Level 3: Patients Who Should Be Treated by a Periodontist
Any patient with:
- Severe chronic periodontitis
- Furcation involvement
- Vertical/angular bony defect(s)
- Aggressive periodontitis (formerly known as juvenile, early-onset, or rapidly progressive periodontitis)
- Periodontal abscess and other acute periodontal conditions
- Significant root surface exposure and/or progressive gingival recession
- Peri-implant disease
Any patient with periodontal diseases, regardless of severity, whom the referring dentist prefers not to treat.
Level 2: Patients Who Would Likely Benefit from Comanagement by the Referring Dentist and the Periodontist
Any patient with periodontitis who demonstrates at reevaluation or any dental examination one or more of the following risk factors/indicators* known to contribute to the progression of periodontal diseases:
Periodontal Risk Factors/Indicators
- Early onset of periodontal diseases (prior to the age of 35 years)
- Unresolved inflammation at any site (e.g., bleeding upon probing, pus, and/or redness)
- Pocket depths ≥ 5 mm
- Vertical bone defects
- Radiographic evidence of progressive bone loss
- Progressive tooth mobility
- Progressive attachment loss
- Anatomic gingival deformities
- Exposed root surfaces
- A deteriorating risk profile
Medical or Behavioral Risk Factors/Indicators
- Smoking/tobacco use
- Diabetes
- Osteoporosis/osteopenia
- Drug-induced gingival conditions (e.g., phenytoins, calcium channel blockers, immunosuppressants, and long-term systemic steroids)
- Compromised immune system, either acquired or drug induced
- A deteriorating risk profile
* It should be noted that a combination of two or more of these risk factors/indicators may make even slight to moderate periodontitis particularly difficult to manage (e.g., a patient under 35 years of age who smokes).
Level 1: Patients Who May Benefit From Comanagement by the Referring Dentist and the Periodontist
Any patient with periodontal inflammation/infection and the following systemic conditions:
- Diabetes
- Pregnancy
- Cardiovascular disease
- Chronic respiratory disease
Any patient who is a candidate for the following therapies who might be exposed to risk from periodontal infection, including but not limited to the following treatments:
- Cancer therapy
- Cardiovascular surgery
- Joint-replacement surgery
- Organ transplantation
