Prior to 2016, the British Society of Periodontology advised doing a 6 Point Pocket Chart (6PPC) for every sextant that has BPE of 3, and a full mouth 6PPC for any code 4’s. This would then be followed by root scaling debridement and general hygiene measures.
On the NHS, this would usually mean a for a 6PPC and root planning for every Band 2 perio claim. Since 2016, the guidelines by BSP have been updated, especially in relation to code 3’s. They advise a 6 point periodontal charting of sextants scoring 3 only be done after initial therapy.
Chronic marginal gingivitis and periodontitis is primarily caused by plaque and poor hygiene (Pihlstrom, Michalowicz, & Johnson, 2005). Patients who have poor oral hygiene and have neglected their dentition, will not benefit from your clinical periodontal/hygiene interventions unless a change in behaviour is adopted.
Clinicians need to gauge patient compliance for having treatment that is going to be successful in treating their condition. Patient’s need to take an initiative in maintaining their own oral hygiene and unless this happens, clinical interventions are likely to be unsuccessful.
2. Gingival Recession
3. True Pocket
4. False Pocket
Furthermore, patients may have code 3 BPE’s but this may not correspond to active periodontitis and bone-loss. Most often, this tends to be moderate-severe chronic marginal gingivitis with false pocketing (gingiva is inflamed above the level of the CEJ). A 6 point pocket chart would not accurately represent the clinical reality in this case and thus treatment may be overprescribed/unnecessary.
As clinicians, we can provide the initial therapy to gauge patient compliance and help them take a step towards betterment. This includes giving oral hygiene advice and encouraging better lifestyle choices with regards to the risk factors for periodontal disease (including stress, smoking and a poor diet).
How would you claim for periodontal treatment on code 3 BPE patients on the NHS
If the patient’s oral hygiene is poor, bearing the above discussion in mind and with consideration of the BSP guidelines, it is reasonable to claim a band 2 course of initial periodontal therapy without conducting a 6PPC.
- The initial therapy would include:
- Oral hygiene instructions
- Diet Advice
- Smoking cessation advice/referrals if appropriate
- Basic supra and subingival calculus debridement
Following 8-12 weeks and improved oral hygiene/compliance, if code 3’s remain, a second band 2 claim of root debridement and a 6PPC may be done.
References:
False pocketing image: https://pocketdentistry.com/6-gingival-enlargements-generalised/
British Society of Periodontology good practitioner’s guide 2016 https://www.bsperio.org.uk/publications/good_practitioners_guide_2016.pdf?v=3
Bruce L Pihlstrom, Bryan S Michalowicz, Newell W Johnson, Periodontal diseases, In The Lancet, Volume 366, Issue 9499, 2005, Pages 1809-1820, ISSN 0140-6736, https://doi.org/10.1016/S0140-6736(05)67728-8. (http://www.sciencedirect.com/science/article/pii/S0140673605677288)