5. Steps 3 and 4 — residual pockets and care for life

Step 3 — sites that did not close

First ask why: still smoking, still not cleaning, still an overhang, still a cracked root, still endo-perio, still a wrong diagnosis. Moderate residual pockets often get further subgingival instrumentation. Deep residual pockets (the BSP chart uses a deeper millimetre cut — check the current flowchart, commonly discussed around 6 mm) may need pocket-reduction or regenerative surgery, or referral if that is beyond the operator and the setting.

If you cannot refer or the person will not go

Document it. Continue the best non-surgical care you can, keep Step 1 honest, and do not pretend an unrestorable hopeless tooth is “in supportive care”.

Engaging versus not engaging

BSP materials describe engagement as a guide (plaque control and attendance), not a moral verdict. Non-engagement changes what surgery can achieve and what you write in a referral. It does not mean you stop offering Step 1.

Step 4 — supportive periodontal care

Periodontitis is a long-term inflammatory disease. SPC is individually timed (often in a 3–12 month range) with hygiene reinforcement, risk-factor control, and targeted professional plaque removal. Annual (at least) full probing in people with a periodontitis diagnosis is the usual UK teaching once they are in maintenance — BPE is the wrong tool here.

Stability language

Use the current BSP/EFP definitions of stability (shallow sites that do not bleed). Do not tell someone they are “cured”. Tell them the disease is controlled if that is true, and what would make you intervene again.

Toothpaste and mouthwash

Evidence-based adjunctive dentifrices or rinses can help control gingival inflammation for some people as an adjunct, not as a replacement for interdental cleaning. Follow current Delivering Better Oral Health and BSP notes rather than a branded sample drawer.