Factors influencing the periodontal referral process

Factors influencing intraoperative and postoperative complication occurrence: A series of 1135 periodontal and implant-related surgeries

OBJECTIVES

In periodontology, it is widely recognized that evidence characterizing the incidence and effect of treatment complications is lacking. The objective of this study was to assess the influence of operator-, procedure-, patient-, and site-associated factors on intraoperative and postoperative complication occurrence.

MATERIAL AND METHODS

A single investigator reviewed records of patients treated by eight periodontics residents from July 2018 through June 2022. For each procedure, the investigator recorded each intraoperative and postoperative complication or indicated that no complication had occurred. These outcomes were analyzed against a panel of explanatory covariates. In addition, the severity of each postoperative complication was assessed using a standardized grading system.

RESULTS

A total of 1135 procedures were included in the analysis. Intraoperative and postoperative complications were identified in 2.8% and 15.2% of procedures, respectively. The most common intraoperative complications were Schneiderian membrane perforation (1.3%) and gingival flap perforation/tear (1%), and the most common postoperative complications were dentin hypersensitivity (2.6%), excessive pain (2.5%), and infection (2.2%). Subepithelial connective tissue graft (odds ratio [OR]: 3.2, 95% confidence interval [CI]: 1.6, 6.1; p < .001), guided bone regeneration (OR: 3.0, 95% CI: 1.4, 6.5; p = .004), and guided bone regeneration with implant placement (OR: 3.1, 95% CI: 1.3, 7.6; p = .011) were associated with higher odds of postoperative complication, whereas lateral sinus elevation (OR: 102.5, 95% CI: 12.3, 852.9; p < .001), transalveolar sinus elevation (OR: 22.4, 95% CI: 2.2, 224.5; p = .008), open flap debridement (OR: 36.4, 95% CI: 3.0, 440.7; p = .005), and surgically facilitated orthodontic therapy (OR: 20.5, 95% CI: 1.2, 358.4; p = .039) were associated with higher odds of intraoperative complication occurrence.

CONCLUSIONS

Consistent with previous reports, procedure type appears to be the predominant factor driving complication occurrence. As analyses of treatment complications increase, individualized risk-benefit assessments will become progressively meaningful for patients.

Periodontal diagnosis, treatment, and referral patterns of general dental practitioners

AIM

The aim of the present study was to investigate the diagnosis, treatment, and referral patterns of periodontal patients by general dental practitioners (GDP).

METHODS

A questionnaire was mailed to registered GDP with publicly-listed postal addresses in Tasmania, Australia. Information was collected on demographics, training and professional development, examination, diagnosis and referral patterns, and periodontal treatment patterns.

RESULTS

Seventy-seven (44.5%) questionnaires were completed. Over 85% always or usually screened for periodontal disease. On average, 0 to ≤7 patients were diagnosed with periodontal disease. GDP were always or usually confident in treating gingivitis (100%), mild (98.7%) and moderate periodontitis (73.7%), and rarely or never confident in treating severe (81.6%) and aggressive periodontitis (86.8%). Over 38% frequently referred to periodontists, 35.5% sometimes, 21.1% rarely, and 5.3% never. Clinical factors associated with referral were periodontal pocketing of ≥6 mm, tooth mobility, no improvement following treatment, and a complex medical history.

CONCLUSIONS

Most GDP performed periodontal screening and diagnosis. They were confident in treating gingivitis and mild-to-moderate periodontitis. Referral to a periodontist was associated with disease severity, tooth mobility, a complex medical history, or unsuccessful treatment.

Non-clinical factors associated with referral to periodontal specialists

BACKGROUND

There is a limited body of literature exploring referral relationships between general dental practitioners and periodontists. Clinical and non-clinical factors associated with the referral process are rarely considered however a better understanding of these will improve the general dentist practitioner and periodontal specialist relationship and benefit patient management. This study investigated which non-clinical factors have an association with the referral of patients by general dental practitioners to periodontists in Tasmania, Australia.

METHODS

A questionnaire was emailed to registered general dental practitioners in Tasmania, Australia and information collected on demographics, referral patterns, and potential factors which may influence referral.

RESULTS

Response rate was 44.5%. Non-clinical factors that influenced referral were previous treatment by a periodontist (70.8%), a complex medical history (56.8%), the patient's reluctance to undergo periodontal treatment, medico-legal reasons, patient awareness of periodontal disease (47.3%), and lack of training (43.2%). Patients frequently declined periodontal referral due to cost (66.2%), oral health not being a priority (55.4%), or inconvenience (46.6%). The most important periodontist qualities were their reputation (84.0%), patient feedback (81.3%), ease of communication (72.0%), report quality (68.0%), and location (62.7%).

CONCLUSION

Non-clinical factors, such as practice type-, general dental practitioner-, patient-, periodontist-related factors are associated with referral by general dental practitioners to periodontists for periodontal management.

Factors affecting periodontal disease referral and the adherence to guidelines among general dentists

BACKGROUND

Current research highlights a need to investigate the factors affecting periodontal disease referral. Limited literature exists on periodontal disease referral in Australia and no comparison to the periodontal disease referral guidelines exists.

OBJECTIVE

This study analyses the factors affecting periodontal disease referral and the adherence to guidelines in general dentists in Queensland, Australia.

METHODS

Fifty-seven general dentists who are members of the Australian Dental Association (Queensland) undertook an online survey.

RESULTS

The disease factor regarded as most important (90% of respondents) was unresolved inflammation upon re-evaluation. The non-disease factor regarded as most important (79% of respondents) was the operator's level of training. There is low awareness of the guidelines (36.7%) yet a reasonable adherence to them (78.3%). Of those aware of the guidelines, there was a statistically significant poorer adherence to the guidelines compared to those unaware (P = 0.036), while there is no significant difference in the adherence to guidelines between those who have and those who have not attended continuing professional development (CPD) courses (P = 0.66).

CONCLUSIONS

Adherence to current guidelines is not significantly impacted by the level of awareness of the guidelines or CPD attendance. The results from this study suggest a need to refine the current guidelines to better inform decisions about periodontal disease referrals.

Non-Clinical Factors Associated With Referrals to Periodontal Specialists: A Systematic Review

BACKGROUND

Comprehensive understanding of the referral process and factors associated with it will assist general dentist (GD)-periodontist relationships and benefit patient care and services. Non-clinical factors (NCFs) influence clinical decision making but are rarely considered. The objective of this review is to identify NCFs found to be associated with referrals to periodontal specialists.

METHODS

A systematic review of English-language literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An electronic search was carried out using the Cumulative Index to Nursing and Allied Health Literature, Dentistry and Oral Sciences Sources, and PubMed. Search terms used included: 1) refer; 2) referral; 3) periodontal; and 4) periodontist. Potentially relevant publications were analyzed in detail using predetermined inclusion and exclusion criteria. Selected papers were assessed using the Mixed Methods Appraisal Tool, and data extracted were thematically synthesized.

RESULTS

Ten studies that examined NCFs fulfilled inclusion criteria. Four NCF themes identified were practice-, GD-, patient-, and periodontist-related factors.

CONCLUSIONS

Limited literature is available on NCFs associated with referrals to periodontal specialists. Within the limits of this systematic review, NCFs affecting the referral process are practice-, GD-, patient-, and periodontist-related factors. These vary among different GD populations studied. Factors that could be targeted to improve referral processes include geographic location, undergraduate training, and continuing professional development.