BSP UK Clinical Practice Guidelines for the Treatment of Periodontitis

The European Federation of Periodontology (EFP) engaged a group of International experts to systematically reviewed evidence from clinical studies to create clinical guidelines for the treatment of periodontitis (gum disease).

The British Society of Periodontology and Implant Dentistry (BSP) has moved rapidly to take the European document and develop a British version of the guidelines, making sure they were suitable for the UK healthcare system. The paper is published today in the Journal of Dentistry: https://authors.elsevier.com/sd/article/S0300-5712(20)30310-9

This is an incredibly important project. Poor gum health can lead to tooth loss and affect other systemic health issues, such as diabetes, cardiovascular disease and dementia. It was wonderful that European experts came together to look at the 4 main phases of periodontal disease management with a view to creating clear guidelines for all.

The BSP has been kindly supported by GSK to record several educational videos and produce flowchart resources to help dental care professionals to implement the guidelines in clinical practice. By creating a series of short video clips, to be shared via social media and our website, we can help to spread the important educational message to the wider dental profession, patients and the public. We aim to distribute our clinical guideline flowchart to all dental practices in the UK to accompany their classification flow chart.

A lay version of the guidelines for the public and patients is also being produced. It was extremely important to the BSP to involve patients, who could present their important viewpoints in the workshops. They have also been involved in the process of creating a lay version of the guidelines.

This lay version will allow patients to empower themselves with evidence-based information to both take responsibility for aspects of their disease management and know that they are being offered appropriate, contemporary, evidence-based treatment.

In addition, the BSP has created a lay flowchart, which conveys the importance of gum health in a simplified, informative way. Our aim in creating resources for patients and the public include:

  • Help the public understand what gum disease is
  • Raise awareness of how you can look after your gums and maintain good oral health
  • Reduce the stigma associated with gum disease (as highlighted in “The Sound of Periodontitis” video) by identifying the many causes including smoking, diabetes etc.
  • Highlight that more can be done to aid gum health in addition to brushing your teeth
  • Encourage the patient to take ownership of their disease and highlight the ways they can do this

Project leads:

Professor Moritz Kebschull

Professor Nicola West

About the BSP

The British Society of Periodontology and Implant Dentistry was founded in 1949 to promote public and professional awareness of periodontology and implant dentistry to achieve our vision of “Periodontal Health for a Better Life”.

We enjoy research, debate and actively getting involved in issues that affect members and our work. We are keen promoters of periodontology and dental implantology and are working hard, through various initiatives, to significantly raise awareness to the public, patients, dental and medical professionals. One of our strategic aims is to work with key stakeholders and influence national and international policy makers to promote periodontal health.

To reflect our commitment to progression and innovation, the BSP awards prizes for research into periodontology – both for undergraduate and postgraduate students – on an annual basis. https://www.bsperio.org.uk/professionals/awards

The BSP hosts one key Conference every year. These are popular, content-rich, excellent networking events with high profile speakers covering a huge range of topics. We also have an educational webinar programme covering a range of topics for members and non-members. https://www.bsperio.org.uk/events/bsp-event-calendar

We have Undergraduate Representatives in all UK dental and hygiene/therapy school. In addition, we have a dedicated Early Careers Group, which is an energetic part of the BSP, helping to support young periodontists at the start of their specialist career. https://www.bsperio.org.uk/early-career-group

BSP, FGDP, CGDent issue joint statement on the provision of a dental prophylaxis under Level 4/3 Covid-19 alert status

The British Society of Periodontology and Implant Dentistry (BSP), Faculty of General Dental Practice UK (FGDP) and College of General Dentistry (CGDent), working with the Office of the Chief Dental Officer for England, have issued a joint statement to clarify and contextualise the differences in guidance issued relating to the provision of a dental prophylaxis under Level 4/3 Covid-19 alert status:

The BSP guidance relates to prophylaxis as part of professional mechanical plaque removal (PMPR) in  people with periodontitis. The FGDP guidance relates to the more general term of ‘tooth polishing’,  which may not necessarily be undertaken for therapeutic reasons.  

The international evidence‐based S3‐level treatment guidelines in periodontology strongly recommend PMPR (highest evidence level: 100% consensus) in managing periodontitis. Clinical  harms may result in periodontitis patients if this is withheld.  

