|Year : 2016 | Volume
| Issue : 1 | Page : 42-44
Referral to a periodontist by a general dentist: An understanding of the referral process
Ashok Kumar Bhati
Division of Periodontics, College of Dentistry, Jazan University, Jizan, Saudi Arabia
|Date of Web Publication||12-Apr-2016|
Ashok Kumar Bhati
Division of Periodontics, College of Dentistry, Jazan University, Jizan
Source of Support: None, Conflict of Interest: None
Periodontal disease is one of the most common health care problems. The type of treatment of periodontal disease depends on the diagnosis. The treatment plan should also focus on managing the risk factors and modifying factors which affect the periodontal disease and treatment. The evidence-based advancements have given a success predictability level to the periodontal diagnosis and treatment plan. The level of specialty education is limited in the curriculum for undergraduates. Patients should receive the same quality of treatment whether administered by a specialist or general practitioner. Therefore, general dentists need to be well informed about how to make timely and appropriate referrals to periodontists when necessary. An online literature search was done through PubMed, PMC, and open access journals to understand the referral process. Articles pertaining to referral process were selected. Based on the search, it was found that knowledge of elements of the referral process, conditions (general and periodontal) requiring referral, and selection of periodontist are important aspects of the referral process. This short communication will help the general dentist to understand the referral process that will enable them to provide the timely periodontal referral and treatment to the patients.
Keywords: Communication, multidisciplinary approach, periodontist, referral
|How to cite this article:|
Bhati AK. Referral to a periodontist by a general dentist: An understanding of the referral process. J Dent Res Rev 2016;3:42-4
|How to cite this URL:|
Bhati AK. Referral to a periodontist by a general dentist: An understanding of the referral process. J Dent Res Rev [serial online] 2016 [cited 2019 Jul 16];3:42-4. Available from: http://www.jdrr.org/text.asp?2016/3/1/42/180120
| Introduction|| |
Periodontal disease is a common disease worldwide. The type of treatment of periodontal disease depends on the diagnosis. The treatment plan should also focus on managing the risk factors and modifying factors which affect the periodontal disease and treatment. Untreated periodontal infections can adversely affect general health, and other diseases can contribute to periodontal pathogenesis.  Furthermore, untreated periodontitis may be a risk factor for myocardial infarction, nonhemorrhagic strokes, and adverse birth outcomes. The advancements have given a success predictability level to periodontal diagnosis and treatment plan. The level of specialty education is limited for undergraduates. Therefore, dentists should know how to make timely and appropriate referrals to periodontists when required.
| Why There is a Need for Referral to a Periodontist from a General Dentist|| |
The specialty of periodontology is growing in diverse aspects. Dentists may perform periodontal treatment as long as they perform it to a level of a specialist. Without proper education and training, the dentist may be doing harm to the patient by neglecting the principles of ethics.  The dentist, who declines to make a referral, and perform the needed procedure or treatment, will be held to the specialist's standard of care. Dentists need to be aware that negligence not only is defined by acts of commission but also includes acts of omission. The dentist must ask him/herself the following questions:
- Is the treatment beyond my capability?
- Is the level of complications high, and can I treat those complications?
- Can I capably perform the procedure? Do I have the proper training and experience?
- Is the patient comfortable with my performing the procedure?
| Elements of Referral Process|| |
Whenever referring a patient to a specialist, a proper communication should be there. Poor communication between primary and secondary care providers is an issue of concern. Huycke and Huycke interviewed 500 patients who filed lawsuits and found that 55% listed a poor relationship with doctor as the precipitating factor in their reason to seek legal representation. 
The following elements of referral should be considered during the referral process: 
- Communication from the dentist to the specialist
- Communication from the dentist to the patient
- Communication from the specialist to the patient
- Prereferral communication between dentist and specialist
- Postreferral communication between the specialist and the referring dentist.
| Possible Referral Situations or Conditions|| |
Referrals to periodontists may not be based on uniform standards. Some general dentists may not be aware of when to refer certain cases. Various factors existed among general dentists in relation to the periodontal referral patterns for advice and treatment. 
