Toolkit makes periodontal care a team effort

23 January 2015

The national contract between the patient and dental team is at the heart of a toolkit on periodontal care produced by dentists, commissioners and other stakeholders in greater Manchester.

Healthy gums DO matter (HDGM) aims to bridge a perceived widening gap between general NHS dental practice around periodontal care and national guidance.

Explaining that gap, lead author and local dentist, Shazad Saleem said: “I believe that sometimes there is a disconnect between the academics producing guidance and general dental practitioners. It is crucial that when developing new guidance both parties should be involved because general dental practitioners under the NHS contract deliver the majority of dentistry.

“We need something that is both practical and deliverable. In HGDM this is the approach we adopted with general dental practitioners, academics, specialists and commissioners working side by side.”

The toolkit has been produced by the Greater Manchester Local Dental Network, supported by the greater Manchester area team and Public Health England’s greater Manchester centre. As well as those listed above, patients, hygienists, therapists and representatives from dental public health helped shape the document.

Saleem told PCC: “This was a local project for greater Manchester dentists following a similar one last year about baby teeth. We resolved on the journey to produce more than just new pathways. Instead, it is a comprehensive guide to the approaches the dental team might take around periodontal care and their legal and ethical responsibilities.”

The toolkit includes evidence-informed preventive and treatment pathways intended to complement the guidance on prevention published in the third edition of Delivering Better Oral Health.

The pathways include a patient agreement developed to “harness mutual understanding between the patient and dental team on their (respective) responsibilities”. This is reinforced by a consent form and an information leaflet.

Saleem emphasises that the agreement not only informs the patient of their self-care responsibilities but also those of the dental team.

“It tells the patient what the team should be explaining and demonstrating to them,” he says.

The document emphasises the general dental team’s responsibility to deliver appropriate tailored advice aimed at delivering behaviour change in patients.

The toolkit sets out a recommended but flexible approach to managing patients with periodontal disease. The pathway a patient may go through will depend on the individual’s willingness to engage in the process - including through self-care.

Evidence shows that the single biggest impact on outcome and the success of periodontal therapy is the patient’s oral hygiene.

The approach of the toolkit is to deliver the most appropriate care at the best time for patients. If oral hygiene is not at the high levels needed to stabilise periodontal disease, treatment will fail.

However the document is intended as flexible guidance for working with patients - rather than a rigid approaching dictated to patients.

The toolkit says: “The aim of the agreement is not to pass over all responsibility to the patient and to deny treatment until they can achieve the desired levels. Rather it is designed to be used to encourage the patient in their self-care responsibility, to focus the efforts on prevention and education and to begin treatment at the ideal time…”

It continues: “The success of this work depends on clinical teams engaging, having the knowledge and confidence to deliver evidence based best practice for periodontal disease with patients understanding their responsibility in self-care to demonstrate improved outcomes for everyone.”

Saleem says the toolkit was intended to provide a clear outline for dentists and their teams but the pilot has shown that dental teams valued being trained in its use.

PCC is delivering training for dental teams on the use of the toolkit.

Rob Haley (below), who leads the dental programme for PCC, said: “It’s essential that dental professionals get the support they need to implement the principles of periodontal care set out by the toolkit in their practices. We’re already running courses in the Greater Manchester area and plan to make them available throughout the country.”

The tooRob Haleylkit concludes with sections by a barrister and an expert dental witness outlining how general dentists can fulfil their legal duty of care and meet ethical expectations in this area.

The toolkit will be available to all who register on the PCC training course. PCC is developing dental leadership by equipping clinicians with all the resources needed to implement the HGDM toolkit in their practices and implement it.

For more information on the first training course in Manchester please visit

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