Virginia‐based periodontists’ perceptions: Current and future trends of the specialty

Abstract

Background The aim of this survey was threefold: (1) describe the demographics of periodontists and their practices in Virginia; (2) explore periodontists’ perceptions of the impact that changes in the field of dentistry (i.e. increasing corporate dentistry, graduate debt, digitalization, and volume of periodontal procedures done by general practitioners [GPs]) are having on the specialty; (3) explore how periodontists might adjust their practices to account for these trends. Methods An electronic survey was emailed to Virginia‐based American Academy of Periodontology (AAP) members assessing personal and practice demographics, trends in treatment modalities and practice models, and to survey how periodontists plan to adapt their practices for these trends. Virginia has large urban, suburban and rural municipalities, which renders the state a favorable representation of the United States as a whole. Results The response rate was 31% (n = 46). Most respondents (87%) were male and practiced full‐time (70%). Respondents reported practicing predominantly in urban (n = 19, 41%) and suburban (n = 24, 52%) and less in rural areas (n = 3, 7%). In current practice, respondents reported greater numbers of referrals from more experienced GPs. Student debt after periodontal residency was significantly associated with age (P value = 0.0002), with 56% of respondents aged <40 years reporting student loans >$250,000 compared with 3% for those aged ≥40 years. Respondents ranked biologic advances, treatment of peri‐implantitis, advances in digital dentistry, development of corporate and group practice models, and integration of more periodontal services in GP practices as the most likely trends to impact periodontal practices. The most commonly reported practice adjustments included expansion of existing services, increasing the number of periodontists in the practice, and joining with other specialists or GPs to create group practices. Conclusion Periodontists perceive the need to expand services, increase the number of providers in their practices or create group practices to account for increased corporate dentistry, graduate debt, digitalization, and volume of periodontal procedures performed by GPs.

Biomarker panel discriminates diabetics with and without periodontitis pre‐ and post‐therapy

“…Dental clinicians rely on clinical and radiographic parameters to make treatment decisions at initial and maintenance periodontal visits. However, not all general dentist screen for periodontal disease or routinely refer to a periodontist; 52,53 thus, our findings support the concept that clinicians and patients could benefit from development of fast, easy, and reliable tests that provide knowledge of salivary biomarker levels at baseline and maintenance visits. Consistent with this and other studies, 33,[54][55][56][57] we found that several salivary biomolecules are differentially expressed in DWoP and DWP compared with periodontally healthier patients, and persistent elevations of salivary IL-1β, MMP-8, and resistin were associated with incomplete resolution of periodontal disease in diabetics at the patient level.…”

Periodontal referral patterns in Norway: 2003 versus 2018

“…As it is reasonable to assume that teeth were extracted due to hopeless periodontal prognosis, the overall periodontal status is supposed to be less severe. In the Virginia‐based American study, (White et al, 2019) it was suggested that there was an increased pressure among general practitioners to perform in‐house periodontal treatment in order to keep the revenue for themselves, instead of referring to specialist. There was also a perception that general practitioners wanted to do implant surgery in‐house.…”

“…In USA and Norway, nonsurgical periodontal treatment is part of the total insurance costs for dental treatment. This financial aspect may play a role in the referral decision for the general practitioner (Flemmig & Beikler, 2013;Kraatz et al, 2019;White et al, 2019). It has been stated that a major factor in failing to refer periodontitis cases to specialist services has been inaccessibility (Linden et al, 1999) 68% used the Community Periodontal Index of Treatment Needs (CPITN) for periodontal assessment.…”

“…Recent reports suggest that nonclinical factors related to patients, general practitioners, practice demographics, feedback from patients, fees, and working relationships with specialty care clinics influence referral patterns (Kraatz et al, 2017(Kraatz et al, , 2019. A Virginia-based survey indicates that periodontitis receive the least referrals from general dentistry providers with less than 5 years professional experience (White et al, 2019). This might be a result of improved periodontal education over the years, but also related to the increasing debt burden faced by younger practitioners.…”

Henvisningsmønstre for pasienter med periodontitt i Norge: 2003 versus 2018

“…Nylige rapporter kan tyde på at ikke-kliniske faktorer relatert til pasienter, tannleger, demografiske forhold ved praksisen, tilbakemelding fra pasientene, honorar og arbeidsrelasjonen med spesialistklinikken påvirker henvisningspraksis (8,9). En undersøkelse fra Virginia (USA) tyder på at allmennpraktiserende tannleger med mindre enn fem års erfaring henviser pasienter med periodontitt i minst grad (10). Dette kan vaere en følge av forbedret undervisning i periodonti over tid, men kan også vaere grunnet større gjeldsforpliktelser blant yngre allmennpraktiserende tannleger.…”