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| A. Reasons for making a Periodontal Referral for your Patients |
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Periodontal Services
We offer a full range of periodontal services including non-surgical and surgical periodontal therapy. Examples of cases you may consider referring are:
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Periodontitis and Peri-implant Disease
Severe Chronic Periodontitis
Furcation Involvements
Vertical/Angular Bony Defects
Aggressive Periodontitis
Periodontal Abscess or acute periodontal conditions
Peri-implant Disease
Regeneration, in certain periodontal defects ‘regeneration’ of the lost periodontal support may be possible through use of regenerative materials.
Any patient with periodontal disease, regardless of severity, whom the referring dentist prefers not to treat.
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Crown-lengthening Procedures
Indications for crown lengthening include:
• Insufficient coronal tooth structure for provision of a crown
• Subgingival margins on a crown preparation or a complex or difficult subgingival restoration
• Unaesthetic gingival contour
• Excess gingiva
Crown lengthening can solve these clinical presentations and allow for the provision of definitive treatment, be it a single tooth or a more complex case.
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Root Coverage Procedures
The management of gingival recessions through the use of autogenous soft tissue grafting procedures. |
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Extractions - Site Preservation and Grafting Procedures
Atraumatic extraction and grafting where indicted to preserve bone for future implant placement. |
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| Frenectomies |
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| Implant referral: Full implant placement and restoration. |
| Cases will be jointly assessed, planned and managed between Prosthodontic, Periodontal and Oral Surgical specialties utilizing the latest diagnostic, radiographic and scanning methods (where indicated). Our goal is to provide the optimum result for your patient in terms of function and aesthetics. Surgical placement only service is also available. |
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Patient Management Options
• We offer patients IV sedation in the Beacon Dental Clinic, delivered by a consultant anesthetist.
• We have admitting privileges to UPMC Beacon Hospital facilitating patient care under general anesthetic.
• A full UPMC Hospital laboratory service is on site to facilitate same day patient INR assessments prior to any procedure, where indicated.
• Cross specialty medical referral service within the Beacon Consultants Clinic for any patient profile assessment and prophylaxis requirements.
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| B. Guidelines for Periodontal Referral (American Academy of Periodontology) |
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The following Guidelines are provided to assist in the timely identification of patients who would benefit from co-management and the unique partnership between a periodontist and referring dentist.
(An explanation of terms is included as part of these Guidelines, and research supporting the content of the Guidelines is available on the American Academy of Periodontology’s Web site at http://www.perio. org.)
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The objective is to encourage referring dentists and periodontists to work together to optimise the health of patients. Determining if and when a patient should be referred to a periodontist are sometimes difficult issues.
These Guidelines are intended to help the general practitioner in the rapid identification of those patients at greater risk for the consequences of periodontal inflammation and infection and, therefore, those patients most appropriate for specialty referral.
They are presented in order of severity 3-2-1, category 3 patients being the most severe.
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| LEVEL 3: PATIENTS WHO SHOULD BE TREATED BY A PERIODONTIST | | | Any patient with:
Severe chronic periodontitis Furcation involvement Vertical/angular bony defect(s) Aggressive periodontitis (formerly known as juvenile, early-onset, or rapidly progressive periodontitis) Periodontal abscess and other acute periodontal conditions Significant root surface exposure and/or pro-
Aggressive gingival recession Peri-implant disease
Any patient with periodontal diseases, regardless of severity, whom the referring dentist prefers not to treat.
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| | LEVEL 2: PATIENTS WHO WOULD LIKELY BENEFIT FROM COMANAGEMENT BY THE REFERRING DENTIST AND THE PERIODONTIST | | | Any patient with periodontitis who demonstrates at reevaluation or any dental examination one or more of the following risk factors/indicators* known to contribute to the progression of periodontal diseases:
Periodontal Risk Factors/Indicators
Early onset of periodontal diseases (prior to the age of 35 years)
Unresolved inflammation at any site (e.g., bleeding upon probing, pus, and/or redness) | | | * It should be noted that a combination of two or more of these risk factors/ indicators may make even slight to moderate periodontitis particularly difficult to manage (e.g., a patient under 35 years of age who smokes).
Report
Pocket depths ‡ 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 (e.g., phenytoins, calcium channel blockers, immunosuppressants, and long-term systemic steroids) Compromised immune system, either acquired or drug induced A deteriorating risk profile
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| | LEVEL 1: PATIENTS WHO MAY BENEFIT FROM CO-MANAGEMENT BY THE REFERRING DENTIST AND THE PERIODONTIST | | | Any patient with periodontal inflammation/infection and the following systemic conditions:
Diabetes Pregnancy Cardiovascular disease Chronic respiratory disease
Any patient who is a candidate for the following therapies who might be exposed to risk from periodontal infection, including but not limited to the following treatments:
Cancer therapy
Cardiovascular surgery
Joint-replacement surgery
Organ transplantation
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