The main problem facing clinical teams when dealing with TSL is the lack of a simple, easy to use assessment tool that can quickly document the TSL being seen clinically. There have been many TSL assessment tools, e.g. the Smith and Knight Index, however they have certain problems. Most are complicated, time consuming and they are not comparable with each other. Clinical teams need a rapid, easy to use and document clinical assessment tool that will enable information to be in some way standardized and transferred amongst clinical teams. In the similar way that the BPE scoring system does for the assessment of periodontal disease.
Dave Bartlett and his team, suggested a simple scoring system for TSL that was based on the BPE scoring system for periodontal disease.
(D.Bartlett, C.Ganss and A. Lussi .Clin Oral Investigations 2008 12(Suppl): 65-68).
During a dental examination the mouth is divided into sextants and a score given to each sextant of the mouth according to the worst TSL seen in this sextant according to the scores shown below:
Dave Bartlett and his team, suggested a simple scoring system for TSL that was based on the BPE scoring system for periodontal disease.
(D.Bartlett, C.Ganss and A. Lussi .Clin Oral Investigations 2008 12(Suppl): 65-68).
During a dental examination the mouth is divided into sextants and a score given to each sextant of the mouth according to the worst TSL seen in this sextant according to the scores shown below:
SCORE 0
A perfect mouth with no evidence of TSL - hence each of the six quadrants would score 0
A perfect mouth with no evidence of TSL - hence each of the six quadrants would score 0
SCORE 1
Early loss of enamel and changes in morphology of tooth. However no dentine exposed.
The upper anterior quadrant would score 1. This may be thinning of the enamel, increased incisal translucency, loss of anatomical form and cusp morphology.
Early loss of enamel and changes in morphology of tooth. However no dentine exposed.
The upper anterior quadrant would score 1. This may be thinning of the enamel, increased incisal translucency, loss of anatomical form and cusp morphology.
SCORE 2
On the same patient as above the UR4 would give the UR quadrant a score of 2 - hard tissue loss and dentine is exposed but on <50% of the tooth's surface.
On the same patient as above the UR4 would give the UR quadrant a score of 2 - hard tissue loss and dentine is exposed but on <50% of the tooth's surface.
SCORE 3
On the same patient as above the LL quadrant would score a 3 due to the TSL on the LL6.
Hard tissue loss ≥50% of the surface area having dentine exposed.
On the same patient as above the LL quadrant would score a 3 due to the TSL on the LL6.
Hard tissue loss ≥50% of the surface area having dentine exposed.
Therefore by using the BEWE scoring system it will enable teams to make a quick documented record of any TSL seen in a patient - importantly even though there may be no evidence of TSL, and hence scores of 0, there has still been a record taken on this date. This will be essential if there are any future claims of negligence against a clinician if the patient goes on to develop TSL in the future, possibly once under the care of another dental practice. However, caution is needed as even though a record is taken and documented it does not indicate the cause of the TSL or whether the TSL seen is active or arrested - this will play a large part in determining the care provided.
The only challenge to face is how to actually record this chart in your notes - most computer software, mine included, do not have the facility to chart TSL - the more dentists that complain and insist on this to their software providers the more likely it is that they will build this into their programs. In the mean time it would be easy to enter a BEWE score into your written clinical notes e.g. for the Score 3 patient above you may simple write " Date... BEWE SCORE U 210, L003 ".
Once you have recorded the BEWE score you can use it to help develop a care pathway for your patient - initially you would add up all the figures in the six BEWE quadrants and arrive at a total figure.
The only challenge to face is how to actually record this chart in your notes - most computer software, mine included, do not have the facility to chart TSL - the more dentists that complain and insist on this to their software providers the more likely it is that they will build this into their programs. In the mean time it would be easy to enter a BEWE score into your written clinical notes e.g. for the Score 3 patient above you may simple write " Date... BEWE SCORE U 210, L003 ".
Once you have recorded the BEWE score you can use it to help develop a care pathway for your patient - initially you would add up all the figures in the six BEWE quadrants and arrive at a total figure.
The main decision the clinician needs to make is placing the patient into a risk category for future TSL. This will depend on many factors - the age of the patient, the activity of the current TSL, the rate of progression amongst other things. In a similar way a BPE score may be recorded for different patients of differing ages, there will be vastly different risks and treatment care pathways of a BPE score of 3 in an 80 year old and in a 22 year old smoker with Type 1 diabetes. Hence, clinical experience will determine the appropriate care pathway for a patient presenting with TSL. The main focus of the care should be the identification and elimination of any causative factors supported with a high level of preventative treatment in order to prevent TSL progressing to such an extent that it will require complicated and expensive restorative work to rectify.
An example of a TSL care pathway can be viewed below and downloaded if required.
An example of a TSL care pathway can be viewed below and downloaded if required.