title: Description of a system designed to assist primary dental care clinicians in decision-making with regard to specialist periodontal referrals and report of two clinical audits using the system.
abstract: BACKGROUND
  Identifying which patients are at risk of significant periodontal breakdown and may need specialist care is a process fraught with problems. This paper summarises factors that should be considered by referring clinicians, describes a system to assist them, and presents the results of two sequential audits carried out in general dental practice using the system. AIMS, MATERIALS AND METHODS: The author aims to present the system and the results of two sequential audits, carried out in the same eight general dental practices by 23 general dental practitioners (GDPs) after training from a specialist in periodontics. The system is based on the use of the Basic Periodontal Examination (BPE), a constant pressure periodontal probe, and a computer screen that prompts the clinician who is performing periodontal screening. A series of risk factors, including smoking, presence of relevant systemic disease and age, is used to modulate the score. Patients are then classified into one of three complexity groups. Those in the Complexity 3 group are deemed to be potentially at risk of significant periodontal breakdown and in need of referral for specialist advice and/or care, in accordance with the published British Society of Periodontology guidelines. In each audit a random sample of the records of ten dentate patients over the age of 20 years, who attended for recall or new examinations by each of the 23 GDPs over a calendar month, were assessed to see whether or not BPE scores had been recorded and whether or not those classified as Complexity 3 (and in need of referral) had been correctly identified and referred.
  
  
  RESULTS
  In both audits the total random sample of patient records was 225 (ten for 22 dentists and five for the remaining dentist who only worked for a short time during the months of the audit). In the first audit cycle 139 (62%) of the random sample of records included a BPE score and 11 (8%) of the patients concerned were identified as Complexity 3 and referred for specialist advice and/or treatment. All 11 accepted the referral and when examined by the specialist in periodontics were confirmed as Complexity 3. In the second audit cycle, which took place seven months later, 179 (80%) of the random sample of patient records included a BPE score and 14 patients were assessed by their GDPs as being Complexity 3. All 14 accepted a referral and were deemed to be Complexity 3 when they were subsequently examined by the specialist in periodontics.
  
  
  CONCLUSIONS
  Although the full potential of the system was not investigated during the two audits, these preliminary results suggest that it may assist referring clinicians in identifying which patients to refer and encourage clinicians to perform periodontal screening.
authors.affiliation: periosnoad@aol.com
authors.forename: Richard
authors.initials: R
authors.lastname: Snoad
mesh_terms: D000328:Adult; D000367:Age Factors; D003199:Computer Systems; D003657:Decision Making; D019230:Dental Audit; D003729:Dental Care; D005792:General Practice, Dental / Q000193:education; D006801:Humans; D020380:Needs Assessment; D010510:Periodontal Diseases / Q000145:classification / Q000175:diagnosis; D010517:Periodontics / Q000193:education / Q000295:instrumentation; D011320:Primary Health Care; D016300:Radiography, Bitewing; D012017:Referral and Consultation; D012307:Risk Factors; D012907:Smoking