Periodontics for Beginners – PS008

How are periodontal diseases managed in general practice? Join us for an engaging conversation with Emma Hutchison, our Protrusive student, as we explore Periodontology (Perio) in the real world. This conversation delves deep into the practical protocols, patient communication strategies, and real-life scenarios every dental student and practicing dentist should be aware of. https://youtu.be/X5ahZ9bzsc4 Watch PS008 on Youtube Need to Read it? Check out the Full Episode Transcript below! Highlights of this Episode: 0:37 Emma's Dental School Experience: Special Care Dentistry 03:02 Emma’s Denture Adjustment Case  06:11 Periodontics Month  06:54 Communicating with Patients about Gum Disease 10:15 Managing Non-Engaging Patients 15:04 The Psychology of Habits 17:13 Referral Protocols in Dental Practice 20:00 Risk Factors in Periodontal Treatment 25:03 Genetic Factors in Periodontal Disease Don't miss the special notes on An Introduction to Periodontal Diseases available exclusively in the Protrusive Guidance app! This episode is not eligible for CPD/CE points, but never fear, there are hundreds of hours of CPD for Dentists waiting for you on the Protrusive App! For the full educational experience, our Ultimate Education Plan gives you access to all our courses, webinars, and exclusive monthly content. If you love this episode, be sure to recap PS007 - Basics of Indirection Restorations Part 2 - The Crown Fit Click below for full episode transcript: Jaz's Introduction: Welcome to another episode of Protrusive Students. We're joined by Emma Hutchison, our Protrusive Student, to talk about Perio. Look, I'm no periodontist. I'm no specialist, but I can share a few pearls of wisdom for treating Perio in the real world. [Jaz]Emma had some absolutely fantastic questions about protocols, communication, and what to do if you have a non engaging patient. Because let's face it, that's what happens in the real world. Our patients don't floss and they don't brush how well we want them to. So how do you manage that? Here at Protrusive Students we try and cover the themes just for you guys. And of course, if you're a dentist watching this, then it's also relevant to you. We just go back to basics. Let's get to the main part of the interview and I'll catch you in the outro. Main Episode:Emma Hutchison, our Protrusive Student. It's now perio month, so it's great to have you back. Just give us an update, basically, in terms of what new things have you learned at dental school? What are the interesting experiences that you've had? Any ups or downs that you'd like to share with us? [Emma]So, I've only seen one patient in the last week, because I've had a few no shows last week and it was for a denture ease, so it wasn't anything too tricky, which was fine for me. But, yeah, it was good, just a wee denture ease. The elderly gentleman was very happy, so that made me happy. In terms of lectures, lots of special care dentistry at the moment. We're very heavy with special care dentistry in our second half of third year at Glasgow. [Jaz]I know in some countries they don't have that as a speciality. Can you explain to everyone listening and watching what special care dentistry is? [Emma]Yeah, so I suppose special care dentistry, a lot of patients that have very complex medical histories. I mean, this week we were doing people with mental health problems, schizophrenia. We've been doing cardiology, oncology, patients with very learning disabilities as well. Patients that I suppose you could consider a bit more medically compromised or that can be a bit more trickier to treat. So we're very heavy on that in our third year at Glasgow. [Jaz]So if you can treat those medically compromised patients and you can treat anyone, right. It really tests us in terms of what medicines are on, which antibiotics you can and can't give, what the guidelines are in terms of when it's safe to treat, when it's not safe to treat, all those things. [Emma]Yeah, definitely. And a lot of it is refer to the BNF and all your drug interactions. But no, it's good. It's really interesting to learn all about these medically compromised patients. And it's amazing how much you need to change of your regular dental routine to suit these patients, I suppose, and make accommodations for them as well. [Jaz]Interesting thing to reflect on based on a couple of things you said is one, the slow pace of dental school in terms of when you have some DNAs, which happens a lot, unfortunately, in dental school, just the nature of the beast. And then how do you fill your time to make sure you're actually doing something productive? I felt like a lot of time when I was studying dentistry, patient wouldn't turn up and then you're just there doing suctioning for someone else or nothing. You're having like an impromptu tutorial or something, which is good, but sometimes you kind of be there. Like