From Guest Blog Contributor: Dr. Michael Rethman
I concur that 80% (or more) of perio therapy can and should occur in the GPs office: the trick is knowing what should occur where and when — in other words when to refer and why. Chronic periodontitis is usually site-specific and often progresses slowly which can trap GPs in situations where they fear referring later on because things went downhill early-on. Furthermore, most dentists (me included, and I’m a perio) aren’t good at blind scaling and root planing, many RDHs aren’t either. So assuming that you or your RDH are somehow good at this is foolish — unless, of course, you are using an endoscope or surgical access, the latter of which may be overkill.
As noted by Dr. Fazio, sites that show no plaque yet persist with BoP suggest strongly for getting help. One trick to a happy practice is to establish a good relationship with a nearby periodontist or two and ask them to help you refine your treatment skills and referral paradigms as well as be involved in multi-disciplinary treatment planning and execution — that may include optimal periodontal or implant placement/maintenance skills that you simply don’t have. (Not all perios are stars either, but they have nearly double the formal dental education of most GPs and if the ones you contact don’t want to help or don’t seem all that informed, find others.) Also, there exists a publication entitled Management of Patients with the Chronic Periodontal Diseases that may help you too, I think it’s available at perio.org. Finally, remember that your state grants you a license to practice dentistry and patients consent to your “touching” because both the state and your patients expect that you will always hold their interests paramount — over yours especially. Part of that responsibility entails not only doing what you think is ethical and correct but also learning more and more over the years so you get better and better at doing knowing what’s “right” — and I’m not talking about your practice gross income here… I am talking more about sleeping well at night…. Aloha all and have fun!
Dr. Rethman is a board-certified periodontist with over five years of general practice experience. He is also a dental research scientist and a former Director of the U.S. Army Institute of Dental Research, as well as a past-President of the American Academy of Periodontology. Dr. Rethman also recently chaired the ADA’s Council on Scientific Affairs for an unprecedented three years and has recently chaired and/or served on numerous expert panels that systematically assessed the scientific literature to provide up-to-date information regarding a variety of important clinical topics.