When to refer

Question 1

When should a perio eval be done

Answer 1

each visit

Question 2

When should a patient be referred? (5)

Answer 2

When there is a question regarding appropriate therapy

Indicated treatment procedure not routinely
performed by the general dentist

When the disease is advanced with severe bone loss

Complex multidisciplinary cases

Refractory or unstable cases. Medically
compromised patients

Question 3

Are general dentist required to diagnose all perio condtions?

Answer 3

Yes, legally

Question 4

____ %of adult patients in GP offices have

Gingivitis or Periodontitis.

Answer 4

90% of all adult patients in GP offices have gingavitis or Periodontitis

Question 5

Treatment responsibilities of GP (sequence of perio screening and beyond)

(7)

Answer 5

Screen –> treatment plan –> patient instruction –> non-surgical perio treatment –> re-eval (4-6 wks) –> perio surgical treatment –> perio recal

Question 6

re-eval period after SRP

Answer 6

4-6wks

Question 7

Non-surgical Perio Treatment includes (6)

Answer 7

 Patient education of etiological factors

 Caries removal, physiological restorations

 Faulty restorations

 Occlusal modifications

 Antibiotic therapy

 Scaling and Root planing

Question 8

Advanced surgical treatment (6)

Answer 8

Full mouth flap procedures with furcation involvement, osseous resective procedure

Guided bone regeneration (GBR

Guided tissue regeneration (GTR)

Soft tissue/plastic surgery-CTG, FGG, Frenectomy

Implants

Sinus lift procedures, nerve repositioning

Question 9

Etiology of perio disease

Answer 9

plaque

Question 10

Advanced Perio diseases (3)

Answer 10

Aggressive periodontitis patient

Advanced surgical treatment

Progressive/refractory periodontal patient

Question 11

Someone with good health but a loss in bone

Answer 11

Agressive perio

Question 12

Benefits of the Referral

Answer 12

Share the treatment responsibility and receive help for complex cases

Request specific procedures that you could not do

Consult on the retreatment planning

Enhance restorative opportunities and make them less difficult

Form a communications network or team for future cases (e.g. implants)

Question 13

Timing of referral

name the 5 phases in which you refer at

Answer 13

Diagnosis

Reevaluation (determine prognosis)

Maintenance

Corrective Phase Treatment

Restoration Phase Treatment

Question 14

Referral is done after one of what three things?

Answer 14

After the first visit, first SRP, or first Re-eval

Question 15

Clinical Scenario from Lecture— Periodontal Surgery is indicated because this patient has returned for a _______ following NSPT (assuming we are following the referral flow chart) and they still present with ____ probing depths, tissue shrinkage, and BoP.

Answer 15

Returned for a re-eval, meaning you can now refer….

Probing depths of equal or more than 5mm

Question 16

Principle of the SAC Surgical classification

Explain what this is for?

Answer 16

Straightforward
Advanced
Complex

This is for progression of doing implants

Question 17

Who is SAC by?

Answer 17

ITI

Question 18

Advanced of SAC

Answer 18

in anterior, thinner tissue, esthetic demands

Question 19

Simple/Straight-forward (SAC)

Answer 19

Post, easier and no esthetic problems

Question 20

Complex (SAC)

Answer 20

 The surgical process is anticipated to be
complicated
 Proximity to important anatomical structures
 Surgical demands on the clinician and staff are
high
 There is a high risk of surgical complications
 There is a high esthetic risk

Question 21

Referral Guide 3 levels of communication

Answer 21

Level 3: Pts who should be treated by a
periodontist

Level 2: Pts who would likely benefits from
treatment by a periodontist

Level 1: Pts who may benefit from
comanagement by GP and periodontist

Question 22

Level 3 patients include who

Answer 22

Those who should be treated by periodontist…

• Severe chronic periodontitis
• Furcation
• Vertical/angular defects
• Abscess
• Significant root exposure

Question 23

Level 2 who would likely benefit from treatment by a periodontist

Answer 23

At re-eval, patient has..

Early onset perio disease (<35 years, not necessary
aggressive periodontitis)

Unresolved inflammation at any sites

PPD ≥ 5 mm

Vertical bone defects

Radiographic evidence of progressive bone loss

Progressive tooth mobility

Progressive attachment loss

Anatomic gingival deformities

Exposed root surfaces

A deteriorating risk profile

Medical or behavioral risk factors/indicators
 smoking/ tobacco use
 Diabetes
 Osteoporosis/ osteopenia
 Drug-induced gingival conditions
 Compromised immune system
 A deteriorating risk profile

Question 24

Level one-co managment

Answer 24

Any pt with periodontal inflammation & any of the
following:
 Diabetes  Pregnancy  Cardiovascular disease  Chronic respiratory disease
 Any pt who is a candidate for the following who might be
exposed to risk from perio infection
 Cancer therapy
 Cardiovascular surgery
 Joint-replacement surgery
 Organ transplant