Periodontal referral patterns of general dentists: lessons for dental education

The objectives of this study were to investigate periodontal treatment and referral patterns and the considerations used in the process of dentists who make no periodontal referrals, relatively few referrals, or more referrals. Specifically, the role of disease characteristics, patient- and provider-related factors, attitudes towards periodontal referrals, and perceptions of dental education were explored. The relationships between the perceived quality of dental education concerning periodontal diagnosis and treatment and the considerations used in this process were evaluated as well. Data were collected from 160 members of the Michigan Dental Association using a mailed questionnaire. The respondents were predominantly male (77 percent) and white (96 percent) and had practiced for an average of twenty-three years (SD=10.7). While 13 percent of the respondents had not made any periodontal referrals during the past month, 69 percent had referred between one and five patients, and 18 percent more than five patients. Dentists who referred more than three patients per month considered the patients' oral hygiene as more important, had fewer patients from lower socioeconomic backgrounds and more patients with private insurance, and felt less well prepared by their dental education compared to general dentists who referred fewer than three patients per month to a periodontist. The more positively dentists evaluated their dental education in periodontics, the more conservative they were when considering percentage of bone loss as a basis for referral (r=.228; p=.014), the more frequently they used systemic antibiotics in their treatment of periodontal disease (r=.180; p=.036), and the more they considered whether their patients would return after the periodontal treatment (r=.185; p=.028) as a factor in their referral decisions. General dentists' perceptions of the quality of their dental school education in periodontics decreased their willingness to refer patients and increased their desire to treat these patients in their own practices. Future research should analyze the ways in which dental school curricula could prepare students to make timely and necessary periodontal referrals.