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When to refer?

I work at a pediatric office. I have a few 18 year olds who don’t plan on leaving anytime soon and the dds doesn’t plan on making them leave. A few have a couple 4 mm pockets with probing. At what point so I tell them they need to start at a gental dds or periodontist? Do you refer patients with 4mm pockets? Or wait until they have 5’s? I have been referring pts with one or two 4 mm pockets.



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7 Answers

I know you are in a pedo office but hygienists should still be skilled enough to scale 4mm pockets effectively. If it there are 5’s maybe refer to a general dds and then they can decide to see them or refer to a periodontist. But as long as you can effectively scale a 4mm pocket I don’t see the need for a referral. Stress home care of course and maybe the 4’s will decrease to 3’s if they can get the gingivitis inflammation under control.

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I also work for a pediatric practice. We allow them to come as long as we can meet their needs. We will clean patients with 4mm pockets as long as we feel we can ethically treat them. It’s basically a case by case decision.

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In my general practice, we refer at 6 mm. to periodontist.. Pedo office is different though, but my question is WHO are you referring at 4mm patients to… a GENERAL DDS or PERIO DDS? Before we refer to perio I give a very thorough explanation , including simple handouts, and tell them we plan to give them a chance to avoid the periodontist by increasing homecare (that you have already gone over) …if in 6 mos there is no improvement, we refer…often they’re motivated to stay out to the perio office.

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With 4mm pockets on an 18 year old, is it gingivitis that OHI needs to be addressed? I would think office policy would need to be the protocol. I ( in a general office) would not refer to a periodontics for 4 mm pockets.

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I work in a collaborative practice and we have a pedodontist. She refers out after the age of 21 to us. I recommend pts with 6+mm pockets and noted bone loss or recession to a periodontist. I may also refer pts i perform SRP on and the tissues are not responding:(

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I refer 6+ mm pockets. I agree that you should be able to effectively scale a 4 mm pocket.

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I wouldn’t think an 18 year old coming regularly has perio disease. 4mm pockets yes……probably pseudo pocket and gingivitis. Pedo can stay until age 21. I usually refer to periodontist 7mm and above if no resolution with non surgical therapies and home care improvements.

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