INTRODUCTION:

Periodontal diseases are the most common disease which can affect one or more of the periodontal structures (includes periodontal ligament, alveolar bone, cementum and gingiva). While there are many different periodontal diseases, by far the most common arethe plaque induced inflammatory conditions, such as gingivitis and periodontitis.(1)

Even though plaque and calculus plays a vital role in initiation of periodontal diseases there are many other contributing local and systemic factors like palateradicular grooves, malocclusion, overhanging restorative margins and diabetes mellitus etc. So diagnosis and treatment planning of periodontally diseased patients’ needs a comprehensive assessment of the etiological and the contributing factors(2).

In a general practice, the general dentist plays a significant role in early diagnosis of periodontally diseased patients, since he is the one to whom the patients report first and the general dentist should have adequate knowledge and invest time for the comprehensive evaluation of periodontally diseased patients.(3)

As many patients with periodontal disease in mild to moderate stages does not experience any pain or discomfort they are not aware of their destructive periodontal disease. So when a dentist tries to explain the periodontal status of the patient, they mostly do not accept the treatment because it is not with the chief complaint(4).

So with all these short comings like unable to diagnose and treatment plan, lower acceptance of periodontal treatment by patients and lack of predictable results for periodontal therapy from general dentist hands, most of the times a general dentist advises for extraction of periodontally diagnosed teeth rather than educating the patient on their periodontal status and considering for comprehensive evaluation and treatment plan by specialist periodontist which has a long term effect of restoring a functional dentition(5)

The role of general dentist extends beyond diagnosis and treatment planning to schedule of maintenance care for the periodontally diseased patients. (6) The contribution of maintenance therapy to the long-term success of the results obtained from periodontal therapist are well known, As a whole the general dentist plays a crucial role when it comes to management of periodontally diseased patients.(7) Within the literature of dentistry there are existence of limited research with regard to referral relationship between general dentist and periodontist.Many studies were conducted in the area of referrals a have attempted to analyse the psychodynamic aspects of the relationship between the referring doctor and specialist.(8,9,10)Only a few studies have looked at the demographic predictors of attitude and perceptions of general practitioner and their current knowledge status on periodontal treatment(11). This study, by means of a questionnaire, aims to identify the attitude and perception of the general dental practitioners toward periodontal treatment, as they form the cornerstone of dental practice and to evaluate the current status of periodontal treatment in clinics and protocol of maintenance therapy, and the general awareness of dental profession towards periodontal care.(12)

MATERIALS AND METHOD:

This study was carried out in the form of questionnaire survey, among 109general practitioners having their dental clinic in the sub urban and urban area of Chennai city. A questionnaire comprising of16 questions were distributed to each of them by visiting their clinic, dental institutions and collected on the same day. The questions focus on addressing knowledge on diagnosis, treatment plan, referral protocol for a general dentist for periodontal disease.

Dental practitioners with a dental clinic in sub urban and urban areas of Chennai with minimum qualification of BDS and at least one years of experience in private clinical set up were included for this study(13). Interns, dentalgraduate students and periodontist were excluded from this study

STATISTICS ANALYSIS:

For each question, independent percentage was calculated to determine the frequency of the responses. To identify the variable factor affecting the responses, multivariate logistic percentage statistics analysis test was used.

RESULTS AND DISCUSSION:

Of 100 dentists included, 41 were females while 59 were males with an average year of experience of 4.5 years ranging from 4-30 years. 87 % of dentist very often encountered patients with periodontal disease in their practice.10 percent of dentist encountered occasionally, only 3% rarely encounter with periodontal disease patients. This shows a more prevalence of patients with periodontal disease reports to dental clinic. (14, 15) Figure1.

Figure 2: Mode of opinion regarding periodontal therapy

Only 47% of dentist approach a consultant for a periodontal opinion regarding the diagnosis of difficult cases. Even though there are recent advancements in technology more than 69%of dentist consult their periodontist by fixing an appointment before and discussing about the case rather than sharing clinical photos and radiographs of patientsthrough social network for diagnosis and management of patients. (18, 19) They still follow their traditional system.

87%of the general dentist took efforts to educate the patientson there of periodontal status and treatment required for the patients. (21).The patients were also found to be satisfactory with the treatment plan suggested by their dentist.

34 % of the dentists carried out some or the other periodontal surgical procedures on their own. Gingivectomy, Frenectomy was the most common procedure carried out by general dentists followed by flap surgery and crown lengthening.(22,23) figure 3.

Figure 3 Treatment which required for periodontal consultant

Above 50% of dentist referred the patients to the periodontist for surgical invasive procedures like flap surgery, bone grafting and regenerative surgery which patient requires (25, 24)

Only 31 % of general dentist have a regular periodontist as a consultant on their clinics. There is a low frequency of periodontal referral relationship among the general practitioners. (26).The reasons for low level periodontal referral may be the chief complaint of patients are not related to their periodontal disease, treatment outcome may be un satisfactory, patient had no interest to carry out the treatment.(27)

General dentists believed that surgical periodontal treatment remains unaffordable to a large section of our population since periodontal therapy in where comprehensive of quite costly.(28,29,30).

CONCLUSION:

The study shows a considerable number of general dental practitioner’s encountered difficulty in diagnosing and treatment planning of patients with periodontal disease. This could be overcome by conducting regular CDE programmes pertaining to periodontal disease diagnosis and management and encouraging general dental practitioners to approach consultant periodontist for complex cases.

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Received on 06.09.2017 Modified on 30.10.2017

Research J. Pharm. and Tech. 2018; 11(3): 930-932.

DOI: 10.5958/0974-360X.2018.00172.5