Non-clinical factors associated with referral to periodontal specialists

The referral pattern and treatment modality for peri-implant disease between periodontists and non-periodontist dentists

OBJECTIVES

This study is to investigate the referral pattern and treatment modality of dentists in the management of peri-implant diseases between periodontists and non-periodontist dentists (NPDs).

MATERIALS AND METHODS

A total of 167 validated questionnaires were obtained from periodontists and NPDs, who had experience of placing implants for at least one year. Question I to IV asked how the dentist would respond if a patient came for treatment of their peri-implant diseases with four different scenarios according to resource of patient and disease severity. For each Scenario, dentists also replied which treatment procedures they would use if they decide to treat the patient.

RESULTS

Periodontal training, resource of patient, and disease severity were shown to significantly influence the referral pattern and treatment modality in the management of peri-implant disease (p < 0.05). Periodontists were more likely to use variable treatment procedures, including occlusal adjustment (OR = 2.283, p < 0.01), oral hygiene instruction (OR = 3.751, p < 0.001), topical antiseptic agent (OR = 2.491, p < 0.005), non-surgical mechanical therapy (OR = 2.689, p < 0.001), surgical therapy (OR = 2.009, p < 0.01), and remove implant (OR = 3.486, p < 0.001) to treat peri-implant diseases, compared to NPDs.

CONCLUSION

The periodontal specialty training, resource of patient, and disease severity significantly influenced the referral pattern and treatment modality of dentist treating an implant diagnosed with peri-implant disease. This study also highlighted the importance of educating basic periodontal and peri-implant disease-related knowledge to all dentists regularly performing dental implant treatments.

CLINICAL RELEVANCE

Peri-implant diseases are highly prevalent among patients with dental implants. Periodontal specialty training could enhance using variable treatment procedures to treat peri-implant diseases for dentists.

Periodontal referral patterns in Norway: 2003 versus 2018

Objectives

Changes in periodontal referral patterns over time have been reported from the United States and Australia. To date, comparable studies have not been published from Europe. The objectives of the present study were to examine changes in periodontal referral patterns in Norway in 2003 versus 2018 and to compare these with trends observed in the United States and Australia using universal criteria for grading of periodontal severity.

Materials and methods

A retrospective analysis of 369 charts from four Norwegian periodontics clinics was completed. Data on year of referral, gender, age, tobacco smoking, periodontal status and missing teeth at initial examination, teeth planned for extraction, and periodontal case type were collected using a survey format; case type I, II, III, and IV representing increasing severity of periodontitis, case type V representing referral for other periodontal conditions (peri‐implantitis, refractory periodontitis, etc.). Chi‐square, t‐tests, and negative binomial regression were used for the statistical analysis.

Results

Compared with 2003, the 2018 data showed an increase in mean age at referral (p < 0.05), overall distribution of case type III and V (p = 0.047), and number of missing teeth (p = 0.001). Further, a decrease in prevalence of smokers (p < 0.05), but no change in number of teeth planned for extraction (p = 0.104), were observed.

Conclusions

During a period of 15 years, changes in periodontal referral patterns in Norway are similar to those in the United States and Australia. The adoption of a guideline‐based referral practice might be beneficial for both the dental profession and patients.