Tim Bradstock-Smith explains how team work can make the dream work when it comes to emphasising to patients the importance of establishing a healthy oral environment
Most people believe that tooth decay is the main culprit for tooth loss and tend to be less aware of the dangers of periodontal disease, even though it affects more than half of all adults in the UK to some extent.
It is thought that because patients are often unaware of any periodontal problems and because they are not directly associated with aesthetics or pain, many patients deem suggested procedures unnecessary, even after discussion.
This negativity is accentuated by patients’ high failure to attend rate for periodontal treatment appointments, as highlighted by Sharpe, Durham and Preshaw (2007). It could, therefore, be argued that patients are not adequately informed about how periodontal disease progresses and how destructive it can be.
The best approach
The successful treatment of periodontal disease should take a multidisciplinary approach with all members of the dental team trained in the management of the disease.
An effective protocol within the practice to implement efficient delegation and a network of clinical support to treat the disease effectively is essential.
In many cases, dental hygienists and therapists can provide a consistent programme of treatment including professional mechanical cleaning, non-surgical periodontal treatment, antiseptic or antibiotic suppression of periodontal biofilms and, perhaps most importantly, detailed home oral hygiene instruction.
In aggressive cases, it may be necessary for a dental surgeon to perform flap surgery to clean the site thoroughly and suture periodontal pockets.
In more severe cases, some patients may also require bone grafting to promote new growth or tissue regeneration to cover any exposed tooth roots.
To ensure that patients receive optimum care and to avoid overlooking any treatment options, it is also wise to have a referral network in place.
In severe or complicated cases, it may be necessary to consult a periodontal specialist.
Often, a specialist dentist in this field will be happy to advise dental professionals and recommend a way forward. However, if the proposed treatment is considered to be beyond the practitioner’s scope of expertise or they do not feel comfortable treating the patient for any reason, the specialist can continue the treatment by referral.
Some practitioners feel reluctant to refer patients to a specialist because they believe that once referred, the patient will not return for their general care. However, specialist treatment should be regarded as part of the network of expertise built-up between practices for the ultimate benefit of the patient.
By creating a good working relationship with a reliable referral practice, such as London Smile Clinic, patients can benefit from specialist clinical skills. Specialists working with referring practitioners become an extension of their professional dental team, taking on as little or as much of the treatment as instructed.
In this way, patients receive the unprecedented care and will feel confident knowing that clinicians are available to support and treat them at all levels.
With well-documented research regarding periodontal disease and its links to heart disease, diabetes and chronic inflammation relating to many other systemic diseases, it is the responsibility of dental professionals to develop strong communication with patients and emphasise the importance of establishing a healthy oral environment.
If periodontal disease is diagnosed, practitioners need to ensure that patients understand the value of treatment and ongoing maintenance and encourage them to comply.
Sharpe G, Durham JA, Preshaw PM (2007) Attitudes regarding specialist referrals in periodontics. Br Dent J 202: E11
Tim Bradstock-Smith is principal of the London Smile Clinic, an award-winning centre of excellence in dentistry that is based in central London. The clinic offers an extensive range of services, which include orthodontics, implant dentistry and dentures.
*This article was originally published in Oral Health magazine
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