The Guided Biofilm Therapy Notes Template

GBT is a structured EMS protocol — without documentation of disclosure, biofilm management, and recall justification, it looks like a cosmetic clean. Below is a template for UK practitioners to paste into their PMS to make GBT auditable as a true periodontal service.

Why this guided biofilm therapy (GBT) template wins

• Disclosure-based plaque score — quantifies biofilm visually for patient AND audit. Differentiates GBT from "polish" cleans.
• GBT protocol steps documented in order — proves the structured protocol was followed, not a cosmetic clean.
• Pre and post disclosure scores — quantifies effectiveness.
• Pocket-depth-specific instrumentation (Perioflow ≥5mm, Piezon PS ≥4mm) — defensible technique selection.
• Powder type specified per area — EMS protocol-aligned (Plus for biofilm, Perio for subgingival, Comfort for sensitive).

The template (paste into your PMS notes field)

Paste the guided biofilm therapy (GBT) template below into your PMS notes field. Patient demographics are left out because your PMS already holds them.

STEP: 4 (SPC) or 1 (Initial therapy) — specify
INTERVAL SINCE LAST VISIT: [Weeks / months]

MHx UPDATE: [Reviewed]
Risk factors: [Smoking, diabetes, dry mouth, medications]

PERIODONTAL ASSESSMENT:
- BPE today (or full chart for known disease):
  UR _   UA _   UL _
  LR _   LA _   LL _
- Plaque score (DISCLOSURE-BASED — % sites with plaque): [%]
- Bleeding score: [%]

GBT PROTOCOL STEPS:
1. ASSESS: Diagnosis and risk assessment (above)
2. DISCLOSE: Disclosing agent applied — biofilm distribution recorded ([photo if taken])
3. MOTIVATE: Patient shown biofilm distribution. Targeted OHI delivered.
4. AIRFLOW (supra and subgingival to 4-5mm pocket): Powder used [Plus / Comfort / Perio] — areas
5. PERIOFLOW (subgingival to ≥5mm pockets): Powder [Plus / Perio] — sites
6. PIEZON PS (subgingival ≥4mm pockets): Sites instrumented — minimally invasive technique
7. CHECK: Tactile check for remaining deposits
8. RECALL: Interval set with rationale

DISCLOSURE SCORE PRE-TREATMENT: [%]
DISCLOSURE SCORE POST-TREATMENT: [%]

OHI TAILORED TO DISCLOSED AREAS: [Specific advice]

FLUORIDE APPLICATION: [22,600 ppm fluoride varnish applied to risk areas Y/N]

RECALL INTERVAL: [3 / 4 / 6 months — rationale based on BPE, risk factors, disease status]

Try the guided biofilm therapy (GBT) note in the live demo → No account needed.

What good looks like — a worked example

The same guided biofilm therapy (GBT) template, completed for a realistic case.

STEP: 4 (SPC) — 3-monthly SPC for treated Stage III Grade B periodontitis
INTERVAL SINCE LAST VISIT: 3 months

MHx UPDATE: Reviewed — unchanged.
Risk factors: Ex-smoker (quit 6 months — significant achievement), diabetes well-controlled.

PERIODONTAL ASSESSMENT:
- BPE today:
  UR 2   UA 1   UL 2
  LR 2   LA 1   LL 3 (residual issue LL6)
- Plaque score (disclosure-based): 25%
- Bleeding score: 18%

GBT PROTOCOL STEPS:
1. ASSESS: Stage III Grade B periodontitis, on SPC. Stable LL6 area pocket since last visit.
2. DISCLOSE: GC Tri Plaque ID Gel applied. Biofilm primarily interdental UR3-UR4 (~25% sites) and lingual LL6 (subgingival). Photograph taken for patient education.
3. MOTIVATE: Patient shown disclosure distribution in mirror. Recognised LL6 area as persistent issue. Targeted OHI delivered.
4. AIRFLOW (supragingival): EMS Plus powder (erythritol), all teeth. Excellent biofilm removal supragingivally. Sub-marginal Airflow with Comfort powder at pocketed sites LL.
5. PERIOFLOW: LL6 distal pocket (5mm) treated with Perio powder subgingivally via Perioflow nozzle.
6. PIEZON PS: LL6 distal pocket (5mm) instrumented with PS (PerioSlim) ultrasonic tip — minimally invasive technique.
7. CHECK: Tactile sweep — no residual subgingival deposits felt.
8. RECALL: 3 months. Continued SPC justified.

DISCLOSURE SCORE PRE-TREATMENT: 25%
DISCLOSURE SCORE POST-TREATMENT: 0% (biofilm completely removed)

OHI TAILORED TO DISCLOSED AREAS: TePe interdental brush 0.4mm pink reinforced for UR3-4. Subgingival TePe (mini) demonstrated for LL6 area. Rubber-tipped stimulator continued for LL6 area.

FLUORIDE APPLICATION: 22,600 ppm fluoride varnish applied to LL exposed root surfaces (recession).

RECALL INTERVAL: 3 months — rationale: Stage III at baseline, ex-smoker (still recent quit), persistent low-grade LL6 area justify continued 3-monthly SPC.

Compliance: the medico-legal angle

• BSP/EFP PMPR principles — GBT is a delivery method for evidence-based PMPR.
• CGDent record-keeping — periodontal records must show biofilm assessment + management + recall.
• GDC Principle 4 — clinical record sufficient to demonstrate care was periodontal, not cosmetic.
• EMS protocol fidelity — if delivering branded GBT, documenting protocol steps is the audit defence.

Common documentation mistakes

• No disclosure score — GBT without disclosure is just polishing; defeats the protocol's evidence base.
• BPE not recorded — GBT framework requires periodontal assessment first.
• Subgingival instrumentation not pocket-depth-justified — over-instrumentation of healthy sites.
• No recall justification — looks like a cosmetic frequency rather than disease-tied interval.
• Documenting as "hygiene" with no GBT protocol detail — undermines the clinical value claim.

Sources

• GDC Standards for the Dental Team, Principle 4: Maintain and protect patients’ information (accessed 18 October 2026)
• CGDent: Clinical Examination and Record-Keeping, Good Practice Guidelines (3rd edition) (accessed 18 October 2026)
• West N, et al. BSP implementation of European S3-level evidence-based treatment guidelines for stage I–III periodontitis in UK clinical practice. J Dent 2021 (accessed 18 October 2026)

Frequently asked questions

Patient leaflets for this treatment

• Understanding Gum Disease

Related dental note templates

Browse the full set of free dental notes templates.