Prioritising periodontal checks

Periodontal disease is widespread and as much a threat to patients' oral health as tooth decay.

  • Dental professionals have a critical role in monitoring patients' gum health at each examination, in diagnosing periodontal disease and advising those who are at risk.
  • Typical symptoms can be easy to miss until it's too late to treat them effectively.

When do claims occur?

If a patient's periodontal disease is not treated or diagnosed appropriately, the treating dental professional might be at risk of a complaint, or even a claim.

Reasons for claims involving periodontal disease include:

  • failure to diagnose and treat gum disease
  • poor management, where the disease is diagnosed but it is alleged the dental professional doesn't manage the condition properly or make a suitable referral
  • poor communication between a dentist and patient, where a patient believes they haven't been fully informed about treatment, risks, benefits and possible alternatives
  • incomplete or inaccurate records, making it more difficult for the dentist to monitor the patient's progress
  • failure to record relevant details of the treatment plan and the advice given to the patient - which in turn can make it more difficult to challenge the patient's version of events.

DDU advice

Follow the guidance

Follow available national guidance to make sure your treatment is evidence-based - for example, the British Society of Periodontology's guidance on the Basic Periodontal Examination (BPE), and the BSP flowchart implementing the 2017 classification.

Keep detailed notes

Record all your examination findings in the patient's clinical notes, including their BPE scores and your assessment of their periodontal health.

Make a note of factors such as the presence of plaque, calculus and gingival bleeding, which may make the patient susceptible to periodontitis and will need closer examination at future appointments.

Communicate with the patient

Explain to the patient if they are at risk of periodontal disease and how they can protect themselves. Explain the link between diabetes and periodontitis, the need for good oral hygiene and more frequent visits to the hygienist, and the importance of stopping smoking. Make a note of the conversation.

If you decide that the patient's gum disease only requires monitoring and advice at this stage, you should still explain this to them, record your discussion and their consent to your treatment plan in the records.

Make sure you have a system in place to record the periodontal condition, such as pocketing and loss of attachment.

Obtain consent

When obtaining consent for periodontal treatment, take time to explain the risks, benefits and alternatives. Make a careful note of what you discussed and the patient's agreement in the clinical records.

If the patient fails to respond to treatment, including a failure to carry out adequate plaque control despite repeated oral hygiene instruction, make a note of this in the records, along with the explanations given to the patient regarding the consequences

Recognise your limits

Recognise the limits of your own clinical skills. Be prepared to offer a referral to a specialist if the patient's condition does not improve despite treatment.

We would suggest that as NHS facilities for specialist periodontal treatment can vary it would be sensible to ensure you are aware of what arrangements are in place in your area.

Periodontology online CPD

The DDU and British Society of Periodontology (BSP) have developed three hours of free online CPD to help dental professionals improve patient care and reduce the risk of a claim.

The BSP also hosts a wide range of useful information and publications on its website.

This page was correct at publication on 15/10/2021. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.