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July 2009
The Top Reasons for Referring to our Periodontal Specialists
1 Situations outside your ‘comfort zone’ These could be anything from advice on a complicated treatment plan to a localized gingival recession. Advanced periodontal disease can throw up some difficult decisions and your local specialist periodontist is the ideal rock for you to lean on. If you recognize and refer a patient with periodontal disease, you can change a person’s dental future from bleak to secure overnight.
2 Unresponsive sites Most periodontal problems can be treated without surgery – only about 20% need to have other options explored, such as re-treatment, antibiotics (systemic or topical), host modulating material such as Doxyxycline (Periostat) or Hyaluronic Acid (Gengigel) and pocket-elimination surgery.
3 Endo-perio problem solving It is often difficult to be sure whether an infection originates from the pulp or the periodontium. Sinuses can usually be diagnosed relatively easily by passing a GP point to trace the fistula to its source, but recurrent abscesses sometimes defy diagnosis. Surgical investigation is sometimes the only way to establish the cause of recurrent problems- fortunately we have perio and endo specialists at the Malt House.
4 Muco-gingival problems Periodontal plastic surgery is quite predictable these days and if your patient has recession defects which are cosmetically unacceptable, difficult to keep clean, or just plain uncomfortable, there is often a surgical solution.
5 Avoidance of litigation Dental Protection advisers tell us that failure to diagnose periodontal disease is their biggest growth area – don’t let it happen to you. Remember, the GDC Standards for Dental Professionals says ‘Work within your knowledge, professional competence and physical abilities. Refer patients for a second opinion and for further advice when it is necessary, or if the patient asks.’
6 Crown Lengthening It is often possible to restore broken down back teeth, or improve the appearance of short front teeth, by means of crown-lengthening, relocating the gum apically. Patients are often wary of this procedure but are always delighted with the results.
7 Furcation involvements Difficult to maintain, these do adversely affect the prognosis for a tooth. However, not all are periodontal in origin and treatment (everything from simple good plaque control to root amputation) can allow affected teeth to be maintained in comfortable function for many years.
8 Complex osseous defects This is the era of tissue regeneration. In many cases, we can actually put the clock back by re-growing bone and periodontal attachment that has been lost due to periodontal disease.
9 Implant treatment Our periodontists at the Malt House are in an ideal position to co-ordinate complicated treatments due to the the comprehensive range of specialities on offer here and because of their ability to handle tissues delicately and their broad base of experience in restorative dentistry. Patients referred for implants often require periodontal therapy prior to placement and are appreciative of the fact that everything can be carried out under one roof.
May 2009
David Cohen Answers Your Endodontic Questions
Q When should I refer a patient for root treatment?
A If you feel unable to carry out endodontic treatment on a tooth, that is the time to refer. For example, unsure about the diagnosis, difficult access, complicated anatomy, curved or calcified canals, separated instruments etc. Some of our referring dentists choose not to do any molar endo, preferring to know their restorations will be placed on teeth with a high chance of being retained after endo. And remember, the GDC Standards for Dental Professionals says ‘Work within your knowledge, professional competence and physical abilities. Refer patients for a second opinion and for further advice when it is necessary, or if the patient asks. Refer patients for further treatment when it is necessary to do so.’
Q How do I refer my patient to the Malt House?
A Once you have identified the tooth, or teeth, that need to be endodontically treated, you can refer your patients by telephone, fax, email, through our online referral form on the website, or by letter. We need all the patients’ details, including telephone numbers, full addresses and e-mail addresses where available, and the number / numbers of the teeth that require root treatment. If the patient is with you when you call, we will offer them an appointment there and then, otherwise we will contact the patient on your behalf, answer any questions they might have, and find them a convenient appointment.
Q What happens next?
A Your patient will then receive a letter, brochure and map from us with full details of their appointment and treatment. In most cases, the treatment will be completed in one visit which will last about an hour. The patient is able to watch the treatment if they wish, or watch a DVD of their choice while the endodontic therapy is carried out. Alternatively, for very nervous patients, sedation is available at an extra cost.
Q How successful is the treatment?
A Unfortunately, when dealing with nature, there is no guarantee that any treatment will work. However, research has shown that when root canal treatment is completed by a specialist endodontist, the success rate is probably in excess of 95% . In addition, we offer a twelve month guarantee so that if any further related treatment is necessary on the same tooth, no more fees will be incurred by the patient. For re-root treatments, the success rate is around 85-90%.
Q What happens once the root treatment is completed?
A When the endodontic therapy is complete, we will write back to you with full details of the treatment, including x-rays, and any restorative recommendations. We advise the patient to get an appointment with you for the restoration as soon as possible and certainly no longer than 3 weeks after treatment.
Q What if my patient cannot afford the fees?
A As part of the James Hull Group, we are now able to offer 0% finance, subject to status, to help patients afford the best treatment possible. At present, our fees range from £625 - £675 depending on complexity and whether the tooth has been endodontically treated before.
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