The American Academy of Periodontology released the Guidelines for the Management of Patients With Periodontal Diseases on Sept. 1, and distributed it to dentists nationwide beginning in November.
The purpose of the guidelines is to facilitate the identification of patients with periodontal diseases who, because of their disease severity and/or risk profile, present significant challenges in treatment. However, some questions have arisen regarding the Guidelines. The academy, therefore, offers the following statement in an effort to address any confusion that may exist.
The guidelines consist of four sections: a narrative introduction, a three-level categorization of patient conditions, definition of terms and frequently asked questions. Taken together, these sections provide the philosophy and context essential for correct interpretation of the document. Excerpting any portion of the document out of context will lead to a misunderstanding of the content.
Concern has been expressed that the guidelines mandate referral of patients with specific conditions to a periodontist; however, the language of the guidelines affords flexibility. The strongest verb used is "should," which is defined in the document as "a highly desirable direction but does not mean mandatory."
The guidelines do not include treatment or referral mandates.
The guidelines do identify a category of patient conditions (Level 3) for which treatment by a periodontist is highly desirable. This identification is based on the experience and judgment of periodontists, dentists who specialize in treating patients with periodontal diseases.
The guidelines do not indicate that periodontists are the only individuals qualified to treat patients with Level 3 conditions. They do suggest, however, that periodontists are the individuals best qualified to do so by virtue of their education and experience. The academy stands by this assessment.
The guidelines also suggest conditions of disease and risk for the general dentist to co-manage with the periodontist in levels 2 and 1. The academy supports the role of the general dentist as primary care provider.
It offers these guidelines as a means for dentists to quickly identify those patients at greatest risk and therefore most appropriate for specialty level care.
The academy recognizes, and the guidelines acknowledge, that all dentists have the right to practice according to their education, training, and experience. The academy also recognizes that a practitioner's recommendations for periodontal treatment are subject to the patients' desire and/or ability to seek specialty care.
The guidelines are not intended to serve as a medico-legal standard of care. They do not replace a practitioner's knowledge, skills or abilities.
The academy has a long history of working with the dental community to develop programs and tools to promote the periodontal health of patients. These guidelines reflect input from academy members and other leading dental organizations.
While the academy is grateful for comments provided by these groups, their participation in the development process does not signify their endorsement of the Guidelines. The academy is committed to communicating with the dental community about the guidelines and to clarify any issues that may arise.
Updates related to the guidelines are available at www.perio.org/resources-products/posppr3-1.html.
