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Dr Redmond completed her MSc in Periodontology in 2016 and since then has accepted referrals both in-house and externally whilst working in a General Practice in Ashton-in-Makerfield,  Wigan. 

Dr Redmond has a particular interest in Periodontal conditions related to pregnancy and her dissertation was based on this. Working with our Dental Therapist, Abbey, Dr Redmond is happy to accept referrals for patients requiring periodontal treatment. 

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The British Society of Periodontology has created guidelines for referring patients for periodontal treatment based on a simple assessment and these are referred to below which may help referring Dentists when deciding on when to refer.

 

This is for use as guidance and not considered prescriptive. 

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Referral of patients with periodontal problems depends on several factors including: 

• The severity of disease and complexity of treatment required 

• The patient’s desire to see a specialist or undergo specialist treatment 

• The GDP’s knowledge, experience and training to treat patients with a range of periodontal problems 

• The presence of other complicating factors such as a patient’s medical history or other comorbidity.

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There are several levels of complexity: level 1, level 2 and level 3. As a general guide, patients with level 1 complexity should normally be treated in general practice, those with level 2 treated in general practice if the clinician has the relevant skills, or referred if not, and the majority of patients with level 3 complexity referred.

 

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Level 1 complexity 

 

Diagnosis and management of patients with uncomplicated periodontal diseases, including but not limited to: 

• Evaluation of periodontal risk, diagnosis of periodontal condition and design of initial care plan within the context of overall oral health needs 

• Measurement and accurate recording of periodontal indices 

• Communication of nature of condition, clinical findings, risks and outcomes 

• Designing care plan and providing treatment 

• Assessment of patient understanding, willingness and capacity to adhere to advice and care plan 

• Evaluation of outcome of periodontal care and provision of supportive periodontal care programme 

• On-going motivation and risk factor management including plaque bio lm control 

• Avoidance of antibiotic use except in specific conditions (necrotising periodontal diseases or acute abscess with systemic complications) unless recommended by specialist as part of comprehensive care plan 

• Preventive and supportive care for patients with implants 

• Palliative periodontal care and periodontal maintenance 

• Any other treatment not covered by level 2 or 3 complexity 

 

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Level 2 complexity 

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Management of patients: 

• Who, following primary care periodontal therapy, have residual chronic moderate (30-50% horizontal bone loss) periodontitis and residual true pocketing of 6mm and above 

• With certain non-plaque-induced periodontal diseases e.g. virally induced diseases, auto-immune diseases, abnormal pigmentation, vesiculo-bullous disease, periodontal manifestations of gastrointestinal and other systemic diseases and syndromes, under specialist guidance 

• With aggressive periodontitis as determined by a specialist at referral 

• With furcation defects and other complex root morphologies when affected teeth are strategically important 

• With gingival enlargement non-surgically, in collaboration with medical colleagues 

• Who require pocket reduction surgery when delegated by a specialist 

• With peri-implant mucositis where implants have been placed under NHS contract 

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Level 3 complexity 

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Triage and management of patients: 

• With severe (> 50% horizontal bone loss) periodontitis, aggressive periodontitis and true pocketing of 6mm or more 

• Requiring periodontal surgery 

• Furcation defects and other complex root morphologies not suitable for delegation 

• With non-plaque induced periodontal diseases not suitable for delegation to a practitioner with enhanced skills 

• Peri-implantitis where it is the responsibility of the NHS to manage the disease when implants have been placed under an NHS contract 

• Patients who require multi-disciplinary specialist care (level 3) 

• Where patients of level 2 complexity do not respond to treatment 

• Non-plaque induced periodontal diseases including periodontal manifestations of systemic diseases, in order to establish a differential diagnosis, joint care pathways with relevant medical colleagues and where necessary, manage conditions collaboratively with practitioners with enhanced skills if appropriate and provide advice and treatment planning to colleagues.

 

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Patients with aggressive periodontitis should be offered referral after initial preventive advice on risk factor management and oral hygiene instruction. All patients with chronic periodontitis should have initial care (including treatment) in general practice and if unsuccessful referral may then be indicated. Patients with modifying factors may require movement to the next level of care, including those where behaviour change is challenging 

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In cases where an onward referral has been made, initial non-surgical periodontal therapy should still be commenced within general practice as part of the GDP’s duty of care to the patient. Also ensure that any other primary dental pathology, such as caries or endodontic lesions, are addressed. Control of other modifiable risk factors where indicated, particularly smoking, should also be instigated by the GDP, if necessary by referral to smoking cessation services. 

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If you have any questions before making a referral to Dr Redmond then please get in touch and we will be happy to assist. 

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