- General factors
- Level of dental education
- Expertise in specialist procedures
- Severity of the disease
- Complexity of the treatment
- Associated significant medical conditions
- Increase number of patients in practice
- Requirement of particular instruments and materials for the treatment
- Staff expertise in handling the patients requiring specialized procedure
- Patient satisfaction
- Any behavioral issues of the patients requiring management by specialists
- Desire to share responsibility for patient care
- Location of the specialist or consultant dental office.
- Specific periodontal conditions
Specific periodontal conditions to consider for referral to a periodontist include: 
- Scaling and root planning in severe cases or cases associated with any medical conditions
- Gingival hyperplasia
- Resective surgery
- Regenerative procedures
- Periodontal plastic surgery
- Occlusal therapy
- Preprosthetic surgery
- Dental implants
- Management of perio-systemic complications
- Phobic patients requiring conscious sedation etc.
| Selection of Correct Periodontist and Referring Dentist (Referring Dentist - Periodontist Relationship)|| |
The patient's welfare is the primary concern in determining when consultation with a specialist is indicated. A visit to the office to observe treatment may be helpful. Park et al. 2011 showed that "technical competence" was the main criteria in choosing a specific periodontist.  Communication through consult and treatment letters, phone calls, and E-mails by the periodontist to the General practitioner ensures the basic tenant of the referral relationship: Shared treatment. The specialists clinical efficiency was considered as the main factor in selecting the specialist or consultant for referring the patients to them.
| Factors Preventing the Referral to a Periodontist from a General Dentist|| |
Inspite of the guidelines for the referral process, still many dentists do not refer the patients to the specialist. Various studies have mentioned possible reasons for not referring the patients to a specialist which includes: ,
- Education loan: Graduates with higher debt they keep more patients in their practices rather than referral
- Solo dental practice: Dentists who practiced with other dentist were found to be twice as likely to refer more frequently than solo practitioners or dentists in larger group practices
- Number of hygienists: Dentists employing more hygienists are likely to refer more patients than those with fewer hygienists
- Low-treatment cost: A patient requiring certain procedures who typically would be referred to a specialist may request the dentist to complete the care because the fees of nonspecialists are lower than those of specialists
- Distances: Long distance to referral centers is a barrier to specialist referral
- Poor communication between primary and secondary provider.
| Conclusion|| |
Dentists are obligated to exert reasonable efforts to preserve dental health. They should understand their role in patient motivation and construct a proper recall protocol.  Dentists should identify the patients with periodontal needs and refer them to a periodontist in the appropriate, timely manner of the disease process.  They should also know the importance of periodontist in both multidisciplinary dentistry and Phase-I treatment. Dental educators have to consider how future dentists should be educated about making appropriate periodontal treatment decisions and referring periodontal patients in a timely manner.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Armitage GC, Robertson PB. The biology, prevention, diagnosis and treatment of periodontal diseases: Scientific advances in the United States. J Am Dent Assoc 2009;140 Suppl 1:36S-43S.
Association Principles of Ethics and Code American Dental Association. American Dental of Professional Conduct, with Official Advisory Opinions Revised to January, 2010. Chicago: American Dental Association; 2010.
Huycke LI, Huycke MM. Characteristics of potential plaintiffs in malpractice litigation. Ann Intern Med 1994;120:792-8.
Sweeting LA, Davis K, Cobb CM. Periodontal Treatment Protocol (PTP) for the general dental practice. J Dent Hyg 2008;82 Suppl 3:16-26.
Park CH, Thomas MV, Branscum AJ, Harrison E, Al-Sabbagh M. Factors influencing the periodontal referral process. J Periodontol 2011;82:1288-94.
Cobb CM, Carrara A, El-Annan E, Youngblood LA, Becker BE, Becker W, et al.
Periodontal referral patterns, 1980 versus 2000: A preliminary study. J Periodontol 2003;74:1470-4.
Zemanovich MR, Bogacki RE, Abbott DM, Maynard JG Jr., Lanning SK. Demographic variables affecting patient referrals from general practice dentists to periodontists. J Periodontol 2006;77:341-9.
Linden GJ. Variation in periodontal referral by general dental practitioners. J Clin Periodontol 1998;25:655-61.
Michael KM. A Referral-based periodontal practice - Yesterday, today, and tomorrow. J Periodontol 2003;74:1542-4.