Full Periodontal Charting and Bitewings
What is the standard of care for frequency of full periodontal charting (is PSR ok too?) and bitewings? What advice can you give regarding a patient who refuses perio SRP and/or referral and just wants ‘a cleaning’? Thank you
This could be an extremely long answer since you’ve hit on several important topics all at once! I’ll try to keep it brief and address each question individually:
1) What is the standard of care for frequency of full periodontal charting and exam? This is a question that is often asked because there technically is no ‘standard of care’ guideline to use. In reality, there should not be a standard of care for full perio charting since each patient is different and has a unique periodontal history. However, because there was no specific guidance regarding the frequency of a complete periodontal evaluation, the American Academy of Periodontology developed the statement, “Comprehensive Periodontal Therapy” in 2010. It states that “Patients should receive a comprehensive periodontal evaluation and their risk factors should be identiﬁed at least on an annual basis. Such an evaluation includes discussion with the patient regarding his/her chief complaint, medical and dental history review, clinical examination, and radiographic analysis.” Note the words at least. There may be some individuals who warrant more frequent periodontal evaluations based on risk factors and past disease history. You can read the full statement here.
2) Is PSR OK? Periodontal Screening and Recording (PSR) is exactly as the name implies – a screening procedure. PSR may be used to determine if a comprehensive periodontal evaluation is needed for certain patients. However, it does not replace a comprehensive exam. PSR was developed in conjunction with the American Dental Association and the American Academy of Periodontology because it was determined that not even basic periodontal evaluation procedures were being performed routinely in general dental practices. So yes, PSR is “OK” when used as it’s intended, but not “OK” if a comprehensive periodontal evaluation is needed. More information on PSR can be read here.
3) What is the standard of care for the frequency of bitewings? The radiographic guidelines were recently updated in 2012 by the American Dental Association and the FDA. You can read the complete guidelines here.
4) What advice can you give regarding a patient who refuses periodontal therapy (SRP) and/or referral to a specialist and just wants a “cleaning”? Patients have the option of refusing treatment recommended by the oral healthcare provider, including refusing to see a specialist. However, such refusal must be carefully and continuously noted in the patient’s record. There is a great response to this ethical dilemma in the ‘Ethics and Risk Management’ section of this Ask the Expert online advice column. Note that even if a patient signs an informed refusal statement, it does not release the practitioner from providing negligent care. Furthermore, the office has the option of releasing the patient if he/she refuses the treatment that is recommended. If you are unable to provide optimum care because the patient refuses that care, it may be in your best interest to no longer treat that patient.
Hope that helps!