I have been practicing dental hygiene since 1968, and have worked in public health and in general and periodontal practices since 1980. I agree 100 percent with the American Academy of Periodontology’s guidelines. Why are the periodontists and general dentists quibbling over the 5 mm pocket? If after RPS, the patient still has 5 mm with bleeding (4 mm on the buccal or lingual of a molar is already into the furcation whether or not it is evident on the radiograph), visible bone loss on the radiographs, recession with a narrow band of attached tissue, then they should see the periodontist!
Why would a dentist risk being responsible for premature tooth loss because of negligence? The dentists that I have come in contact with that do not send patients to the periodontist are the ones that do not want any other dentists seeing their poor dentistry.
The article listed several reasons that dentists do not refer to periodontists. As far as the statement that “the patient is never released back to the care of the general practitioner,” what periodontist in his right mind could forget that his practice depends on continual referrals. I haven’t heard this statement in over 20 years. (In the mid-1980s I worked for a periodontist in Virginia as a temp. The periodontist insisted on doing all of the perio maintenence every three months and did not encourage the patients to return to their general dentist.)
All periodontists that I know encourage the patient to return. You also say that another complaint is that the “specialist makes disparaging remarks about the quality of dentistry received in the referring doctor’s office.” I haven’t heard this one in years either! Patients are not stupid. Many times they come to realize for one reason or another that they have not been getting quality dentistry and make the decision to find another general dentist.
I suppose that I just happen to work for a good dentist who appreciates that I know more about periodontal disease that he does.
Giovanna Becker, RDH
Charleston, South Carolina
Editor’s Note: The author of the article referred to above (which appeared in the January 2007 issue of RDH) was Dianne Glasscoe, RDH. She offers this response: “Giovanna, thank you for your thoughtful comments. I think the ‘sticking point’ centers on the AAP position that the general office should not attempt to treat the 5mm pocket at all, but rather, refer. At least that’s what many general dentists took the guidelines to mean. My opinion is that the hygienist in the general practice is equipped to treat and manage most 5 mm pocket situations, which usually reduce after thorough debridement. I agree that any recalcitrant pocket that fails to heal or achieve resolution after treatment in the general practice needs to be referred.”