Scenario: Periodontal Disease

This is a basic outline of areas to cover when discussing the scenario with the patient:

• Introduce yourself and check the patient’s details – this is commonly forgotten!
• Take a brief history from the patient about their concern and what treatment they have had – try to lay a foundation for further discussion. Don’t forget to check medical and social histories – this patient may be a diabetic or may smoke!
• Explain the process of periodontal disease to the patient and its progression – use terms like ‘gum disease’. It’s useful to mention some potential causes along the way to put things in to context.
• Use diagrams/radiographs to help show what periodontal disease looks like – if you don’t have one in the interview, pretend you’re showing one – the actors will play along!
• Explain how you are going to manage their immediate problems – relieving pain is the most important thing in this emergency appointment – discuss options of monitoring, extraction or attempting periodontal treatment to the tooth (if this is still feasible). Settle on short-term management.
• Discuss briefly options for long-term management – improving oral hygiene, address risk factors and conduct periodontal treatment.
• Carry out shared decision-making and a patient-centred treatment plan.
• The patient may be unhappy about their historic treatment and may want to complain – apologise that they feel this way but be diplomatic with answers, state facts and do not place blame anywhere. Sentences like ‘I cannot comment on what has been recorded at your previous appointments as I wasn’t there’ are quite helpful. Offering to arrange a meeting with your colleague may also help calm patients down. Ultimately, if they feel they still want to complain, explain the complaints procedures to them. If the patient DOES want to complain, try to stress the importance of their dental treatment and things going from this point so it helps show you are considering the patient’s problems first.
• End on an agreed plan going forwards to ensure the patient is happy.

You short-term management is about patient safety and mediating the initial situation:

• Be clear and jargon-free with explanations – use terms like ‘gum disease’ and ‘gum cleaning’.
• Use diagrams or hand motions to help illustrate your points.
• Show empathy – empathetic noises and gestures will go a long way.
• Demonstrate good non-verbal skills – body language and posture need to friendly. Ensure you carry out attentive listening.
• Let the patient speak and don’t interrupt them – allow them to explain their concerns and ask questions.
• Use open and closed questions as necessary
• Chunk and check your information – give a small amount and then check the patient understands as well as allowing them to ask questions. 
• Repeat and summarise important information – for example, once you’ve discussed all aspects of long-term treatment, finish by stating ‘so the treatment plan involves improving your general toothbrushing, managing your smoking and providing you with some gum cleaning’.