Plaque and Bleeding Recording

Plaque and bleeding recording in the treatment of periodontal diseases is important as a diagnostic, preventive and treatment aid.

There is sufficient evidence for the implication of plaque in the aetiology of periodontal diseases that the recording of area of plaque in the mouth is important in developing a good baseline picture of the patient's periodontal status.

The gingival bleeding index is used to note areas of inflammatory change. Even though gingival inflammation is common, it is still an indication of ineffective plaque control and should be recorded. The pocket should also be probed to access its depth and record the presence or absence of subgingival calculus. 

There is debate in the literature on whether the bleeding from the base of the pocket should be recorded, rather than bleeding from the crest of the gingival tissues. The former way of inducing bleeding may indicate that the probable pocket is undergoing some destructive activity at its base, although its predictive capacity in determining weather the site will definitely deepen is unclear. The latter approach reflects a more simple index that captures the presence or absence of marginal gingivitis. 

An important aspect of any plaque and bleeding form is to make it comprehensible to the patient. This will, in turn, mean that patients will be able to detect improvement in their scores and this is very relevant in the process of behavioural change and continued motivation. 

Plaque and bleeding forms are excellent aids to demonstrate to your patients the areas of plaque remaining on their teeth and inflammation of the gingival tissues and can be used to monitor improvements resulting from home care by the patient and your treatment. 

We have aimed at providing a plaque and bleeding form which will be simple to use and yet record the presence or absence of plaque and bleeding accurately enough to use as a treatment aid and to motivate the patient. The form included in the Introductory Kit is quick and easy to record by either your hygienist or yourself. It can be filled in with either a cross "x" in the appropriate buccal, lingual, mesial or distal box or coloured (for example: a green pencil for plaque index and a red pencil for the bleeding index).

The Gingival Bleeding Index must be taken before any disclosing solutions are used. Following this, plaque disclosing solutions can aid in the detection of plaque and can provide a visual means to help patients identify the build-up of plaque in their mouths. Plaque may also be detected by running a fine probe around the cervical margin of each tooth, and recording its presence or absence on the charting form. 

To calculate the gingival plaque and bleeding index, record - 

1. Number of teeth present; 
2. Number of areas which showed plaque/haemorrhage on probing. 

As a 'follow-up' exercise, the plaque and bleeding score sheets are ideal motivators for patients, and they have been designed to record the 'number of visits' and 'remarks' so easy comparison can be made. 

It must be remembered that the plaque and bleeding data recorded only aids in the diagnosis and is not the only measure of the patient's periodontal health. However, it may play an important role in the instruction and motivation of the individual patient, and their oral hygiene skills.