looking out the window. And so it's really important to make sure you're not doing that. So I'm hoping everyone's going to have their productive student notes ready, reading them, taking them with them. So if a patient doesn't show up, they can have that. So this is just the nature of the beast. The other reflection I have is denture ease. What do you think caused this patient to have an area that needed adjustment for this denture? [Emma]So I had delivered this denture, it was a wee while ago, the patient was, had unfortunately been in hospital for a wee while, so I had planned to see him two weeks after the denture delivery, just as standard protocol to see if there was anything wrong with it. He was in hospital for a month, so it had been a while. And when we fitted that denture, it was perfect. It was like a glove. And then he said, when he went home obviously, it's a brand new denture, it's going to take some time to get used to, but when he started eating, that's when he noticed it was painful and it was really digging into his freedom down there, but it was easy enough to see he had a huge ulcer there, the poor man, and pressure indicating paste, showed me exactly where to adjust it as well. So it is quite tricky with those things because it can take a wee while for it to almost heal start hurting these new dentures. It's tricky as well. I've seen a patient before who hadn't been wearing the denture because it was sore. And then it's a bit more trickier to see where the pain is actually coming from because you've not got redness or something like that. [Jaz] So it's a couple of lessons to share then based on that. Just so I don't forget is, always warn your patient that this is normal. Like you should say to your patient. It's like you said, like a glove. That's exactly it. It's like a brand new pair of tight shoes, right? You're going to get some foot blisters on your feet, right? It's normal and to adjust it. And when they come in and it's like the ulcers there, you could use pressure spot indicator paste. But do you guys have Dycal in your clinic? [Emma]We do have Dycal, but not on our Prosth clinic. I don't think- [Jaz]It's something I was taught by Mark Bishop to use just on the ulcer, just the base, actually, not even the Dycal, just the base on the ulcer and then put the denture on and then see and pick it up. It's like anything that will just mark because what you're testing for pressure is where it's actually too much pressure. But for the ulcer, you just wanted to rub off on exactly where to adjust the denture. So you can actually use anything that marks off onto the denture. So that's a good thing to use. We actually had an episode with Mark Bishop, I think it's episode 28 of the podcast. So anyone who's new to dentures, check out that episode with Mark Bishop. We talked about the use of pressure spot indicator, the use of the Dycal in that way. And it really talks you through everything. Now, one thing to bear in mind, like your one is obvious because it was like overextended probably in that frenum area. But number one thing before you do an adjustment on the teeth on the actual chewing surface of teeth themselves is before you adjust anywhere on the inside of the denture, check the occlusion because it could be the fact that the patient bites together, it actually is hitting on an incline and the entire denture is then moving and then the teeth bite together. And so you need to make sure it's got a nice, clear, easy, repeatable bite. Because if it isn't, it's actually the bite that's the problem, not the fact that it's overextended anywhere. Do you know about that? [Emma]Yeah. No, I've never actually really thought about it like that to check the occlusion first. Because then I suppose nothing's going to get much better if you don't address that. [Jaz]Because imagine the denture itself is actually perfectly flush to the tissues, but it's the bite being off and then the pressure gets on that's causing it. So really good top tip is to check the occlusion first in those areas. But anyway, we digress. It's Perio Month. Thanks for sharing your experiences with us, always gives us a few things to talk about there. Tell, ask us your student based perio questions. How much experience have you had of treating periodontal, or managing should I say, periodontal disease in your student clinic so far? [Emma]We don't get on to our perio clinic until fourth year, so we've had a lot of teaching on periodontal diseases, but I've not seen any perio patients at all yet. [Jaz]You haven't seen any perio patients yet, but I bet you've studied all the, I bet you can name all the bacteria. [Emma]Yeah, yeah. [Jaz]Well, this month's notes, revision notes in crush your exam section will be your perio notes. So it'll be good to have all that. But now that you know you're going to be treating more and more and managing this next year and whatnot.