MPS Foundation
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The research on which my essay was based was undertaken with three clinicians at Filton Dental Practice and aimed to improve periodontal care and record keeping.
We wanted to ensure that the practice was adherent to the document ‘delivering phased-care for periodontitis patients under the units of dental activity (UDA) banding in England: Road map to prevention and stabilisation’.1
The initial audit identified 14 areas out of 28 domains that did not achieve the ideal standard. By using process mapping and peer review the situation improved. By the final round of peer reviews, 12 domains of the initial 14 domains were present in records reviewed.
Periodontitis is the sixth most common disease worldwide, affecting 11.2% of the adult population.2 It is caused by the accumulation of bacteria around the tooth, resulting in a shift from commensal to pathogenic microflora and consequently chronic inflammation. In susceptible individuals, this causes the destruction of tooth supporting structures. Although plaque is a prerequisite for periodontitis to occur, risk factors must be present for the disease to propagate. Known risk factors include genetics, smoking and diabetes, in addition to local factors that facilitate plaque accumulation.3 Given its prevalence, periodontitis causes significant social, economic and health consequences.
A failure to diagnose and manage periodontal disease can have significant consequences for the patient, such as tooth loss, masticatory inefficiency, and psychological issues. Furthermore, the impact of periodontal disease on systemic health cannot be underestimated.4 Therefore, it is essential clinicians are able to manage periodontal disease appropriately. However, despite the best interventions from clinicians, periodontal treatment will fail if patient engagement is poor.5
Litigation issues due to undiagnosed and untreated periodontal disease are rapidly increasing. Most allegations relate to the clinician failing to make the patient aware of the presence, extent, or implications of their periodontal disease.6 The increasing frequency of complaints creates an uncomfortable environment for clinicians, who often practise in fear. When complaints do arise, they can have a detrimental effect on the dentist’s professional practice and personal wellbeing.7 Therefore, it is in the interest of the patient and dentist that appropriate periodontal care is delivered.
Despite this, discussions with clinicians at Filton Dental Practice have identified a difficulty in being able to comply with all aspects of periodontal care as per the recommended guidelines. This was mainly attributed to the time constraints of NHS general dental practice. As a result of these discussions, the current standard of care was assessed through auditing clinical records, which highlighted the issues raised. Therefore, the quality of periodontal care was identified as an area for improvement and is the rationale behind this quality improvement project (QIP).
This QIP was successful in improving the quality of periodontal care in general dental practice and supports the literature that process mapping and peer review are effective methods for quality improvement. Therefore, GDP’s may find it beneficial to outline their periodontal care workflows within general practice and to discuss cases and reflect on their performance periodically as a team to ensure continued development. Working with neighbouring practices to identify gaps in care provision and facilitate learning between one another may be more effective and objective, allowing for relationships to develop between clinicians who would otherwise not cross paths.
I am very grateful to the MPS Foundation for the opportunity to enhance my quality improvement project and provide a platform for my results to be disseminated and others to benefit. I look forward to moving on to Dental Core Training in OMFS and to continue developing my clinical and research skills.
