Section II - Preventive Care and Periodontal Treatment

2-(a) Enhanced Preventive Advice and Treatment (including Childsmile)

• Item 2-(a) can be claimed after 2 complete calendar months from a previous claim under item 2-(a), if clinically required, by the same dentist.
• Item 2-(a) should be claimed when treating patients with a BPE of 1 or 2 or as part of periodontal maintenance therapy. This aligns with Step 4 of the BSP guidance.
• Item 2-(a) should be claimed for the delivery of Childsmile. This can also be delivered by a Therapist, Hygienist or Childsmile nurse on the instruction of a dentist.
• Item 2-(a) cannot be claimed with items 2-(c) or 2-(d) in the same course of treatment.
• A scale and polish, now termed Professional Mechanical Plaque Removal (PMPR), can be claimed under item 2-(a), alongside preventive advice.
• Fluoride varnish can be applied to any dentate or partially dentate patient, including adults, if a patient is at high risk of caries. Fluoride varnish should, with parental/guardian consent, also be applied to children as part of Childsmile up to the age of 12 years old.
• Interdental cleaning advice should be provided to any patient based on clinical findings.

In some specific clinical circumstances, it may not be possible to record a basic periodontal examination by probing. If BPE examination has not been recorded by probing due to a specific clinical issue, then code X should be entered as the appropriate periodontal matrix code.

2-(b) Fissure Sealants

• Fissure sealants can be applied by dentists, hygienists and therapists.
• Fissure sealants can be applied to and claimed for:
  • unfilled permanent molars within 2 years of eruption
  • hypoplastic premolars within 2 years of eruption
  • unfilled retained deciduous molar teeth
• If a fissure sealant de-bonds within 23 months of its application, it should be maintained/replaced as part of the original claim.
• For patients with special care needs (adults included) or those with high caries risk, item 2-(b) can be claimed for:
  • initial applications after 2 years of eruption and;
  • additional applications can be claimed after 23 complete calendar months from the last application on the same tooth.

2-(c) Periodontal Assessment and Treatment for patients with a BPE of 3 or 4 and/or interdental bone loss (standard)

• This item is to be used for initial periodontal assessment and subsequent treatment and advice.
• Professional Mechanical Plaque Removal (PMPR) with supra- and subgingival scaling can be completed at the start of treatment, to allow for assessment. This aligns with Step 2 of the BSP guidance. This can be completed by a hygienist or therapist and claimed via the prescribing dentist.
• A treatment plan should be given to the patient, explaining their role and responsibility in their own treatment.
• Where more than 1 treatment appointment is required, additional appointments (up to 3) can be claimed under item under 2-(e) in a course of treatment.
• Item 2-(c) can be repeated and claimed after no less than 2 complete calendar months from the previous course of treatment claimed under item 2(c) or 2(d) as long as a review examination 1-(b) with a 6-point pocket chart has been completed.
• If a patient has responded well to treatment and is stable then they should proceed to maintenance therapy, step 4 of the BSP guidance claiming item 2-(a) as appropriate. This treatment can be completed by a hygienist or therapist and claimed via the prescribing dentist.
• Should the patient have responded well to treatment and advice, but there are residual non-responding sites, then item 2-(d) Periodontal Assessment and Treatment (enhanced) for patients with a BPE of 3 or 4 and /or interdental bone loss could be provided and claimed. See Step 3 of the BSP guidance.
• If a patient has not responded well to treatment or advice, then item 2-(c) can be repeated as required. This can be carried out every 2 complete calendar months (following a 1-(b) review each time) if, in your clinical opinion, you consider a patient is engaged or is attempting to engage and has mitigating factors beyond their control.

Periodontal review

• Item 1-(b) can be claimed for a Periodontal Review, 2 complete calendar months after a claim for periodontal treatment has been completed, prior to proceeding with another course/claim of treatment under 2-(c) and 2-(d). This can be completed by a hygienist or therapist.
• If in your clinical opinion, you consider a patient is not taking responsibility or engaging with their treatment, then the dentist may decide to cease treatment. This decision should be recorded in the patients records with clear justification.
• If a patient returns and wishes to re-engage with the necessary periodontal treatment, then the process can be re-started.

2-(d) Periodontal Assessment and Treatment for patients with a BPE of 3 or 4 and/or interdental bone loss (enhanced)

• This item can be claimed for the treatment of patients who have completed item 2-(c) and have non-responding sites. This aligns with Step 3 of the BSP guidance.
• If a patient has not responded well to treatment or advice, then item 2-(c) or 2-(d) can be repeated as required. This can be carried out every 2 complete calendar months (following an item 1-(b) review each time) if, in your clinical opinion, you consider a patient is engaged or is attempting to engage and has mitigating factors beyond their control.
• If a patient has responded well to treatment and is stable then they should proceed to maintenance therapy, step 4 of the BSP guidance which can be claimed under item 2-(a).

2-(e) Additional Periodontal Supplement

• This can be claimed alongside item 2-(c) or 2-(d) where multiple appointments are required to treat more than one sextant.
• It can be claimed a maximum of 3 times per course of periodontal treatment under items 2-(c) or (d).