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periodontal disease, it is much easier for patients to allege, after the event, that they would have preferred a referral for specialist care. Similarly, one should minimise any delay in referral. The BSP has created guidelines for referral4 which are summarised below: Complexity 1 cases may be treated in general practice- BPE scores 1-3 in any sextant. Complexity 2 cases can either be referred or treated by the general practitioner- BPE score of 4 in any sextant or surgery involving the periodontal tissues. Complexity 3 cases should be mostly referred- BPE score of 4 in any sextant and including one or more of the following factors: - Patient under the age of 35 years - Smoking 10+ cigarettes daily - A concurrent medical/oral factor that is affecting the periodontal tissues - Root morphology that adversely affects prognosis - Rapid periodontal breakdown >2 mm attachment loss in any one year - Surgical procedures with implants - Surgical procedures, periodontal tissue augmentation and/or bone removal (e.g. regeneration or crown lengthening surgery) A referral letter should contain: the patients personal details, reason for your referral, any urgent problems, relevant medical history, smoking status, details of periodontal treatment completed and relevant charts and radiographs. Many NHS funded services have an enormous demand for services; your patient will have a greater chance of being accepted if as much relevant information as possible is provided. If the patient declines referral, details should be documented in the clinical notes and the option of referral should be discussed again at their next recall appointment. In summary, accurate diagnosis with appropriate care for a patient is critical in avoiding any initiation or progression of a litigious claim. Currently there is a level of expectation that tooth loss is avoidable and there can be strong emotional implications to losing teeth. In many cases, the levels of periodontal disease present in a patients mouth are due to factors beyond the dentists control, and do not reflect any fault whatsoever on the part of the dentist. However, it is made much easier to demonstrate this fact, when all the details have been recorded accurately. If the condition, along with the treatment options and appropriate advice, is not explained to the patient, the individual may well feel that they have been let down by the professional person they have trusted over many years.
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Exercises in risk management, Periodontal monitoring- Dental Protection [online] 2012. Available at: http://www.dentalprotection.org/adx/aspx/adxGetMedia.aspx?DocID=1363 [accessed 06/01/13]. BSP (2012). Young Practitioners Guide to Periodontology. Second edition. BSP. London. Basic Periodontal Examination [online] 2013. Available at: http://www.bsperio.org.uk/publications/downloads/39_143748_bpe2011.pdf [accessed 06/01/13]. Parameters of care [online] 2013. Available at: http://www.bsperio.org.uk/publications/downloads/28_143801_parameters_of_care.pdf [accessed 06/01/13].
REENA WADIA