Asked for Dental NHS Scale and Polish.Told "Go to Hygienist at £25 extra"

boozercruiser

welshdent wrote: »

for the one who ... "gum disease" is indeed a scale but it IS IMO a catch all term. It is a broad term that refers to 2 conditions and most dentists find its easier to tell a patient "you have gum disease" because the ACTUAL diagnosis would take a lot of time to covey seeing as most people do not really understand the terms. The 2 simple conditions are Gingivitis and Periodontitis. These are further subdivided for example acute ulcerative necrotising gingivitis and aggressive periodontitis. These are complex enough for the professionals . Gingivitis is simple inflammation of the gingiva (soft tissue aka gum) and it is caused by plaque accumulation. The plaque contains many different types of bacteria which all induce an immune response to the host. This manifests as often swollen, deep red coloured gums than are prone to bleeding. If the plaque is removed then it goes and the damage is reversible. The previously mentioned BPE gives it a score of 1 and treatment here is oral hygiene instruction. "scaling" is not indicated as the patient is capable of removing the plaque with a brush. If we removed it then it would only be back again in a day or so. If this plaque is not removed, it can form calculus which is a plaque retentive factor. It can host more bacteria and plaque and is given a BPE score of 2. Treatment indicated is scale it off. HOWEVER having calculus does not mean you have gingivitis. Its been shown that people that have calculus but keep it clean of plaque can have perfectly healthy gums despite the presence of calculus.

In the event of this plaque not being removed, in some people (approx 30% of people are naturally susceptible but modifying factors such as diabetes and SMOKING!!! can and do increase this number) .... go on to develop periodontitis. This is inflammation of the periodontum which is the supporting tissues of the tooth and relates to the periodontal ligament holding the tooth and the bone the tooth is within. What happens is the plaque forms causing inflammation, the bacteria and importantly the HOST produce toxins and inflammatory mediators that attack the bone supporting the tooth. In simple terms you get swollen gums that become hard to clean and the plaque then forms sub gingival calculus/plaque that is almost impossible to remove with cleaning alone. The swollen gums for a pocket and you get "apical migration" of this pocket floor as the bone is broken down. If you do not address this inflammation by plaque removal, in time the pocket keeps getting deeper due to swollen gums and loss of bone. With periodontitis you have to have gingivitis present as this is the initial inflammation that causes the disease process. The bpe scores here are 3 or 4. Treatment involves stressing oral hygiene instruction but also "deep scaling" and "subgingival debridement to remove the plaque and calculus that are under the gum line and that which is firmly adhered to the side of the tooth out of sight. This would the proceed to surgical treatment where the pockets are so deep that its impossible to adequately clean them going down the side of the tooth as normal. I try not to do this as its is really a specialists job. Only band 2 falls in to the scale and polish bracket and thus band 1 IMO. Often some people have so much calculus though that although they would only score 2, the do infact qualify for more advanced cleaning and thus band 2 treatments.

As some examples ... band 1 qualifying i.e. mild gingivitis with some calculus deposits supragingivally




No scaling indicated here but there is gingivitis. Note the red gums between the teeth and general puffyness.



I think this would be a band 3 score. Note the probe - it is graduated at mm intervals and at then some 2 mm intervals. This patient does not have the calculus deposits and they do not LOOK that bad. However they clearly have pocketing and this attachment loss and the bleeding around the gums indicates inflammation. They need band 2 treatment



This is advanced periodontal disease before treatment and would need the deep scaling I mentioned. Some may wish to do surgical treatments.



The X rays show the bone loss around the teeth (about 50%).

This is just unpleasant in general. Apparently this is in a poorly controlled diabetic


I hope this clarifies any points.

Blimey Welshdent....that horror show clarifies all the points alright:eek:

But is there a system of Certificate on this Forum?

In that case.....Rate this post X:eek:

coldstreamalways

Boozer, must you quote entire posts and articles constantly? It makes the thread very tedious to read.

I hope welsh's post (don't know where you get the time or inclination tbh) has demonstrated that it's not totally clear cut and what looks bad may be ok, what looks ok may be bad and what looks awful is awful.

blue_monkey_2

Why did I open this thread while my having breakfast?????

The_One_Who

Wow, thanks Welshdent! Some horror story of pictures there as well. I'm considering asking my dentist for what my BPE score is, just out of general interest.

welshdent

coldstreamalways wrote: »

Boozer, must you quote entire posts and articles constantly? It makes the thread very tedious to read.

I hope welsh's post (don't know where you get the time or inclination tbh)

Snow days

coldstreamalways

Ah, no UDAs losing out then. As a salaried GDP and being on leave, I just see this as a waste of snow!!!!

boozercruiser

"Boozer, must you quote entire posts and articles constantly? It makes the thread very tedious to read."

That is a fair point on using full quotes Coldstreamways. I shall try and be a bit more carefull on it in future!:)

boozercruiser

The_One_Who wrote: »

Wow, thanks Welshdent! Some horror story of pictures there as well. I'm considering asking my dentist for what my BPE score is, just out of general interest.

I WILL ask what my BPE score is, just out of general interest of course.:D

boozercruiser

blue_monkey wrote: »

Why did I open this thread while my having breakfast?????

I was having my late night beer with some salted peanuts when I opened the post.

I nearly threw up!:(

welshdent

coldstreamalways wrote: »

Ah, no UDAs losing out then. As a salaried GDP and being on leave, I just see this as a waste of snow!!!!

I just bite the bullet and re charge the batteries! got some running around to do such as last min presents buying so not too bad!