PERIODONTOLOGY IN GENERAL DENTAL PRACTICE
A New, Simplified Classification System For General Dental Practitioners
By
@DentistGoneBadd
Introduction
We present here, the results of a thirty-five minute workshop on new periodontal classifications compiled by the only few General Dental Practitioner’s we could find that were even remotely interested in gums and jawbone. This is the first time GDP’s have been bothered to categorise (or take notice of) gum conditions and we feel it will be a more useful day-to-day guide than those new classifications issued recently by the American Academy of Periodontology and the European Federation of Periodontology. The workshop was carried out during a Curry Club Thursday at the Salisbury Wetherspoon’s.
Methodology
Brian wrote everything down on a beer mat because the screen on his iPhone stopped working after his ios12 update went pear-shaped. We wrote down everything we could think of regarding perio, without Googling it, not that Brian could anyway.
Classifications
GINGIVAL TISSUES
- 1. Perfick
The patient has no inflammation, deposits or staining. This has nothing to do with you or your ‘diligent’ care. Either the patient has been to another practice, or is just extremely lucky. Treatment – NHS – none required. Private – One to two sessions with the hygienist.
- 2. Bit Gammy – But Not Worth Getting The Scaler Out
The patient has a little bit of plaque or stain that is forgivable bearing in mind the goofiness she presents with and having to control the three kids that are currently all trying to make a human pyramid on the nurse’s chair. Teeny bit of bleeding when you bodged it with the BPE probe, but no calculus. Treatment – NHS – MAYBE a polish. OH advice – “You’re missing a bit – get an electric.” Private – Two to three sessions with the hygienist.
- 3. Quite Gammy
The patient has dirty-filthy-muk-muk everywhere as usual – I say everywhere, it’s mainly on the lower linguals of three to three (there MAY be other stuff but you didn’t look anywhere else). Some crowding is hindering OH, but the patient doesn’t really make an effort. Neither do you really. Treatment – NHS – get the blunt hand scaler out. No air scale since the phantom of the practice has bent all the inserts (how DOES that happen?) Private – Three monthly scales. This proves to the GDC disciplinary panel that you were providing continuing care.
- 4. Incredibly Gammy
Even YOU can’t ignore the dirty-filthy-muk-muk between the 6’s and you are too scared to push the BPE probe in too far in case you hit a ‘3’ and end up having to do a full perio chart (even if you COULD find a perio probe). Treatment – NHS – See what you claimed previously and see if you can get a Band 2 perio out of it. Order an air scaler and hide it so it doesn’t get either nicked, bent, or boils the water as it passes through. Private – This pays the hygienist nurse’s wages for six months.
- 5. Acutely Gammy
Punched out interproximal gingivae, necrotic look, breath that would stop a charging rhinoceros in its tracks at 100 metres. This is the first time you have asked if the patient smokes or is under stress. Treatment – NHS – Metronidazole and smoking cessation advice – SORTED! Private – The patient doesn’t return after the Flagyl.
- 6. Pregnancy Gammy
You can breath a sigh of relief. It’s not you, it’s hormones. Treatment – NHS – A quick prophylaxis. Private – You can’t, she’s exempt. It doesn’t seem right.
- 7. “Brushed Too Hard This Morning”
This does not exist. Occurs because the patient uses a brush like a Brillo Pad and doesn’t try and get in between the teeth. This is YOUR fault.
PERIODONTAL TISSUES
- 1. Bone Loss, But Patient Knows About It
You have inherited this patient from another practice or a colleague, so breathe a sigh of relief. Pre-existing bone loss, but patient is on top of OH. Treatment - NHS – Give the patient a pat on the back. Private – Two-monthly scales with the hygienist under local.
- 2. Bone Loss, But You Didn’t Know About It
As you are flicking around the lower incisors with a blunt sickle, you notice the lower right one is a bit wobby. You sneakily apply a little bit of lateral force with the scaler to all the teeth and discover ALL are a bit wobbly. Treatment – NHS - As you were, but in the notes, emphasise that you reinforced the need for interdental OH and daily TePe use. Private – Refer to the hygienist and on the prescription note “Hygiene has slipped a bit.”
- 3. Bone Loss, You Knew About It And Splinted It
Your pathetic broken splint is cutting into the patient’s tongue. Treatment – NHS – You casually mention the phenomenon known as ‘Immediate Dentures’ and hope the patient doesn’t listen to local commercial radio and catches an advert for dental litigation lawyers. Private – Not appropriate. The hygienist is a stickler and might report ‘concerns’ to the authorities.
- 4. Terminal Bone Loss
You check how long you have treated the patient and then check your dental indemnity subscriptions are up-to-date. Treatment – NHS – Ask lots of questions about gum disease in the patient’s parents and plant the seed that the condition is inherited. Private – If the patient asks if they need to see the hygienist, either say you haven’t got one, or price the patient out of it. You really don’t trust that hygienist. Her eyes are too close together.
- 5. Chronic Periodontitis
Also known as ‘chronic’ periodontitis. Has been there forever and you haven’t really addressed it. Treatment - NHS - Pull yourself together and do something about it before you retire. Private - NOOO! You keep checking the hygienist’s scrubs pockets for digital voice recorders.
- 6. Acute Periodontitis
Also known as Peri Peri Periodontitis. You diagnose that a bit of Nando’s chicken has got stuck and irritated the gum. Treatment – NHS – Pull the bit of chicken out (preferably with your eyes closed – Ewww Ewww Ewww) and claim Acute Mucosal. Private – Squeeze in with the hygienist and get them to pull the chicken out. Charge £60.00.
PERI-IMPLANTITIS
- 1. Also known as “What the Hell? I didn’t know that was even possible.” Treatment – NHS – Arrange the following words in order: Touch Barge Pole Don’t A With. Private – Refer back to the implantologist.
- 2. Advanced peri-implantitis. Same reaction. Treatment – See above, but TWICE as fast.