Dr Anika Patel shares her views with us regarding issues that surround periodontal health of children and periodontal screening and management in under 18s. We are reminded to use the modified BPE screening tool and the importance of early referral if a BPE code 4 is recorded.
Public Health England has reported that tooth decay is the most common disease amongst children. Thus, there is no question why the management of dental caries has dominated the delivery of child oral health. However, over the years it has emerged that dental plaque induced periodontal conditions are common amongst children. Non-plaque induced periodontal conditions can also be seen in childhood and can act as indicators for problems with a child’s general health. The significance of the health of oral tissues in particular periodontal tissues, have been acknowledged by the BSP and BSPD. They have introduced guidelines that set out recommendations for periodontal screening and management for under 18’s.
Is gingivitis really an issue in children?
YES! Cole et al discussed how the Child Dental Health Survey 2003 showed an increase in levels of gingival inflammation and plaque accumulation since the last survey in 1993 in three of the four age groups (5,8,12 year of age). It was also noted in this study that half of the 15 year olds examined presented with gingival inflammation.
Therefore as dental practitioners we need to be identifying this early and managing it. We cannot wait until children are adults to address poor gingival health!
This is where the guidelines come in:
Guidelines for Periodontal Screening and Management of Children and Adolescents Under 18
BSP and BSPD recommended that periodontal screening becomes a routine part of the dental clinical examination in all co-operative children and adolescents.
As stated in the executive summary the aim of these guidelines are:
To outline a method of screening children and adolescents for periodontal diseases during the routine clinical dental examination.
To provide guidance on when it is appropriate to treat in practice or refer to specialist services.
NOTE: The guidance states that BPE codes 4 are unusual in under 18’s and these with the addition of bleeding, suppuration and or tooth mobility should prompt consideration for referral to specialist periodontal or paediatric services.
We must also consider possible systemic risk factors that can present in childhood which can severely affect the periodontium including:
Leukaemia
Down syndrome
Ehlers-Danlos syndrome
Papillon-Lefevre syndrome
Chediak-Higashi
Hypophosphatasia
If a child presents with one of these systemic conditions and severe periodontal destruction, early and prompt referral to a specialist is vital.
We already know ignoring poor gingival health can lead to detrimental effects on a patient’s dentition. It is also no secret that over the years litigation in dentistry has been on the rise and one of the number one allegations include the failure to diagnose ‘irreversible periodontal destruction’ earlier on.
Cole et al discusses that the potential damages/consequences (for the dentist and patient) following a failure to recognise Periodontitis in a child are far greater than for an older patient. Therefore, as we routinely assess caries risk for paediatric patients we must implement assessing periodontal risk in children as well, and the simplified BPE provides us with a suitable tool. Using the screening tool will aid dentists to provide appropriate management (following guidance) and help prevent irreversible destruction to periodontal tissues in the future.
Are we using the modified BPE screening tool?
An audit was conducted at a dental practice in Essex during November 2018 looking specifically at the use of the modified BPE at check up appointments for under 18’s. Data was collected from all 8 of the dentists working at the practice. ‘Check-up’ notes from 10-paediatric patients for each of the dentists were analysed retrospectively. The data was collated and evaluated. It showed that only 2 of the dentists used the modified BPE routinely. 3 of the 8 dentists failed to use the modified BPE at all.
Why is it the screening tool not being used and how can we change this?
Throughout the years far less attention has been paid to the periodontal health in children, however this must now change. Paediatric dentists and periodontists have teamed together to create a set of guidelines and as dental practitioners we must implement this guidance in our day-to-day treatment of paediatric patients. A balanced approach needs to be established with equal attention to the health of oral tissues, whilst taking into consideration their significance beyond the mouth. Below is a table which helps summarise how to manage the simplified BPE codes.
Resources:
Guidelines for Periodontal Screening and Management of Children and Adolescents Under 18 years of age- Guidelines produced in conjunction with the British Society of Periodontology and British Society of Paediatric Dentistry
Executive Summary- Guidelines for Periodontal Screening and Management of Children and Adolescents Under 18 years of age
Cole, E., Chaudhri, R, A., Vaidyanathan, M., Johnson, J., and Sood, S. (2014) Simplified Basic
Periodontal Examination (BPE) in Children and Adolescents: A Guide for General Dental Practitioners. Dental Update, 41, 328-337.
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