3 Reasons Why Dentists Should do a Plaque Score...
Updated: Mar 10, 2019
Do you hate doing plaque scores? so do we... But unfortunately it is an important part of our jobs as dentists. There are several very important reasons that a plaque score should be done especially for perio patients. You probably already know the first few but reason 3 below is surprisingly ignored by dentists.
Plaque is undoubtedly the biggest risk factor for periodontal disease and dental decay. So as dentists we cannot ignore it. It is incumbent upon us to monitor and quantify plaque scores and feed this back to the patient to help implement strategies to reduce it.
1. Plaque scores act as a patient motivator
Doing regular plaque scores is a very effective way of engaging your patient. Getting the patients involved in this process increases their awareness of the role of oral hygiene in periodontal disease and provides more tangible feedback on their performance. It can provide targets and a quantifiable measure of how they should be performing. Giving them a percentage score means a lot more than a subjective comment like "good" or "bad".
Apart from motivating them, patients tend to take you and your advice more seriously. Any advice which is backed up by quantifiable evidence tends to be more effective.
2. Plaque scores give you important information to make clinical decisions
For periodontal therapy to be effective plaque scores must be low. A value below 20% is regarded as conducive to periodontal health. By undertaking a plaque score you can get an instant impression of the patient's current oral hygiene condition and you can make important decisions such as:
Risk of further deterioration of the periodontal condition
The type of treatment that is suitable for the patient
For patients with significantly high plaque levels you can decide whether it is worth starting any periodontal therapy at this stage. A lot of practitioners advocate withholding any periodontal treatment till the patient has demonstrated a reduction (or at least a reducing trend) in plaque scores.
Unless you do a plaque score there is no way of you accurately deciphering the patients oral hygiene efforts. Granted you may be able to make a good estimate upon clinical examination if their hygiene is good or bad. However are your eyes good enough to distinguish between 15% and 25% plaque scores? Have ever wondered why despite your best efforts, the periodontal treatment isn't working even though it seems like the patient has good oral hygiene? A very likely reason is that their plaque control is sub-optimal and your eyes are not sophisticated enough to pick that up.
3. Plaque scores can provide you with medico-legal protection
There will be scenarios where your periodontal treatment results are poor due to poor patient compliance. You may have done the best job that is possible but due to poor oral hygiene it is no surprise that their condition has not improved. What do you do in such situations?
Do you withhold further treatment? Do you carry on aimlessly doing the same thing which you know is futile?
There are a few ways such situations can go...
The patient may become irate that his/her periodontal condition is deteriorating despite them coming to see you for treatment...
The patient gets offended that you are blaming them for not maintaining good oral hygiene... they instead start pointing the finger at you and make claims of your incompetency at the job... If you tell them that you are withholding further treatment that can in turn make them even more angry.
Such situations can be very tricky, especially when as far as the patient is concerned he/she believes that they are brushing their teeth like you told them. If they were to lose any teeth they are likely to blame you rather than themselves. This puts you at risk of medico-legal exposure.
In such situations having good plaque score records will save your life. If you can demonstrate with sound and quantifiable clinical records that the patient's oral hygiene has been consistently poor despite your efforts to improve it then you cannot be blamed. It becomes a lot easier to convince any investigative body that poor results have been due to patient's non compliance rather than your incompetence if sequential plaque records can be shown.
How to do Plaque Scores?
We do not wish for any dentist to be in such difficult situations however it can happen. So it is important to find an efficient and sustainable system of recording plaque for your patients. There are a number of ways it can be done:
Making a guess by visual assessment
By running a probe along the gingival margins
Using index teeth (Ramfjords teeth- modified plaque index)
Full mouth plaque score while using disclosing solution Want to add a caption to this image? Click the Settings icon.
Luckily we don't need to do plaque scores for every single patient. It is only required for patients with BPE code 3 or 4. In a lot of cases it becomes obvious that the plaque scores are high. In such cases if you find it wasteful to document an exact percentage of plaque when you know its extremely high then you can make a reasonable estimate based on visual inspection or inspection with a probe. You must however document some quantifiable measure such as "widespread visible plaque deposits... plaque score estimated as >80%". For extreme cases this may be sufficient however as the plaque levels start improving then a basic estimation won't be enough.
On the flip side if your periodontal treatment results are excellent and it seems like the patient is making good efforts at oral hygiene you might get away with just an estimation of the patient's oral hygiene.
For all the other scenarios it becomes important that you undertake a full mouth plaque scores. Ideally a disclosing solution should be used as the accuracy of your plaque score will double. This is the most accurate method of determining a patient's oral hygiene measures. We understand that time is a limitation however once you start doing these regularly you will find that within 60-90 seconds you can complete a full mouth plaque score. If you feel that you do not have the clinical time to do it then you can utilise your hygienist to do it. But one way or another you must record some sort of quantifiable monitoring of the patient's plaque levels.