Dental Transition to Recovery

The BSP has been working with the OCDO England as a stakeholder to develop a standard operating procedure (SOP) for the safe return to practice. Our specific remit was to look at which aspects of periodontal care could be managed with non-AGP, while the risk levels in the community are still relatively high. 

This SOP embraces the European S3-level treatment guidelines published in May 2020, which are endorsed by the BSP, and which will be distributed more widely soon. The S3 guidelines divide periodontal treatment into 4 steps:

Step 1 – Motivating and supporting patients to attain and maintain successful removal of supra-gingival dental plaque biofilm, control risk factors for the disease and reduce periodontal inflammation.

Step 2 – Aims to control and reduce/eliminate the sub-gingival plaque biofilm and calculus and considers adjunctive agents to support traditional mechanical therapies.

Step 3 – Aims to address areas and sites that do not respond adequately to step 2, and may involve repetition of step 2 and/or surgical interventions to gain access to the areas that are difficult to treat and/or to regenerate or resect lesions that add complexity to effective maintenance (Step 4).

Step 4 – Involves supportive therapy delivered at regular intervals of 3-4 times a year in order to maintain periodontal stability and retain teeth, function, and prevent disease recurrence.

Steps 1, 2 and 4 are sufficient to stabilise periodontal health in the majority of sites and in the majority of patients, and the evidence-based guidelines do not support superiority for ultrasonic/sonic instruments (AGP) over hand instruments (non-AGP) and strongly recommend that either may be used for sub-gingival treatment, either alone or in combination. 

At the same time though, clinical experience indicates that non-AGP management of periodontal diseases, whilst being effective, requires hand instrumentation carried out to a high standard. This may take more time than the equivalent use of powered scalers and can be technically challenging in some circumstances. As such, additional appointments to deliver treatment to the same level may be required.

This SOP does not address the management of peri-implant mucositis or peri-implantitis, as the 2020 European S3-Guidelines did not address these conditions. However, the principles of non-AGP management of periodontal diseases outlined in this SOP could be considered as clinically applicable to peri-implant diseases as well.

The Office of the Chief Dental Officer England, NHS England & NHS Improvement team have today released their guidance for returning to practice - Dental Transition to Recovery SOP. CLICK TO VIEW