by Beverly Maguire, RDH
Managing periodontal disease requires a team effort. The dentist must diagnose the case, assistants are needed to gather data, and the business staff must schedule and collect for services rendered by the hygienists — the hub of the perio therapy process. This scenario, however, is incomplete. The periodontist is vital to the bigger picture. Without specialized treatment, many patients will lose teeth and suffer from chronic and systemic infection. Early to moderate cases often can be managed in the general practice, provided there is an organized and well-thought-out system for diagnosis, treatment, re-evaluation, and maintenance. And yet, we must know when to refer patients to our partners, the periodontists. That is the question — when should we refer?
In my discussions and consultations with periodontists, I continue to hear one remark: You must refer when you have reached the limitation of your ability to adequately care for the patient. What does that mean, exactly? If our initial conservative efforts have not produced stability, the case requires additional treatment and must not be simply placed in maintenance status. For the stable patient, we also must be able to consistently reassess for signs of disease activity. If such changes become apparent, it's time to refer to our periodontist. Some patients must be considered a referral prospect from the beginning. If the disease is too far advanced, it's wise to suggest a referral at the outset.
The key lies in:
- Accurate assessment of the disease process
- Realistic assessment of our own clinical abilities and limitations
- Excellent communication skills fostering maximum success in patient compliance with suggested referral and treatment
Create a responsible relationship with a periodontist based upon compatible philosophy, open communication, and trust. Trust is a factor that goes both ways. The GP must trust the periodontist to provide excellent treatment in a caring and professional manner, good communication so the patient understands treatment and expected outcomes, and monitoring of home care compliance in maintaining a successful outcome.
On the other hand, periodontists should expect to receive patients in a timely manner so they're not put into the category of "miracle worker." Sending patients too late for reasonable surgical success, or with no clue as to how they arrived in this situation is a periodontist's worst nightmare. How can they feel confident to release a surgical case back to the GP/hygienist team if there are no protocols in place for monitoring the disease process? Consistent data collection and evaluation, as well as communication between all parties involved, are the keys to success.
There is no shortage of patients needing periodontal care. Rather, there is only a shortage of adequate diagnosis and tracking systems. Both GP and hygienist should meet with several periodontists to determine a good match. Each provider should fully understand his or her role in the process and define expectations of the other. Periodontists are an excellent source of education on diagnosis skills, treatment protocols, and new products. It is up to us to take advantage of those opportunities.
Hygiene departments serve the public by managing periodontal disease. This requires a commitment to ongoing education and a strong relationship with the periodontist. A consistently excellent hygiene protocol allows the periodontist to have great confidence in releasing advanced, stable patients back to the GP for maintenance. Any new disease activity will be quickly detected and referred again. We must continue to nurture this referral relationship. If we do, we will be providing patients with all that they deserve: excellent and timely intervention in a disease process which we can manage with excellence.
Beverly Maguire, RDH, is a practicing periodontal therapist. She is president and founder of Perio Advocates, a hygiene consulting company based in Littleton, Colo. She can be reached at (303) 730-8529 or by email at [email protected].
