Description of a System Designed to Assist Primary Dental Care Clinicians in Decision-Making with Regard to Specialist Periodontal Referrals and Report of Two Clinical Audits using the System

The periodontal examination profile of general dentists in Nova Scotia, Canada

BACKGROUND

In this cross-sectional study we investigate the extent to which general dentists in Nova Scotia carry out periodontal examinations of their patients. In addition, factors that significantly influence performing a periodontal examination by a dentist are identified.

METHODS

A survey questionnaire was mailed to all 443 general dentists practicing in the province of Nova Scotia in the summer of 2009. The survey included questions on demographics and the various components of the periodontal examination. Simple and multiple logistic regression tests were used to analyze the results.

RESULTS

Of the 279 (63%) responses received, 272 (61%) responses were eligible to be included in the analyses. The majority of responders (94.8%) reported performing periodontal examinations of their patients. However, only 37.8% and 43.3% of the dentists reported performing full-mouth and selective probing depth measurements, respectively. Dentists who practiced in urban locations (P = 0.05), dentists whose practices were situated <5 km from a periodontist (P = 0.08), and dentists who planned to take a continuing education course in periodontal plastic surgery in the next 2 years (P = 0.07) were more likely to perform a periodontal examination.

CONCLUSIONS

Although the majority of dentists in our study report performing periodontal examinations of their patients, only a small portion report recording complete probing depth measurements or using appropriate radiographs in their examinations. These practices could lead to an underestimation of diagnosis and treatment of periodontal disease.

A retrospective study of compliance (adherence) with a care pathway in periodontal therapy in a primary care setting

OBJECTIVE

Recently the issue of patient adherence with prolonged periodontal therapy and the importance of smoking and its influence as a significant co-factor in the outcome of treatment for patients with periodontal disease has been of interest to health care professionals. This paper is an audit of adherence in regard to both smoking cessation for those who admitted to a smoking habit at the initial examination and patient compliance with a periodontal treatment protocol.

DESIGN

During the initial examination, patients referred to the practice with periodontal problems were photographed both with and without lip retractors as part of their clinical record, and a charting of the teeth made with any 5 mm or greater probing depths recorded. Tooth mobility and furcation involvement of molar teeth were also charted. Two separate time periods (Series 1 and Series 2) were audited in this study. Patients enrolled in Series 2 were routinely asked about their smoking habits at the initial examination. Two time periods were audited, as the initial purpose of the investigation was to audit the success of the practice in treating this group of patients, and to identify any improvements that could be made in care provision as each audit cycle was completed.

SETTING

Primary care setting.

RESULTS

Patient adherence rates were high through all the various stages of periodontal therapy, even though the treatment protocol took over 18 months to complete. Approximately 55% of patients in both time periods presented for the one-year post treatment re-evaluation appointments. 56.5% of the patients reported they had smoked to within five years of their initial consultation, of which 38% reported that they had stopped by the time they had completed the initial hygiene phase of treatment.

CONCLUSIONS

With a comprehensive and clearly defined supportive periodontal care programme (SPC), this paper demonstrates that high adherence levels can be achieved in a primary care setting. The results suggest that treatment should include not only the teaching of an effective oral hygiene regime, but also include giving advice in relation to smoking cessation for those patients who admit to a smoking habit at the initial examination. Patients who smoked and chose to have treatment for their periodontal condition went on to report good adherence with smoking cessation advice. Continuing supportive smoking cessation (SSC) advice should be part of any effective SPC programme. New methods of treating periodontal disease that become available to practitioners in the future should use established benchmarks against which to evaluate the success of any new treatment strategy.

An Audit of the Quality and Content of Periodontal Referrals and the Effect of Implementing Referral Criteria

Aims

This audit aimed to assess the effect of implementing referral criteria on the quality and content of referral letters sent by general dental practitioners (GDPs) to the periodontal department of a teaching hospital.

Methods

Retrospective data were collected from a total of 450 referrals made in: (i) 1997, prior to any changes; (ii) 2000/2001, after referral guidelines were implemented; and (iii) 2004/2005, after referral criteria were redefined and circulated via Primary Care Trusts. A standardised data-collection form was used to record the information that was provided in the referral letters. This information was also compared to the findings at initial hospital consultations.

Results

There was a small improvement in the administrative details provided in the referral communications in 2000/2001 and 2004/2005. Medical history was often incomplete and was mentioned in 31–34% of referral letters. Use of the Basic Periodontal Examination (BPE) score increased from 17% (1997) to 57% (2004/2005). The information on clinical details otherwise increased in 2000/2001 with a tendency to decrease in 2004/2005. There was little agreement between the clinical details in the referral communications and the findings at consultation in the periodontal department.

Conclusions

Following implementation of referral criteria, there was an increase in the clinical details provided in referral letters. However, the validity of the information provided by the GDPs was often questionable. The number of referrals that provided medical history details remained unchanged. Use of a pro forma was not associated with an improvement in the quality of referrals in this audit.