Many of my patients commonly ask the question “Why should I be treated by a Periodontist and/or why was I not referred earlier?” Every patient’s case is different and there is no one correct answer. To shed some light on this topic, I’ve summarized guidelines and trends for why or why not a patient has been referred to a periodontist. This summary is based on peer reviewed studies published by the leading experts in the field of periodontology.
Guidelines for when should a patient be referred to a Periodontist
In 2005, the American Academy of Periodontology undertook the development of guidelines for the management of patients with periodontitis. The Academy concluded that any patient with the following parameters should be treated by a Periodontist: Severe chronic periodontitis, Furcation involvement, Vertical/angular bony defect(s), Aggressive periodontitis, Periodontal abscess and other acute periodontal conditions, Significant root surface exposure and/or progressive gingival recession, Peri-implant disease, and any patient with periodontal diseases, regardless of severity, whom the referring dentist prefers not to treat.
Trends in periodontal referral patterns
A published article by the American Journal of Periodontology 2003 reviewed the trends and patterns of patient referrals to Periodontist for comprehensive periodontal treatment over the last 2 decades. This study noted the following trends at the time of referral: increase in the average age of the patient, decrease in tobacco use, increase in severity of disease, increase in the average number of missing teeth, and increase in number of teeth that need to be extracted. The authors reasoned that these trends seem to indicate that lack of diagnosis, decrease in referrals due increase use of repetitive site-specific drug delivery systems, and increased extraction of teeth with a questionable prognosis.
Where have all the periodontal referrals gone?
Unfortunately, many patients that would benefit from the care of a qualified Periodontist are being denied the opportunity by their trusted dentist. The reason for this can be attributed to a movement towards limited periodontal care called soft tissue management. Soft tissue management is a nonsurgical and profitable treatment modality that includes use of systemic and local delivery antibiotics / antimicrobial (Periostat, Arestin, Perioguard, PerioChip, and Artidox). A 10 fold increase in unnecessary tooth loss is common in practices that rely heavily on repetitive and ineffective soft tissue management protocols.
How did soft tissue management start?
All dental practitioners are taught the importance of maintaining a referral-based relationship with specialist for optimal treatment of their patients. Today, a aggressive business model has replaced the traditional patient care model in order to maximize practice profitability. This is due to practice management seminars that encourage general dentist to take advantage of the financial gain of these protocols and to become a “one stop shop” without regards to patient needs.
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- Diagnosis: Deception
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