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.

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.

Costly chronic diseases: a retrospective analysis of Chronic Disease Dental Scheme expenditure.

OBJECTIVE: The aim of the present study was to investigate Medicare rebate claim trends under the Australian Chronic Disease Dental Scheme (CDDS) over time, region and type of service. METHODS: CDDS data obtained from the Department of Human Services reflected all Medicare item claims lodged under the CDDS by dental practitioners and processed by Medicare. Retrospective analysis of CDDS rebate claims was conducted. RESULTS: The CDDS rebates for the period 2008-13 totalled A$2.8 billion. Just under 81% of claims were from dental practitioners working in major cities. The most frequent rebates were for crown, bridge and implant (32.4%), removable prostheses (22.4%) and restorative services (21.3%). The rebate claims of restorative services, crown and bridge, and removable prostheses per dentist in all regional areas increased over the time of the CDDS. Per capita, the rebates for every type of dental service were lower in the more remote regions. CONCLUSIONS: Rebate claims increased in each of the last 3 full years of the CDDS across all areas. The majority of Medicare rebate claims were from major city areas and for crown and bridge, removable prostheses and restorative services. The service mix varied between regions.

Regional use of the Australian Chronic Disease Dental Scheme.

OBJECTIVE: To determine whether a different number and type of services were provided in Australian regional areas under the Australian Government-funded Chronic Disease Dental Scheme (CDDS). DESIGN: Retrospective analysis of administrative payments data. SETTING: Australia. PARTICIPANTS: Patients receiving dental services under the Medicare CDDS. INTERVENTIONS: The CDDS. MAIN OUTCOME MEASURES: Number and type of services. METHOD: CDDS service categories Australian Statistical Geography Standard (ASGS) regions were collected by the Australian Department of Human Services between 2008 and 2013 and compared by Australian Bureau of Statistics ASGS estimated resident regional 2011 population, and by employed number of dentists, dental specialists and dental prosthetists from the 2011 National Health Workforce Dataset. RESULTS: Number of services provided was greatest in major cities (79.0%), followed by inner regional (15.4%), outer regional (5.2%) and remote/very remote Australia (0.4%). Number of services per head of population decreased from 1.088 in major cities to 0.16 in remote/very remote areas. Number of services provided per dental practitioner showed minimal variation between major city (1672), inner (1777) and outer regional (1627) areas, but was lower in remote/very remote areas (641). Crown and bridge, periodontic, endodontic and removable prostheses per dental practitioner were most frequently supplied in the major cities, but restorative care and oral surgery were more frequently supplied in inner and outer regional areas. CONCLUSION: The number of CDDS services provided declined with regional remoteness. There was a marked difference in the utilisation of the scheme between major cities and remote/very remote areas in both number and type of service levels.