oct ewj 24 online - Flipbook - Page 44
Periodontal Disease What to Look for in the Records
by Dr. Ravinder Varaich
pocketing), while 8% of the population suffers from
severe periodontitis (pocketing exceeding 6mm).
Periodontal disease
Claims involving periodontal disease have been at the
top of the leaderboard of dental claims for some time,
and for good reason! Failure to appropriately screen,
diagnose and manage the condition results in loss of
teeth and need for replacements. But what are we
looking for in the records? When has there been a
breach of duty and failures from a dental health professional, and when are the effects of the disease due
to patient factors?
• Periodontal disease is a slowly progressing disease,
and bone loss occurs over a period of years. Therefore, a case of periodontal disease should include
records as far back as possible in order to establish
when the disease is likely to have begun, and the
pattern of progression.
• Periodontal cases are usually multifactorial, and
involve numerous dentists over a period of years,
and causation is usually split between numerous
defendants.
Aetiology of periodontal disease
• Periodontitis is a chronic inflammatory disease of
bacterial origin that affects the supporting tissues
around the teeth. The disease is initiated by the accumulation of plaque, which is a biofilm composed of
bacteria and their products on the tooth surface. The
host’s immune response to the bacterial challenge is
responsible for the destruction of the periodontal tissues. The severity of the disease is influenced by various factors, such as smoking diabetes, and genetic
predisposition. The risk to the disease can be reduced
by maintaining good oral hygiene, and regular
dental examinations.
Breaches of duty
• As healthcare providers, dentists are expected to
screen, diagnose and manage periodontal disease.
Failures to do so is a breach of duty.
• Any negligence case is generally split into pre treatment assessment and consent, treatment and aftercare
• The minimum standard of care is a periodontal
screening tool, the BPE score (basic periodontal examination). Screening involves probing of the gums
and scoring according to the presence of bleeding on
probing, presence of plaque and calculus deposits,
and the depth of pockets present. Failing to perform
basic periodontal screening is a breach of duty.
• The 2009 UK Adult Dental Health Survey indicates
37% of the adult population suffers from moderate
levels of chronic periodontal disease (with 4-6mm
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