Dental Tribune United Kingdom Edition

13Perio TribuneSeptember 10-16, 2012United Kingdom Edition Tobacco Use: This is THE most significant risk factor for gum disease Please circle if you now or have ever used Cigarettes Cigars Pipe Chewing Tobacco/Paan Snuff Amount Per day Used for How many Years If you quit, when did you quit? _____________ _____________________ ________________________ Heart Attack/Stroke: Untreated gum disease can increase your risk of heart attack or stroke Do you have any other risk factors for heart disease or stroke? (please circle) None Family history of heart disease Tobacco Use High Cholesterol High Blood Pressure Medications: A side effect of some medications causes changes in gums Have you ever taken the following medications? None Anti-Epileptic Medications Calcium Channel Inhibitors Cyclosporin Genetic: The tendency for gum disease to develop can be inherited Has anyone on your side of the family had gum problems (eg mother, father or siblings)? Yes No Diabetes: Diabetics are more prone to gum disease. If left untreated, gum disease makes it harder to control their blood sugar. When gum disease is eliminated, diabet- ics may improve their blood sugar control and make diabetic complications less likely. Any family history of diabetes? Yes No Have you had any of these warning signs of diabetes? Frequent urination Excessive thirst Excessive hungerNone Weakness and fatigue Slow healing of cuts Unexplained weight loss Rheumatoid Arthiritis: The causes of gum disease and RA may be related. One doesn’t cause the other, but when one is present the other is more likely to be going on. If your gums are inflamed you may be at increased risk for developing RA. Have you ever been diagnosed with Rheumatoid Arthritis? Yes No If you have rheumatoid arthritis, emerging research suggests that eliminating any gum disease and then keeping it at bay can lessen the crippling effects of arthritis Special Concerns for Females: Pregnancy: Tell us if you are planning to become pregnant. Gum disease can make it up to eight times more likely that you will have a pre-term low birth weight baby. You can greatly reduce the likelihood of having an adverse pregnancy outcome by finding out if you have any gum disease and then doing whatever is necessary to eliminate it before you get pregnant. It is also important to make sure your gums are inflammation free while you are pregnant. Osteoporosis: Do you have osteoporosis? Yes No The following are risk factors for osteoporosis: Post-menopausal, Family history of osteopo- rosis, Early menopause, Rheumatoid Arthritis, Inadequate exercise, Smoking Do you have any risk factors for osteoporosis? Yes No Have you ever been tested? Yes No page 14DTà O ne way to ensure that the advice, assess- ment, diagnosis and treatment path remains at a consistently high standard in practice is to build a protocol which the whole practice will work to. This also makes in- duction training for new staff members robust and in keep- ing with CQC guidelines. The protocol is a map for anyone to refer to which will add re- assurance and weight to their own conclusions. The secret to success within general practice is to be consistent in your delivery. Protocols really help this to happen. What should go in your protocol? Well, if I am honest, as much or as little as you feel appro- priate. If you have several dental professionals working on periodontal cases in your practice, for example three part time hygienists and a specialist periodontist who comes in once a month, then you would need a detailed pro- tocol as they will undoubtedly have different opinions on what is right and not and what should be advised or used and not. The initial mapping of the protocol can take longer the more dental professionals are involved but is never the less worthwhile compiling. From a patient’s perspective, there is little more de-motivating than visiting another dental profes- sional within the practice and receiving different advice and comment for the normal. It of- fers confusion and a feeling of mistrust in some cases and annoyance in others. A basic protocol would contain: • Risk assessment guidelines • BPE measurement guide- lines and the plan for each • When to refer Risk assessment guidelines Mathew Perkins, a specialist periodontist in general prac- tice in Coventry www.modus- dental.com , kindly shared his risk assessment question- naire with me for this section, (pictured). You may want to combine your risk assessment to incorporate caries and tooth surface loss but this ex- ample is purely assessing for risk in relation to periodontal treatment. Protocol building for effective periodontal case management in general practice Mhari Coxon discusses why having a protocol is vital ‘The protocol is a map for anyone to refer to which will add reassurance and weight to their own conclusions’