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The periodontal pathway for successful referrals

July 1, 2006
If you work in a general dental practice, you will most certainly be dealing with periodontal disease to some extent.
Click here to enlarge image

If you work in a general dental practice, you will most certainly be dealing with periodontal disease to some extent. Do you ever wonder, “What would the doctor prefer that I do in this case?” Well, there IS an answer. But first you must establish the proper pathway to know why, when, and how to refer those perio cases to the periodontist.

In today’s fast-paced, high-tech dental offices, there seems to be an unspoken process for just about every task. The schedule is computerized with standard steps taken for every appointment. The radiographs are taken and developed in the normal sequence. Crown preps are also a patterned procedure. These routines are simply understood practices among the dental team.

But in the dental hygiene department, sometimes questions arise concerning the course of action necessary for periodontal patients. The doctor is not always available on short notice for advice about periodontal cases. Consequently, the dental hygienist is left to wonder, “What would the doctor prefer that I do in this case?”

The strategy for simplifying this dilemma is to have a plan for referring periodontal cases to the periodontist. Though this may seem elementary, reviewing the details for a referral program is crucial for the sake of being consistent.

Where do you begin in making the periodontal referral decision? The answer is not written in stone; it truly depends on the comfort level of the dental hygienist as well as the dentist. This “comfort zone” can vary from hygienist to hygienist, so communication with your dental team is a high priority when establishing a periodontal referral program.

Are the other dental hygienists on board?

Logically, it is relevant to include other dental hygienists who work in the practice as active participants in any idea that may be implemented into the hygiene department. Acceptance from other hygienists will be essential for a positive outcome.

On the other hand, resistance will most likely influence the breakdown of attaining the desired goal. Be prepared to validate the necessity of setting referral guidelines prior to approaching other hygienists in the practice. However, creating these guidelines should be an easy task to achieve.

What periodontal pocket depth am I comfortable treating?

Let’s face it; some dental hygienists would rather not treat any periodontitis. That’s OK if you work in a pediatric dental office. But if you work in a general dental practice, rest assured that you will be dealing with periodontal disease to some degree.

If you are “wired” to treat periodontitis, establish to what degree. For example, determine that the hygiene department will treat periodontal disease with pocket depths up to 6 mm, but no more than three 6 mm pockets per quadrant. The success of your patient’s periodontal treatment will depend on your ability to treat periodontal disease within your own limitations.

The “comfort zone” of the other hygienists in the practice should also be considered in the implementation of a periodontal referral program. Have a clear understanding of their periodontal expertise. Examine and compare the comfort zones of all dental hygienists. Bear in mind the results of this “comfort zone” assessment among the dental hygienists when deliberating on the referral measurements for periodontal patients.

Which health history complications am I comfortable treating?

The patient’s medical conditions can also play a role in determining where to draw the line in treating periodontal disease. The majority of periodontal patients have at least one of the following conditions: cardiovascular disease, high blood pressure, or diabetes. The latest research confirms the relationship between heart disease, preterm low-birth-weight babies, and diabetes. There is also research on C-reactive protein and its effects on inflammation in the body which can be caused by periodontal disease. Treating these and other health disorders can complicate periodontal treatment.

Also take into account which medications a patient is taking. There are hundreds of drugs that are being prescribed today. It is not uncommon for a patient to be taking three or more prescribed medications. It is not easy to keep track of the medicines that pose side effects in the oral cavity. In the interest of your patients who are taking several medications, the outcome of treatment may pivot on your knowledge of these drugs.

Remaining current on the latest research can be a challenge. However, knowing what you are dealing with is vital in successfully treating compromised periodontal patients. A compromised health history or numerous medications may be an indicator for a periodontal referral.

Will the dentist be supportive of a periodontal referral program?

Discuss with the dentist your desire to establish a periodontal referral system in the hygiene department. It is key that the dentist understands and agrees with your boundaries of treating difficult periodontal cases.

Most likely, the dentist will be very supportive and appreciative of your assertiveness to incorporate a “plan of action” to treat the more complicated periodontal patients. With the support of the dentist, this approach can set a standard of care in your office for the treatment of periodontal disease and benefit the overall health of your patients.

Has the patient been informed properly?

How something is said can lead the patient either to commitment or confusion. Make sure the patient knows that he/she has periodontal disease and understands what it is. “Some bleeding” or “swollen gums” is not an accurate diagnosis. Use your hand mirror to show the patient the bleeding when you probe as well as the difference between healthy gums vs. unhealthy gums. Patients who are knowledgeable about their condition will most likely take action.

Is communication consistent throughout the office?

A breakdown in communication among the staff will lead to an undesirable outcome. Assuming that the staff knows the ropes is a huge mistake. Cover all the bases to prevent a mix-up.

Make sure that the entire team, including the front-desk staff, is aware of what periodontal disease is and how it is treated. Implement a system for effective communication between staff members and the patient. A staff meeting may be necessary to review the process of proper periodontal verbiage that should take place between the staff and the patient. This will help ensure a smooth transition for the patient from the general practice into the periodontal office.

Does the periodontist have the same beliefs about treatment?

If the dentist is not familiar with the periodontist, it is a good idea to organize a meeting of the minds between the two. Make sure the dentist is informed about treatment the periodontist will recommend. Remember, the people you are referring are still your patients and should be treated in a manner similar to the general dentist’s point of view.

Confirming that the treatment your patients will receive is satisfactory according to your beliefs and standards is essential. For example, if your dental office believes in using locally administered antibiotics and the periodontist you are referring to does not incorporate this conservative treatment in his/her practice, it may be necessary to shop around for a periodontist with similar opinions.

Will the patient accept referral?

As dental professionals, we know that patients have a fear of the unknown. Informing your patients about what to expect at the periodontal office will result in a pleasant transition. Revealing your confidence in the periodontist’s care will help promote treatment acceptance among referred patients. Your patients will appreciate your knowledge of the periodontal procedures that they will receive at the periodontal office. Your trust in the periodontist will certainly contribute to decreasing the patient’s apprehension.

Making the appointment for the patient is one way of being assured that the patient makes a consultation appointment with the periodontist. Relay to the patient any necessary information that he/she should take along with a paper referral, including the appointment date and time. Now you can breathe comfortably and give yourself a pat on the back for a job well done!

What is our role after the referral?

Now that your patient has taken action against periodontal disease through the care of the periodontist, how does the referring dentist fit into the picture? Sometimes we tend to forget that these referred patients are still our responsibility. After referral to the periodontist, it could be a year or more before the patient begins to alternate maintenance visits between the two offices. Inquire with the periodontal office about the method it uses for communication with the referring dentist.

It’s always a good idea to share radiographs between the offices. Of course, the general dentist should check incoming radiographs for possible decay. If the patient is seeing the periodontist for regular treatment, it is advisable to schedule the patient with the general dentist for a short appointment once a year to check for decay.

Although it may seem routine to refer a patient to a periodontist, there are many factors that must be analyzed. Through the application of proper diagnosis and effective communication in the dental office, the pathway of referring dental patients to the periodontist will be successful. Before you know it, the referral procedure will become second nature to each dental team member. Also, the dental hygiene department will operate more efficiently and without reservations about in-office treatment vs. periodontal referral.