Periodontal Referral

According to American Academy of Periodontology, “Periodontics is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes; the replacement of lost teeth and supporting structures by regeneration, tissue engineering, implantation of natural and/or synthetic devices and materials; and the maintenance of the health, function and esthetics of these tissues and structures.” Healthy periodontal tissues are essential to overall dental health. Therefore, the detection and management of periodontal disease is an integral part of general dental practice.1 In contrast to an expected increase in demand for periodontal services with aging of the population, it appears that referrals to periodontists are declining.2 The curriculum for undergraduates being limited, the general dental practitioner may not be able to completely treat periodontal diseases as desired3 and they need to be guided about when to refer a patient to the Periodontist so as to treat it from its roots.4

The referral procedure in periodontal treatments involves the mutual care and treatment of the same patient shared between the referring doctor and the Periodontists to whom the patient has been referred.5 Information in the specialties is continually augmenting to the point that what is current today may not be current tomorrow. The individual dentist should take this situation to suggest that he should use dental specialists as an extension of his/her practice-that the specialist can provide the expertise that can benefit the patient directly-that in doing so he/she is fulfilling the moral and ethical commitment made in his/her dental licensure.6

The specialty of periodontology is growing in diverse aspects. Dentists may perform periodontal treatment as long as they perform it to a level of a specialist. Without proper education and training, the dentist may be doing harm to the patient by neglecting the principles of ethics.7 Dentists need to be aware that negligence not only is defined by acts of commission but also includes acts of omission.

To improve the referral relationship the patient, the referrer and the specialist have the responsibility to communicate well and be informed and educated to each other’s needs. The three most common criteria reported for selecting a periodontist were previous patient satisfaction, the personality of the periodontist and previous success with the periodontist. Other common criteria were good communication with the periodontist, surgical skills and competency of the periodontist and availability in the community.8

For each patient with periodontal disease, the general dentist must decide when to treat and when to refer. The outcome of this decision is critical to the long-term control of progressive bone and attachment loss. In order to make this decision, the dentist must consider patient related factors, dentist related factors, and the entire range of periodontal therapy available.9 Alleged failure to refer a patient with periodontal disease is a frequent cause of malpractice actions against general dentists.


  1. Darby, I., et al. (2005). “Factors influencing the diagnosis and treatment of periodontal disease by dental practitioners in Victoria.” Australian dental journal 50(1): 37-41.
  2. Ghiabi, E. and D. C. Matthews (2012). “Periodontal practice and referral profile of general dentists in Nova Scotia, Canada.” J Can Dent Assoc 78: c55.
  3. Bhati, A. K. (2016). “Referral to a periodontist by a general dentist: An understanding of the referral process.” Journal of Dental Research and Review 3(1): 42.
  5. Cherian, D. A., et al. (2015). “Rationale of referral of patients to a periodontist by general practitioners: Review with a cross-sectional survey.” Journal of Interdisciplinary Dentistry 5(1): 7.
  6. Kratenstein, D. (1989). “Periodontal ethics and referral modes.” The New York state dental journal 55(6): 46-47.
  7. on Ethics, C. (1990). “American Dental Association Principles of Ethics and Code of Professional Conduct.” The Journal of the American Dental Association 120(5): 585-592.
  8. Ghiabi, E. and D. C. Matthews (2012). “Periodontal practice and referral profile of general dentists in Nova Scotia, Canada.” J Can Dent Assoc 78: c55.

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