Patient Knowledge and Treatment Provided Prior to Specialist Periodontal Referral

Inappropriate referral to Glasgow Dental Hospital for specialist periodontal treatment potentially inflicts a significant burden on this service. We wished to investigate if patients were receiving appropriate periodontal treatment in primary care prior to specialist referral, and whether this was influenced by providing updated guidelines to the referring dentists. Objectives: To determine patient knowledge and treatment provided prior to specialist periodontal referral. Methods: Referral guidelines were provided to general dental practitioners advising that patients should be provided with an explanation of periodontal disease and a course of scaling and oral hygiene instruction prior to specialist referral. Patient knowledge and treatment provided prior to referral was assessed by questionnaire at the initial specialist appointment. Data was obtained from 66 consecutive patients prior to the introduction of revised referral guidelines, and from 81 consecutive patients following the introduction of the new guidelines. Results: The introduction of new referral guidelines resulted in an increase in the proportion of patients receiving oral hygiene instruction prior to referral (51% vs. 67%). However, 22% of patients were using a chlorhexidine containing mouthwash at time of referral, obscuring their ability to practise effective mechanical plaque control. The proportion of patients receiving a course of periodontal treatment prior to specialist referral (at least 2 linked visits) was 20% before guideline introduction, and 6% following guideline introduction. Conclusions: The circulation of referral protocols does not significantly influence the treatment patients receive prior to referral. Alternative options should be considered which are focused on facilitating appropriate treatment in primary care prior to specialist referral.