Considerations for restorative dentistry secondary care referrals - part 3: assessment of case complexity.

Assessing the complexity of a case is a challenging exercise, with many tooth-specific as well as patient-specific considerations required. This decision is not made in isolation but goes hand in hand with the assessment of restorability, as well as strategic importance, both of which have been covered by the previous papers in this series. A number of guidelines regarding this matter have been devised in order to aid clinicians in determining the complexity of their patients and thus the most appropriate setting for their treatment. This paper aims to discuss the various complexity criteria available and their application, thus aiding clinicians in managing some of the more challenging cases.

Considerations for restorative dentistry secondary care referrals - part 1: defining strategic importance.

Strategic importance is an essential concept for dental service providers. It allows clinicians to differentiate treatment needs on both a patient level and a health care commissioning level, not simply based upon complexity alone. On a patient level, it influences both the clinician's and patient's decision as to whether a tooth/teeth should be restored, as well as determining the possible need for specialist input. On a commissioning level, it facilitates the prioritisation of limited resources.Strategic importance can be considered at a patient level, taking into factors such as age, tolerance to treatment and the patient's choice. It can also be considered at a mouth level, accounting for factors such as its impact on function and aesthetics function. All these factors together can influence the decision as to whether complex treatment is warranted on a given tooth, especially in a healthcare model where the allocation of limited resources is necessary.

Considerations for restorative dentistry secondary care referrals - part 2: predictability of treatment.

The assessment of restorability is necessary to determine whether it is possible to predictably restore a tooth once primary disease has been managed.There are a multitude of factors that may determine the restorability of a tooth. It varies on a case-by-case basis and as such, clinicians must consider both local tooth factors and general patient-related factors, ensuring a holistic approach when assessing these patients.This article discusses the many factors that determine a tooth's restorability, including a review of the current indices available to clinicians to aid in this process.

Implementing the 2017 Classification of Periodontal and Peri-Implant Diseases - how are we doing in the South West region of the UK?

Background A new world classification of periodontal diseases and conditions was developed in 2017 and implemented throughout the United Kingdom by the British Society of Periodontology and Implant Dentistry.Method A retrospective audit was undertaken at Bristol Dental Hospital (BDH) (December 2019 to March 2020) to assess uptake of the new classification in referral letters and its implementation by staff. In total, 75 consecutive new patient referrals seen at BDH were manually searched for diagnosis/classification. Additionally, the 75 most recent referrals where both the referring practitioner and BDH staff used the 2017 classification were analysed for agreeability.Results Within South West England, there was a positive uptake of the new classification in general practice, with 85% of referrals using the 2017 periodontal classification. Further, 98% of patients attending BDH for periodontology consultations were diagnosed using the 2017 classification. Results indicate 50.7% and 57.3% agreement for staging and grading, respectively, when comparing consultants to referring clinicians.Discussion The new classification has been widely conveyed to the profession and is being adopted quickly by specialists, general practitioners and dental health professionals. There is an underestimation of both stage and grade by referring practitioners, with 40% of referrals underestimating the stage and 38.7% underestimating the grade.