Dental profile: Emily Clarke

In a new feature for Irish Dentistry, Siobhan Kelleher interviews members of the dental profession for insights and opinions into the world of dentistry. Here, Siobhan talks to Emily Clarke about periodontal assessments and referral trends in dentistry

Siobhan: What led you to become a periodontist?

Emily: I’ve always had an interest in the surgical side of dentistry. There is a lot more to being a periodontist than root planing, and I felt it was the perfect combination of surgery, creativity, and for all intents and purposes, ‘weeding’ the oral cavity! The end result is usually quite rewarding and patients are happy, healthy and rehabilitated.

SK: What’s involved in an initial consultation in your clinic?

EC: I usually start with a chat with the patient about their reason for referral and their awareness and understanding of the problem. I then check their medical, dental, family and social history, all of which may help in the diagnosis of their problem and identify risk factors for periodontal disease.

Following this, I carry out a full clinical exam. Full mouth probing pocket depths are recorded at six sites per tooth along with any bleeding or suppuration on probing. Gingival recession and attachment loss is recorded and notes taken of any mobility or furcation involvement. Baseline plaque score records are taken and are an essential motivational tool in oral hygiene instruction. Giving the patient an active role in their treatment plan encourages and improves compliance.

I then take any relevant X-rays – either a combination of periapical X-rays and an OPG or full mouth periapicals.
Once I have all the information gathered, I discuss the diagnosis with the patient, describe the aetiology of periodontal disease and disease progression, and outline a treatment plan and expected prognosis.

SK: Could you explain the criteria for referring to a periodontist?

EC: Well, there are no specific criteria as such; as a periodontist I am happy to accept all patients with periodontal problems!
Some questions to ask when deciding whether to treat or refer would be: what is the diagnosis? Is there a clear treatment plan? Am I capable of completing the treatment plan successfully? Are there areas likely to need surgical treatment?
Generally, if an area is unlikely to respond to non-surgical treatment alone, then referral before any treatment is carried out is probably wise.

I am noticing a reluctance to refer. There seems to be a leaning in modern dentistry towards doing everything ‘in house’

My advice would be to treat cases that are within your capability and for which you have the necessary skills and resources. Be clear about your treatment aims and expected treatment outcomes. Identify potential difficulties at the treatment planning stage rather than during treatment or at the reassessment.

In my experience, a patient is much more loyal and grateful to their referring dentist or hygienist for prompt referral when necessary, than if an attempt was made unsuccessfully to treat the disease.

SK: What is the main difference between a periodontist and a dental hygienist treating non-surgical debridement?

EC: I think the difference is not always necessarily down to skill, but more to resources, ie, a range of instruments, nursing assistance, time allocated to treatment. For example, I treat a quadrant in an hour. I suppose my non-surgical treatment may be more aggressive as I can deal with any consequences such as the need for sutures, gingivoplasty etc.

In addition, by carrying out the non-surgical debridement in advanced cases, it allows the periodontist to have a greater insight into the subgingival condition, such as the presence of infrabony defects, furcation involvement, and to make decisions on the requirement for periodontal surgery, extractions, medication and so forth.

SK: What trends are you noticing in dentistry at the moment?

EC: A reluctance to refer. There seems to be a leaning in modern dentistry towards doing everything ‘in house’. ‘Why was I not referred sooner?’ is, unfortunately, becoming a common complaint. Dentists should be reassured that patients are not lost once referred. Once my patients are consistently stable, I refer them back to the general dentist to continue to maintain their periodontal health. These maintenance appointments are usually at four-monthly intervals. A successfully treated, happy patient is a long term, compliant and regularly attending patient.

Dr Emily Clarke works in practice limited to periodontology and implant dentistry in the Riverpoint Specialist Dental Clinic in Limerick and at Galway Periodontics and Implant Dentistry, Clybaun Road, Galway. She can be contacted via emily@riverpointdentalclinic.ie or info@emilyclarke.ie.

Siobhan Kelleher RDH is the owner of Dentalhygienist.ie. She practices in Co Cork, Ireland. She is a member of the Irish Dental Hygienists Association and continuing education officer on committee. She was awarded Best Dental Care Professional at the 2014 Irish Dentistry Awards and was highly commended at the 2015 Irish Dentistry Awards for Best Child Dental Health Initiative.