September/October 201736

Team talk

S

The best routeWhen it comes to referring to a periodontal specialist, Katie Rowland discusses the pathways

ince qualifying as a dental hygienist and therapist I have worked in a range of different practices, varying between NHS

and private settings. Most recently, I have joined the team at Pure Periodontics; a private periodontal specialist practice. It has been incredibly informative and educational to work in a practice centred around this condition.

The clinic is run by a consultant periodontist, and this has influenced my view of how patients are treated, managed and triaged in general practice. Although we are assisted in our decisions by guidelines and protocols issued by organisations such as the British Society of Periodontology, some patients may still be slipping through the net.

From participating in the treatment of patients who have been referred to a periodontal specialist, I have started to question and explore the reasons behind why so many of our patients are in the later stages of the disease process before this has occurred.

In this article, I have outlined some possible barriers and reasons for hygienists in general practice not referring, and the reasons why referral to a specialist may benefit the patient in ways that don’t immediately occur to clinicians in this environment.

Patient related factorsAfter discussing this topic with various colleagues, the cost

implications surrounding private referrals are the most common reason for a refusal from a patient.

Of course, this is entirely understandable and this may well not be an option for them. However, are we doing enough to outline the added benefits that they would gain from seeing a specialist?

Furthermore, could we be doing more to research the practitioners in our area and look in to the option of a referral to a dentist who has a specialist interest in periodontology?

There is also the option of referring to a specialist to gain a second opinion and to help outline a more comprehensive treatment plan for the patient, which can then be carried out in a primary care setting.

I also think that it is more beneficial to offer patients a private referral from the outset, so that they are more aware of the treatment pathway if their initial therapy in general practice does not have the desired outcomes.

All this information can help the patient in making more of an educated decision.

Clinician related factors Personally, until I started to work as a hygienist in a specialist practice, I hadn’t fully appreciated the different approaches that could be undertaken during the treatment of periodontal diseases.

The information given regarding

specialist

and surgical treatment during my degree programme was quite limited, and meant that it was harder to inform patients when talking to them about what their referral may involve.

My knowledge has now evolved, and I am able to advise patients in general practice that they may not even undergo conventional surgical treatment; they may receive more contemporary modalities

Benefits of developing practice protocols• A unified team that communicates

effectively and constantly to ensure that patients receive the same advice, education and management from whomever they see at the practice

• Follow-up communication between specialist practitioners, referring dentists and patients for continual documentation of the patient’s progress and goals

• Streamlined treatment plans tailored to the patient’s needs, but in line with practice protocols, to guarantee efficient progression through the patient care pathway

• Providing a clear outline of your patient management and treatment modalities to interested parties, such as referring clinicians in general practice, and the evidence base behind this

• All of these points can help to bring consistency to a surgery, improve professional relations, and ultimately deliver enhanced patient outcomes.

Katie graduated from the University of Essex with a FdSc in Oral Health Science in 2015. She then went on to complete her BSc to become a dental therapist. She currently works in London at a specialist clinic called Pure Periodontics, along with a further two general practices in Essex. As well as her work as a hygienist/therapist, Katie is also a clinical educator for trainee hygienists at the University of Essex.

Katie Rowland Fdsc BSc

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September/October 2017 37

such as the use of laser treatments and guided biofilm therapy with the EMS Air-Flow.

I feel that thorough research of specialist practices and the treatment modalities they offer is essential when you are considering the referral of a patient. It also helps to try and build a professional relationship with your chosen specialist practice.

Ensure that you are familiar with their protocols and the way they manage their patients, and that they are aware of your relevant skills and how this may aid a patient’s treatment plan. This can benefit both parties and result give better patient outcomes.

A position in secondary care has meant that I am more informed when considering the prognosis of a patient’s dentition, and able to discuss treatment options with regards to the consequent side effects of periodontal disease, such as gingival recession.

At our practice, we approach these factors at the patient’s initial preliminary appointment to ensure they are fully aware of all the possible outcomes of treatment. Furthermore, referral to a specialist is not only appropriate when a patient is in the active stages of the disease, but can also

aid those who are now in a maintenance phase and require continual supportive therapy.

I also believe, as hygienists, we sometimes may feel that we are fully equipped and able to deal with a patient’s periodontal condition in our general practice setting, which for the most part is entirely true if the case is managed correctly.

However, there are some cases such as those that fall within a higher complexity category, which may benefit more from a referral to a specialist due to factors such as their medical history, complex root morphology, and the presence of non-plaque induced periodontal diseases.

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36, 37 OH Sept Rowland (2) (Team).indd 37 22/09/2017 16:48