*02/03 - Dentist and Periodontist

Question 1

What are a dentist’s responsibilities?

Answer 1

• diagnose the disease
• inform the patient of a diagnosis of disease
• inform the patient of the availability of treatment
• inform the patient of the limitations of various treatment modalities
• inform the patient of the consequences of not receiving treatment

Question 2

What often occurs when a clinician is reluctant to refer?

Answer 2

• clinician attempts to maintain patient’s periodontal status with non-surgical therapy
• lack of documentation for furcation involvements or periodontal pockets

*many clinicians continue to treat a progressive loss of attachment or worsening furcation involvement using the same techniques prescribed for early, less severe disease

Question 3

True or false: There is not one type of periodontal disease. Thus, there is not one type of treatment for periodontal disease.”

Answer 3

true

Question 4

True or false: Several software programs are available to help general dentists in decisions for making referrals.

Answer 4

true

Question 5

What are some reasons you should refer out?

Answer 5

• most appropriate treatment for patient
• unable to perform procedure in the office
• improved patient experience
• treatment efficiency in office
• overhead cost of specialty procedure

Question 6

What are some reasons you should not refer out?

Answer 6

• cost of specialty work for patient (value of treatment and understanding ideal treatment)
• patient comfort in GP office
• enjoyment and mastery of specialty procedure (must be performed at the level of the specialist)

Question 7

What are some characteristics of the ideal referral?

Answer 7

• good patient care/skill (board certification)
• good patient experience
• timely care
• good communication (treatment letter, email)
• always available (emergencies)
• good case acceptance

Question 8

What are the most common perio referrals?

Answer 8

• periodontitis
• mucogingival deformities
• pathologic conditions
• dental implants
• tooth exposures
• crown lengthening

Question 9

When should you refer a patient that has chronic periodontitis?

Answer 9

• at initial exam, there is generalized or localized severe case (over 30% bone loss, initial pocket depths greater than 6 mm)
• following SRP if remaining pockets are 5+ mm or if no resolution in gingival inflammation

Question 10

Why should you refer a 5 mm PD after SRP?

Answer 10

• inability for patient to provide adequate home care
• inability to remove majority of calculus non-surgically
• continued attachment loss in 5+ mm pocket depths even with good home care and compliance

Question 11

Why is surgical therapy performed?

Answer 11

• access to root surfaces
• access to bony defects (recontour, regenerate)
• reduction in future attachment loss and tooth loss (diligent with home care; compliant with periodontal maintenance visits)

Question 12

What does periodontal maintenance consist of?

Answer 12

6 month exam alternating between the periodontitis and GP

Question 13

What mucogingival deformities are often referred?

Answer 13

• gingival recession
• lack of keratinized tissue
• gingival excess/crown lengthening
• aberrant frenum

Question 14

Why do we treat gingival recession?

Answer 14

• esthetics
• sensitivity
• progressive (every year it gets worse)
• lack of keratinized/attached tissue with gingival inflammation

Question 15

In terms of pathologic finds, what is the bottom line?

Answer 15

• be able to distinguish normal from abnormal
• understand possible etiology
• identify differential diagnosis
• standard of care is surgical biopsy

Question 16

What are the reasons for implant-related referrals?

Answer 16

• extraction/socket preservation
• ridge augmentation
• sinus augmentation
• peri-implantitis

Question 17

What is socket preservation?

Answer 17

• performed in preparation for implant placement
• “preserves” alveolar ridge height and width
• 3-6 month healing period before implants