running PerioAcademy certificate teaching course and private practice.