For the preparation of written patient information for a dental study on periodontal screening I am looking for a standard formulation regarding possible risks and side effects of a medical/ dental periodontal disease examination. Are there relevant risks? Or can I just write that it is an established routine examination in which there is no risk expectable? Must I mention possible bleeding as a risk or can I say it is a symptom of inflammation and not a side effect of the examination?
Transportatio of pathogen bacteria with perio. probe from diseased side into healthy sulcus/ pocket
also, there are reports on induced transitory bacteremia after probing... but not sure if we consider this a risk.
Dear Michael Krichbaum, thank you for sharing your question with us. I am working as general practitioner and specialist in endodontics and dental prosthesis, but I work in prevention, periodontics, implant surgery since 25 years ago. Diabetes (especially type I, uncontrolled) can bring risks in dental procedures: yes, even during a periodontal probing, whether made with a WHO probe type (with blunt tip) either by computerized survey, as the Florida Probe System where the intrapocket pressure is usually higher than that exerted by conventional clinical survey. My humble opinion is that the switch from one site to another site probed in case of bleeding or pus, the probe tip should be disinfected (by the simple technique of applying 3 past gauze soaked in 70% ethanol or 0, 12% chlorhexidine digluconate) for example. Before any clinical examination in the oral cavity of my patients / clients, they are instructed to use mouthwash (30 seconds is the case of chlorhexidine or essential oils mouthrinses or 1 minute if cetylpyridinium chloride) to prevent cross-infection within an individual is that people with diabetes. I also do interventions - however simple they may be - always in the morning where blood glucose levels are more suitable. For more invasive procedures in controlled individuals, just be careful with the aseptic chain and mouthwash pre-procedure. As for those uncompensated, I contact the doctor who accompanies him/her and usually required for evaluation and antibiotic prophylaxis sometimes is performed.
Periodontal exam in the UK is mandatory when examining the mouth. Rodger may be refering to the need for antibiotic cover (ABC) in patients with a heart murmer but in the UK as long as the patient has not had bacterial endocarditis (BE) we no longer cover this pathology. NICE / SIGN guidlines see the risk from the antibioitc as outweighing the risk of contracting SBE. However if they have had BE the there is no safe probing of the crevice without ABC - for this is one of the reserviours of bacteria which cause a bacteraemia potentially precipitating BEin suspceptable patients. It would be very unusual for a patient to bleed after this examination anymore than they do when tooth brushing if they have inflammation; so I suppose it is true to say it is the inflammation not the examination.. Healthy gingivae should not bleed. Specialist list Oral Surgeon for 38 years
Dr Palaiologou, Your answer is really good but lacks references. Can you please provide us non-clinicians with one or two recent reviews or references to back up your answer?
Dear Mr. Krichbaum, there may be a clinical complication to be added to the potential risk of pocket probing: in periodontitis patients with deep pockets and very active inflammation sometimes an exacerbation can be observed over the following days. The primary cause is periodontitis of course, but the symptoms of the exacerbation are probably caused by the procedure of probing. This is not very common and not of severe consequence either, but the patient may feel some discomfort at the site for some days
Dear Dr. Burgemeister, Many thanks for this information. Yes, we will add this as a possible discomfort to the patient information. One aditional question: Is this your personal clinical experience or do you also know a reference to this aspect? Kind regards, Michael (Schöne Grüße aus dem lieblichen Taubertal in die Schweiz)
Dear Dr. Krichbaum, sorry for answering late! In fact it is only from clinical experience, interestingly nobody seems to have published anything on the clinical "side-effects" of pocket probing (in contrast e.g. to its impact on the microflora prior to DNA-Probing). A large proportion of my patients since 2000 are periodontitis patients; and I observe the phenomenon maybe once or twice a year. But it typically occurs in patients with severe untreated periodontitis and high "overall inflammatory activity", which may be more likely in diabetes patients or in cases with an impaired immune function. (Viele Grüsse an die Tauber) Stefan
The denger of bacterial transmission is very low, from a inflammated site to the healthy sulcus
If dentist examines well by knowing patient,s history .the examination is without risk.
Think these references could help you.
https://ispub.com/IJDS/9/2/13418
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