CD0412

I special _ practical periodontics Fig. 1_Inflamed gingival tissue and pocketing around a bridge abutment. Fig. 2_Healthy-looking gingival tissues, but the patient is a smoker and 5 mm pocketing is noted. Fig. 3_BPE probe. Fig. 4_Williams’ probe. Fig. 5_Furcation probe. Fig. 6_Long cone radiograph of teeth 14 to 17. _Cosmetic and implant dentistry has become increasing popular among dentists and patients. Asthistypeofdentistryincreases,sodoeslitigation. Legal defence organisations have noted that their highestlitigationcostsareduetoanincreaseinun- diagnosed periodontal disease, as well as poorly plannedcosmeticandimplantdentistry.Afailureto diagnose periodontal disease, inadequate records, poor quality treatment and treatment planning, supervised neglect, and failure to refer all lead to increased litigation within the profession. The guidance for standards set by the General Dental Council states that a clinician should work within his or her knowledge, professional compe- tence and physical abilities, should refer patients for a second opinion and for further advice when necessary, and should refer patients for further treatment when necessary. It is important as the clinician to assess the pe- riodontal condition before starting any restorative dentistry, whether simple or complex. There is very good long-term evidence that once the foundation of the periodontium is stable and good plaque con- trol has been achieved, the restorative treatment will have a better long-term prognosis. This article will briefly discuss the simple tools we have in our surgeries to help diagnose periodontal disease and when to treat and when to refer using the British Society of Periodontology’s referral guidance. The clinical signs of chronic periodontal disease are gingival inflammation and bleeding, pocketing, gingival recession, tooth mobility and migration, alveolar bone loss and halitosis. Figure 1 shows a patientwithgingivalinflammationandbleedingon probing with a pocket depth of greater than 5 mm. Agoodpredictorofgingivalhealthisnobleedingon probing, but it is important to note that in smokers the gingival tissues look relatively healthy and in most cases do not bleed on probing, as smoking masks the presence of disease (Fig. 2). An essential tool for the assessment of the peri- odontal tissues is the BPE (basic periodontal exami- nation)probe,otherwiseknownasaWHO621probe (Fig.3).Thisprobehasaballtipof0.5mmindiameter Practical periodontics in daily practiceAuthor_Dr Amit Patel, UK 14 I cosmeticdentistry 4_2012 Code Signs Treatment 0 No bleeding on probing Pocket depth of ≤ 3 mm No treatment 1 Bleeding on probing Hygiene instruction 2 Plaque retentive factors present No pocket depth of > 3.5 mm Hygiene instruction and scaling 3 Pocketdepthof>3.5mmbut<5.5mm Hygiene instruction, supra- and subgingival scaling 4 Pocket depth of ≥ 5.5 mm Full periodontal assessment * Furcation Full periodontal assessment Table I_Basic periodontal examination codes. Fig. 1 Fig. 2 Fig. 3 Fig. 5 Fig. 6 Fig. 4