Scale & Polish Notes Template for UK Hygienists & Dentists

Most scale and polish notes are too short to be defensible. Below is a template for UK hygienists and dentists to paste into their PMS — using the current BSP terminology (PmPR), with everything BSP and SDCEP expect documented at every visit.

Why this scale & polish template wins

• Captures both periodontal status (BPE + plaque + bleeding scores) AND the actual instrumentation — the two halves of a defensible perio note.
• Fluoride application is its own line — an easily missed field in hygiene notes.
• Recall interval is risk-based (3/4/6 months) with a reason field, not just a number.
• OHI is broken into the four elements BSP recommends: brushing technique, interdental, mouthwash, dietary advice.
• Sign-off includes GDC number, satisfying the GDC requirement for an attributable record.

The template (paste into your PMS notes field)

Paste the scale & polish template below into your PMS notes field. Patient demographics are left out because your PMS already holds them.

REASON FOR ATTENDANCE: [Routine hygiene / SPC visit / acute concern:]

MHx: [Reviewed — unchanged / changes:]
Anticoagulants: [None / list]
Bisphosphonates: [None / list]

PERIODONTAL STATUS — BPE:
  UR _   UA _   UL _
  LR _   LA _   LL _
Pocket depths (if applicable):
Plaque score / BoP: [%]
Calculus: [Supra / sub — light / moderate / heavy]

OHI DELIVERED: [Brushing technique / interdental aid + size / mouthwash / dietary advice]

TREATMENT PROVIDED (PmPR):
- Method: [Hand instruments — sickle / Gracey / ultrasonic — piezo/cavitron / both]
- Areas: [All sextants / specify]
- Subgingival debridement: [N/A / sites + depth to which instrumented]
- Polish: [Prophy paste — fine/medium / air polish — powder]
- Fluoride 22,600 ppm: [Applied — date / declined]
- LA: [None / topical / LA — agent, volume]

PATIENT RESPONSE: [Tolerated well / discomfort / any adverse event]

DIAGNOSIS / CLASSIFICATION: [Plaque-induced gingivitis / Stage __ Grade __ periodontitis / on reduced periodontium]

RECALL / REASSESSMENT: [3 / 4 / 6 / 12 months] — rationale: [BSP Step / SDCEP / NICE CG19]
Reassess BPE: [Next visit / in __ weeks]
Aftercare leaflet: [Verbal + written]

CLINICIAN: [Name]   GDC No.: [ ]   NURSE: [Name]   DATE: [ ]

Try the scale & polish note in the live demo → No account needed.

What good looks like — a worked example

The same scale & polish template, completed for a realistic case.

REASON FOR ATTENDANCE: Routine hygiene appointment. No acute complaint.

MHx: Reviewed — unchanged. No new medications.
Anticoagulants: None. Bisphosphonates: None.

PERIODONTAL STATUS — BPE:
  UR 2   UA 1   UL 2
  LR 1   LA 1   LL 2
Pocket depths: All ≤3mm today.
Plaque/BoP: Interdental plaque UR & LL — patient reports inconsistent floss use. BoP at UR4/5 mesial and LL5 distal.
Calculus: Supra-marginal, moderate UL & LL anterior.

OHI DELIVERED: Modified Bass technique reinforced. TePe pink 0.4mm demonstrated for UR4-6 and LL4-6 embrasures. 2x daily brushing, 2 min, fluoride ≥1,450 ppm. Reduce frequency of acidic drinks between meals.

TREATMENT PROVIDED (PmPR):
- Method: Hand (sickle + Gracey 1/2 anterior) + ultrasonic (EMS Piezon) all sextants
- Areas: All sextants. Subgingival debridement LL sextant to pocket depth ≤3mm
- Polish: Prophy paste, rotating cup, all surfaces
- Fluoride 22,600 ppm: Applied
- LA: None

PATIENT RESPONSE: Tolerated procedure well. No adverse events.

DIAGNOSIS / CLASSIFICATION: Plaque-induced gingivitis on reduced periodontium (previously treated BPE 3 LL). Currently stable; no recurrence of deep pocketing detected.

RECALL / REASSESSMENT: 3 months SPC — per BSP Step 4 given previous BPE 3. Reassess BPE next visit. Aftercare leaflet given verbal + written.

Compliance: the medico-legal angle

• BSP (British Society of Periodontology) Step 1 guidance requires a documented BPE plus plaque and bleeding scores at the start of any periodontal intervention. The template prompts both.
• CQC Regulation 17 requires an accurate, complete and contemporaneous record of the care provided and the decisions taken. The dedicated fluoride field records whether it was applied or declined.
• GDC Standards Principle 4.1.1 — attributable, contemporaneous, complete record. The sign-off block with clinician + GDC + nurse + date satisfies this.
• Air polishing protocol (powder type, areas) is part of the standard of care under BSP guidance for biofilm management — the dedicated field protects you if technique is later challenged.

Common documentation mistakes

• Recording "S&P done" without BPE or plaque score — fails BSP Step 1 documentation requirement.
• No fluoride recorded for high-caries-risk patients (CQC will flag this).
• Recall interval of "6 months" with no risk-based justification — NICE CG19 expects justification.
• OHI marked "given" without specifying what was discussed (brushing technique, interdental tool, mouthwash, diet).
• Anaesthetic batch number missing — required for traceability under MHRA medicines record-keeping.

Sources

• GDC Standards for the Dental Team, Principle 4: Maintain and protect patients’ information (accessed 18 October 2026)
• NICE CG19: Dental checks: intervals between oral health reviews (October 2004) (accessed 18 October 2026)
• BSP: The Basic Periodontal Examination (BPE), 2019 (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)
• DHSC and NHS England: Delivering better oral health: an evidence-based toolkit for prevention (accessed 18 October 2026)

Frequently asked questions

Guides that cover this

• GDC Scope of Practice for Hygienists and Therapists (2025 guidance, updated 2026)
• Dental Hygienist New Graduate UK Guide
• Record-Keeping for Dental Hygienists and Therapists (UK): What DCPs Must Document
• Direct Access Records for Hygienists and Therapists (UK): What to Document
• ORE vs LDS: Which GDC Registration Route Should Overseas Dentists Choose?
• Using a Dental Notes App Alongside Dentally (UK)

Patient leaflets for this treatment

• Understanding Gum Disease

Related dental note templates

Browse the full set of free dental notes templates.