A prophylaxis undertaken with a slow speed handpiece, with no water, reduced prophy paste and due diligence, is considered a Non‐Aerosol Generating Procedure (non‐AGP) as defined by emergent particle sizes (WHO 2007) and can be safely undertaken with level 2 PPE (R11 mask, gloves,  goggles/visor, plastic apron over scrubs). However, non‐AGP procedures are not without some risk and polishing teeth for cosmetic reasons is not recommended until Level 2 alert status is reached.  Prophylaxis does cause splatter which can travel in a ballistic manner between 15‐120cm from  patients’ mouths and which may contact the eyes, mouth and skin of the operator/assistant; hence the need for level 2 PPE. Teeth should be dried with gauze and high volume aspiration is recommended.  

The BSP guidance provides a risk categorisation based on procedure. The FGDP-CGDent guidance adopts a similar approach but uses the terms low and high‐risk Aerosol Generated Exposure (AGE), to ensure additional factors are taken into consideration when considering exposure to risk. These include length of procedural exposure to splatter, risk of exposure to naturally-generated aerosol (coughing, sneezing or breathing), and the potential to apply mitigation measures. These are different approaches and both have value and require professional judgement by clinicians on a case-by‐case basis, whilst accounting for the Covid‐19 risk of the operator and assistant.

Professor Nicola X West, Honorary Secretary, British Society of Periodontology and Implant Dentistry

Ian Mills, Dean, Faculty of General Dental Practice UK, and Trustee, College of General Dentistry

Sara J Hurley, Chief Dental Officer for England

UK joins Gum Health Day 2020

“Say NO to bleeding gums” was the slogan for Gum Health Day 2020, celebrated on 12 May in the UK and around the world. Its goal was to raise awareness about bleeding gums and how they are usually a sign of gum disease and need urgent treatment at the dental practice – otherwise they may pose a risk to health.

Gingivitis, periodontitis, and peri-implantitis are chronic, inflammatory gum diseases that affect a significant number of adults in the UK and worldwide. Unfortunately, gum diseases are still poorly acknowledged, even though scientific evidence shows that they pose a threat, not only to our oral/dental health but also our general health. Gum disease is associated with cardiovascular disease, diabetes, chronic kidney disease, rheumatoid arthritis, certain forms of cancer, pregnancy complications, erectile dysfunction, and other serious, chronic and/or systemic conditions. More than 40 countries have joined Gum Health Day 2020 – from Europe, the Americas, Africa, Middle East, and the Asia-Pacific region.

This year, together with the kind support of GSK, producers of Corsodyl, the BSP planned to join forces with our Undergraduate Representatives from UK dental and hygiene therapy schools to promote the campaign in and around the UK dental schools. Due to Covid-19, the public events have now been postponed until later in the year.

The BSP seeks to raise public awareness of the importance of identifying bleeding gums as a sign of gum disease. This awareness initiative encourages people with bleeding gums to visit their dentist, hygienist or therapist for a dental examination, including periodontal screening. The BSP has made resources available to its 1,500+ members to share with their patients in practice, including information leaflets, powerful videos and images. We have also run a gum health lockdown challenge on our social media platforms, which has been a huge success in engaging the profession.

Last year, Gum Health Day was celebrated in 47 countries: 28 in Europe, 13 in Latin America, five in Asia, and one in Africa. Interest in Gum Health Day was so high that 12 national periodontal societies from outside the EFP decided to take part in this campaign. This year, the BSP joins this worldwide initiative again to raise awareness of the importance of gum health with the UK public.

“Gum Health Day 2020 is a major EFP initiative to get the public informed every year of the value of healthy gums for a healthy life,” explained Xavier Struillou, president of the
EFP. “Even if we are living exceptional, strange times worldwide with the Covid-19 pandemic, we should not forget the role of our gum health in our global health. Taking care
of our gums also applies in these days.”

“Gum Health Day 2020 aims to remind people that – even if still often overlooked – gum
health is a key factor for general health and wellbeing throughout life, and that gum disease is an important public-health issue as it is linked to very serious conditions, including heart disease, stroke, and diabetes,” added Andreas Stavropoulos, coordinator of Gum Health Day 2020.

Gum diseases are usually painless, so the most frequent sign of suffering them is bleeding gums. “Gums are not supposed to bleed without reason,” noted Prof Stavropoulos. “If your gums bleed when you brush your teeth or when you bite on food, for example an apple, go and visit your dentist for a periodontal check-up as soon as possible.”