Implementing Periodontal Treatment Guidelines in Primary Care: A co-development and feasibility study
For any enquiries, please contact: Dr Aalia Karamat at a.karamat@qmul.ac.uk
Staff from the Institute of Dentistry are conducting research to co-develop and evaluate the feasibility of an implementation strategy to improve the adoption of international clinical guideline for the treatment of periodontitis in NHS primary dental care.
Professor Eduardo Bernabe, from the Centre for Dental Public Health and Primary Care, in collaboration with Professor Nikolaos Donos, from the Centre for Oral Clinical Research (COCR) and Doctor Jamie Ross, from the Wolfson Institute of Public Health, have secured funding from Barts Charity to identify factors that facilitate or restrict the adoption of periodontal treatment guideline in NHS primary care dental practices. By understanding these factors, the project will develop strategies to overcome these barriers and improve the delivery of high-quality gum disease care.
International clinical guidelines for treating periodontitis (gum disease) were published in 2020 and subsequently endorsed by major UK professional organisations. The guideline offers well-researched, evidence-based recommendations aimed at improving the quality of periodontitis management and the patient experience. However, implementing these guidelines in routine clinical practice has proven somewhat challenging.
Key Information about this project
Work packages 1 & 2 Recruitment documents:
WP1&2 Project information sheet for patients [PDF 187KB]
WP1&2 Project Information Sheet for Practice Staff [PDF 186KB]
WP1&2 Project Information Sheet for Commissioners [PDF 187KB]
WP1&2 Consent Form [PDF 120KB]
Work package 3 Recruitment documents:
WP3 Project Information Sheet for Patient [PDF 186KB]
WP3 Project Information Sheet for Clinical Staff [PDF 221KB]
WP3 Consent Form for Clinical Staff [PDF 119KB]
WP3 Consent Form for Patients [PDF 120KB]
Why was a treatment guideline introduced?
The European Federation of Periodontology (EFP) published the first formal evidence-based guideline for the treatment of periodontitis in 2020. The guideline was introduced to standardise care, improve outcomes, and ensure treatment is based on the best available evidence. It defines clinical objectives for therapy, outlines when to use non-surgical vs surgical approaches, and stresses the importance of long-term maintenance so that the disease does not recur (1).
Managing periodontal disease according to the guideline involves a continuous cycle of assessment, treatment, and re-assessment, with treatment plans modified based on patient responses and preferences. This enables the clinician to offer personalised diagnoses and tailored treatment plans for each patient.
Clinical treatment guideline
The European Federation of Periodontology’s (EFP) guideline for the treatment of periodontitis contains 62 evidence-based recommendations on different therapies for the first three stages of periodontitis (3). According to the guideline, periodontal therapy follows four steps, which are outlined in the following table. Most periodontal care (steps 1, 2 and 4) is expected to be provided by dental care teams in primary care.
Steps to follow for periodontal therapy
Step 1: Establishing the basis for effective care outcomes
- Explain disease and risk factors, improve self-performed oral health and control risk factors (smoking and diabetes)
- Tailored Oral Hygiene advice
- Advise quitting smoking/refer
- Monitoring plaque and bleeding score
- Supragingival Professional Mechanical Plaque Removal
- Evaluate if the patient is engaging
- Video/audio calls for remotivating
Step 2: Non‐surgical treatments to clear the roots of bacterial plaque and biofilm
- Only for motivating patients, detailed pocket charting
- Sub-gingival instrumentation (hand or powered)
- Use of adjunctive systemic antimicrobials
Step 3: Surgical intervention aiming to manage nonresponding sites
(Consider referral for pocket management or regenerative surgery)
- Detailed pocket charting
- Plaque scores
- Re-examination after 3 months following step 2 care
- Re-instrumentation of non-responding sites
- Behaviour change support
- Reinforce plaque control & daily interdental cleaning
Step 4: Long-term periodontal maintenance for sustained periodontal care to preserve the stability of achieved oral health
- Recall in 6 months, Reassess in follow-up
- Supportive periodontal care: Reinforce OH advice, smoking advice
- Targeted Professional Mechanical Plaque Removal as needed
The British Society of Periodontology (BSP) adapted the guideline to ensure it was suitable for the UK healthcare system and recommended that dental care professionals use it in their clinical practice. BSP has developed multiple resources to help clinical teams adopt the guideline. These resources can be accessed by clicking on the links below:
Periodontal treatment flow chart
Implementation of treatment of stage I-III periodontitis
https://www.youtube.com/watch?v=nvi9lWYccN0&t=6s
Stepwise personalised care pathway in NHS General Dental Practice
https://www.bsperio.org.uk/assets/downloads/Delivering_stepwise_Care_version_2_7th_August_2025.pdf
Our project
This project comprises three work packages to be conducted in the primary dental care. The first focuses on identifying barriers and facilitators to implementing periodontal guidelines. The second involves co-designing implementation strategies with key stakeholders, including dentists, dental teams, commissioners, and patients, drawing on insights gained from the first work package. The third evaluates the feasibility of applying the co-designed strategy in primary dental care. Work packages one and two will run for 12 months, followed by work package three over the next 18 months. 
The Team
Project Steering Group
You can click the links below to see the staff profile of each team member:
Professor Eduardo Bernabe (Principal Investigator), Institute of Dentistry
Professor Nikos Donos (Collaborator), Institute of Dentistry
Dr Jamie Ross (Collaborator), Wolfson Institute of Population Health
Dr Aalia Karamat (Research Associate), Institute of Dentistry
Dr Chara Triantafyllou (Clinical Trials Coordinator), Institute of Dentistry
Our Lay Advisory Group
Daniel Olabisi
Manos Kumar
Israel Aduak
Dissemination activities
Dissemination of the project will include:
- Presentations in local meetings and national and international conferences
- Creating Website
- Poster display in the practice’s waiting area
- Information Leaflets
Dissemination outputs will be posted in this site as they become available.