Background to the guidance

Periodontal disease is prevalent in a large proportion of the Scottish population. Around half of dentate adults have evidence of gingivitis and/or periodontitis and a significant minority display signs of advanced disease.

One of the most frequent dental procedures carried out in Scotland is the simple supra-gingival scale and polish. However, less than 10% of patients receive the more intensive categories of care designated for managing patients with moderate to severe periodontal disease. Considerable variation is evident across Health Boards.

Most patients with moderate to severe periodontal disease can be adequately managed in primary care. Referral to a specialist or to secondary care is an appropriate pathway for the most severe cases of periodontal disease. However, there is concern that an apparent reluctance to treat advanced disease in primary care has resulted in an increase in inappropriate referrals.

Interviews with clinicians suggest that drivers to referral include:

  • a lack of confidence amongst general dental practitioners in performing periodontal treatment
  • the time necessary to treat periodontal diseases effectively
  • the need to rely on the patient to be an active partner in the treatment process

The medico-legal defence unions report that an increasing number of claims relate to allegations of failure to diagnose and treat periodontitis.

This guidance seeks to present clear and consistent advice to support dental professionals to deliver preventive care and, where necessary, to treat periodontal diseases in primary care.