You refer your patient to a periodontal office to receive treatment, and now they are under the supervision of a periodontal team in an alternating recall program. You did your part and can wash your hands of it now, right? Ehhh! Patient awareness of periodontics is not always strong, and for many, this alternating pattern is difficult to understand and feels complicated if offices are not working together. What’s procedural for us can be confusing for our patients. Consequences arise when the collaborative effort between the two offices fails, including oversights as simple as not reading shared reports.

The concept of shared periodontal care requires a joint effort from everyone involved to support patient understanding and compliance. Effective communication is associated with patient trust, satisfaction, and adherence to care recommendations. Fortunately, this communicative effort can be simple. Most periodontal practices send periodontal maintenance reports following visits, providing the general dental team with an update on the patient's condition and recommendations. But what happens when the communication only goes one way, or worse, gets ignored? As a hygienist who has worked solely in periodontics, I have to ask: Are we working together?

Referral to periodontics: What are we telling the patient?

One of the most challenging conversations can occur when a patient arrives for a comprehensive periodontal evaluation and asks, “How did this happen to me all of a sudden?”

Generalized periodontal disease typically does not appear overnight. By the time a patient has been referred to a periodontist, there may be a lengthy history behind the diagnosis. Perhaps the disease has progressed rapidly. Perhaps the patient has a more aggressive disease pattern. It could be that the general office has identified periodontal concerns and attempted to manage them over several visits, but the patient didn't fully understand the significance of the diagnosis. Or the patient is coming from an office where periodontal probing has not happened consistently.

Regardless of the reason, our responsibility is not to determine who missed what. Our responsibility is to help the patient understand where their periodontal health is today and what we can do about it through effective collaboration.

That conversation becomes much easier when the general dentist, hygienist, and periodontist are communicating the same message. Patients should not feel as though they are receiving and relaying two separate stories from two separate dental offices.

I explain that periodontal maintenance visits should be the same in both offices, differentiating that while we are monitoring for signs of periodontal concerns and intervening when indicated, the general dentist will intervene with hard tissue concerns such as restorative needs and cosmetic treatments. Providing clear explanations, giving opportunities for questions, and being consistent with follow-up are among the communication strategies identified in recent dental literature as what’s important to patient-centered care and treatment engagement.¹ To make it easy, you can read a peripheral maintenance report.

Periodontal maintenance reports

Correspondence via letters or reports are sent from most periodontal offices following examinations, periodontal maintenance visits, and reevaluations after surgical and nonsurgical treatment. These reports can contain valuable information, including:

• The patient's current periodontal status
• Areas of concern
• Recent periodontal treatment
• Recommended treatment or continued periodontal therapy
• Changes in periodontal findings
• Recommendations for future maintenance
• Other information relevant to the patient's care in the general practice, like potential decay or the need for a fabricated night guard

One request I include in my periodontal maintenance reports is for the general dental office to provide current radiographs. This request is not a “nicety,” but a necessity. Having access to current radiographs allows the periodontal team to perform a more complete assessment and can help prevent unnecessary duplication of radiographs. More broadly, sharing relevant diagnostic information allows providers to work from the same clinical picture. At minimum, this shared information is paramount in providing cohesive care and avoiding patient frustration.

The importance of shared information in maintenance reports should not be underestimated. We have an obligation to share appropriate diagnostic information and practice within the accepted standard of care; it is not a task that goes without dedicated effort. For example, I spend approximately 40 minutes per day writing periodontal maintenance reports. I do this because it saves the patient from being a messenger and adds value to their care. Yet, I rarely receive a letter—or even a brief note—from a clinician in general practice. When I do, I really appreciate it because that simple communication tells me that someone on the other side of the referral is paying attention. Imagine my frustration when these reports are not reviewed or when a patient relays that their office didn’t know they were coming to see us all this time.

