Referral To A Dental Specialist

Understanding why and when this may be necessary

Dear Doctor,
My family dentist has been treating me for periodontal (gum) disease for several years, but now he wants to send me to a periodontist. Can you tell me why?

Dear Derrick,
Your question is an important one because it describes what many people face in both dental and medical situations. While you've not provided specifics of your periodontal (gum) condition, it raises a number of important points.

The American Academy of Periodontology, the organization representing the specialty of periodontology (the diagnosis and treatment of disorders of the supporting structures of the teeth), broadly recognizes four categories of disease. It incorporates all known types of periodontal diseases and their complexity. Periodontal specialists spend three or more years in residency studying to become specialists in the diagnosis and management of these diseases and disorders. Therefore, if your condition is progressive your dentist may refer you to a periodontist. Some common reasons for referral include:

• Your specific type of periodontal disease as there are many varieties
• General health issues or conditions such as pregnancy or diabetes that can impact your periodontal condition
• Your level of oral cleanliness and motivation
• The frequency of your periodontal maintenance (dental cleanings)
• Progressive loss of periodontal tissue attachment to your teeth which results in either recession or pocketing
• Bite problems and loose teeth
• Referral for periodontal surgery or dental implants
• Planning future restorative treatment depending upon the fate for individual periodontally involved teeth

Most general dentists have relationships with specialists in their communities, in whom they have confidence, trust, and feel comfortable referring their patients to for treatment.

Gatekeepers Of Oral And Dental Health

All dentists, whether generalists or specialists, have a primary responsibility to hold their patients' best interests at heart, which means treating to the standard of care set by the profession. General dentists are the primary oral health gatekeepers. They generally see people first, evaluate their oral and dental health needs, and then treat or refer for specialty care depending on the conditions they assess and diagnose. Some patients present with the need for periodontal or other specialty care. General dentists have differing levels of expertise, post-graduate training, and comfort levels treating more complicated, advanced dental conditions. For this reason, most general dentists have relationships with specialists in their communities, in whom they have confidence, trust, and feel comfortable referring their patients to for treatment.

The Referral Process

The relationship you have with your general dentist together with your treatment history, are important pieces of information that when communicated to a specialist can have a significant bearing on your care. An introductory referral report from your dentist, or a personal call following the transfer of records, e.g. radiographs (x-rays), will give the periodontist an overview of your case. It should also provide information about the stage of development, treatment to date, and whether or not your disease is arrested or progressive, all of which can facilitate your treatment.

You may also be referred for specific types of treatment; a decision you really should make with your general dentist. For example, if you have a tooth which is broken to the gum line, you might need a crown lengthening surgery to expose sound tooth beneath the gum tissue to secure a crown. This is a typical surgical procedure that periodontists perform. By discussing and then making a decision with your dentist, you are best equipped to obtain your goals.

Another issue that shouldn't be overlooked is the concern that may arise with seeing a new doctor. Your first visit will give the periodontist the ability to compare the information received with his or her own assessment of your condition, as well as give you the opportunity to meet and ask questions. In the end, you should always feel cared for and that your dental health is a priority. The specialist in turn will communicate his or her findings and recommendations back to your general dentist for the two of you to review, discuss, and approve.

In Your Best Interests

The relationship between a general dentist and a dental specialist, such as a periodontist, is a close-knit bond in which the doctors work together to provide you with optimal treatment. The close working relationship between your general dentist and your periodontist should give you confidence.

I hope you find my response helpful so that you can avoid any concern that you may have regarding why a referral is necessary. Follow through with your dentist's recommendation and have a consultation with a periodontist so that you are well informed for making any decisions regarding your dental and periodontal health.