The patient shouldn't be the messenger

We know that periodontal therapy is a long-term commitment, and its success requires asking patients to change habits, improve their oral hygiene, attend more frequent appointments, accept a diagnosis they may not fully understand, and invest time and money into a disease process that may not produce obvious symptoms. If we then place the responsibility for communication between offices on the patient, we are adding another barrier. This is why collaboration becomes particularly important.

Imagine being the patient who says: “I only started coming here because they sent me to you, so why aren't they sending my x-rays and information?” It's a fair question. Patients shouldn’t become the communication system between their dental providers, remembering which office has their most recent radiographs or explaining what procedure they had done six months ago. They shouldn't have to carry paperwork from one office to another or repeatedly request that one provider send information to another. Most importantly, they shouldn't feel as though their providers aren't communicating.

Communication failures can contribute to misunderstandings, anxiety, decreased satisfaction, and delays in care. Research identifies continuity, follow-up, clear explanations, active listening, and cohesive communication as important components of effective dental care.² When communication breaks down, frustration can quickly become disengagement. And disengagement can become missed appointments, inconsistent periodontal maintenance … and eventually a patient who decides the entire process is too complicated and drops out of it, leading to advanced disease and potential tooth loss.

What does collaboration actually look like?

When patients see that their general dentist and periodontal team are actively communicating, they see a followed plan is in place for them, and that consistency builds trust. It doesn’t need to be a full letter from the general dentist either. Collaboration can be as simple as a short note from the general hygienist: “Patient has been maintaining well at three-month intervals. Localized bleeding remains around no. 30. We will continue to monitor and reinforce home care. In addition, we have scheduled a crown for no. 2, and current films have been emailed.”

When communication between the general dental office and periodontal office breaks down and we allow the patient to become the messenger, they will lose confidence in the system and may stop participating in the program. It is arguably negligent to expect a patient to be responsible for coordinating between two professional offices. Explaining their diagnoses, procedures, recommendations, and follow-up instructions from one provider to another is not only frustrating, but we know that patients don’t have the clinical knowledge to accurately communicate what occurred, causing fragmented treatment.

Patients already have plenty of reasons to postpone dental care. Cost, anxiety, time, transportation, competing responsibilities, and treatment fatigue can all become barriers. If a patient feels as though they are doing all the work to coordinate their own care and are always worried about radiograph duplication, eventually they may simply decide I'm tired of going back and forth.

All together now

A referral to a periodontist should not feel like the general dentist is handing the patient off, and effective communication ensures that periodontal therapy does not exist in isolation from the rest of a patient's dental care.

The hygienist plays a critical role in periodontal maintenance by providing reinforcement, motivation, and identifying changes between visits per recommendations of the general dentist or periodontist. When everyone fulfills their role, the process is seamless for us and them.

Most importantly, we should remember that the patient doesn't understand the boundaries between our offices the way we do. If one office says one thing and the other office appears unaware of it, the patient doesn't necessarily blame the communication system; they may simply conclude that nobody knows what’s going on. They see one dental care team—not two offices with multiple departments. When that team communicates well, the patient experiences continuity. When it doesn't, the patient experiences confusion. We must ask the question: Are we communicating well enough for our patient to know we're working together?

More from the author: Asking for a Friend: Can we stop saying “deep cleaning”?

Editor’s note: This article first appeared in Clinical Insights newsletter, a publication of the Endeavor Business Media Dental Group. Read more articles and subscribe.

References

1. Naqvi JR. Why patients don’t seek periodontists, and how to fix that. Perio-Implant Advisory. April 2, 2025. https://www.perioimplantadvisory.com/periodontics/article/55279252/why-patients-dont-seek-periodontists-and-how-to-fix-that
2. Ho JCY, Hui JCY, Chai HH, Huang MZ, Lo ECM, Chu CH. Transforming dental care through empathetic and clear communication: a comprehensive review and implementation framework. Dent J (Basel). 2026;14(2):111. doi:10.3390/dj14020111