Cleanings- Thomas C. Kelley,DDS, MSD, LLC

Brian P. Kelley, D.D.S., L.L.C.
Oral and Maxillofacial Surgery
Taking appointments 1-414-321-0650

My patients , dentists-referring dentists , dental specialists and medical doctors have helped me modify this webpage. Any suggestions to improve this webpage are welcome. Thank you to all of you who have contributed to my webpage. Your suggestions have helped patients, dentists and dental hygienists. You have made the patient experience at my office a positive one.

Current patients have asked that I post a testimonial page. If you are interested, please e-mail them to me at tck@kelleyperio.com. You may identify yourself as you wish. This is a work in progress. Thank you for your participation.

Patient compliance with periodontal treatment recommendations plays an important part in overall patient care. This would include following post operative therapy instructions, scheduling regular alternating maintenance appointments with your general dentist and following oral hygiene instructions. Smoking cessation recommendations are meant to improve your periodontal and overall health.

Are you being referred to a periodontal specialist for proper treatment or are you taking another path?

Below is an unfortunate list of personal and patient experiences which I am embarrassed to post, but I feel that it will orientate the public with a perspective on what dental care should not be. I've included the cost of procedures in this section to help future patients understand the consequences of their decision making.

Insurance coverage should not be the basis for developing your treatment plan or determining whether you should be referred to a periodontist. The majority of periodontal procedures are covered by your dental and or medical insurance and should be performed by a periodontist, a specialist in the field. An appointment can be scheduled with me without a referral.

Below are common red flags:

1.
Who is a periodontist? What do they do? -
Beware of dental practices, dental group practices or franchises which make no mention of the specialty of periodontics to patients who have periodontal disease. A complete periodontal exam and charting is usually omitted. A periodontist diagnoses, prevents and treats gum disease. Periodontal diagnosis and treatment are the first steps in the sequence of dental treatment. In the United States, a periodontist requires 3 years of training beyond 4 years of dental school. Ask the following questions: Do they have specialty training? Do they treat patients under their own dental license or another dentist's license? Do they practice within the state or live in another state or country -this may affect the follow-up care you receive.

2.
Practice Containment-"Our periodontal cases are "managed" by the dental hygienists." or "We don't alternate appointments with periodontists."-
This opens the general dentist up to ethical questions and their ability to diagnose and treat periodontal disease at the level of a specialist. A hygienist's nonsurgical treatment of periodontal disease alone or failure to refer periodontal cases may fall far short of saving your teeth - "supervised neglect". Oral and systemic health concerns can be raised. Nonsurgical or surgical periodontal treatment may be indicated. These concerns are especially raised when orthodontic treatment ($3000-$7000) is contemplated or performed without a proper periodontal evaluation by a specialist. With time it may be too late to receive proper periodontal treatment.

Please let your general dentist know that you would like to alternate your periodontal maintenance appointments with a periodontist. Maintenance is started after completion of active periodontal therapy and continues at varying intervals for the life of the dentition. It is meant to minimize recurrence and progression of periodontal disease. Maintenance appointments reduce the incidence of tooth loss by monitoring the dentition. It increases the probability of locating and treating problems in a timely manner.

3.
"The Pull and Replace" Concept- "You'll lose your teeth no matter what. Periodontal treatment doesn't work." or "Skip your periodontal treatment, we need to fix teeth - otherwise your insurance will run out."- Keep your own teeth! Note- Skipping periodontal treatment in a dental treatment plan may affect any future dental work performed including preparing restorations in tartar (defective restorations), future gum recession if periodontal treatment is performed later or losing teeth shortly after dental work is completed. Crown lengthening can help restore a tooth prosthetically that may otherwise be extracted.
[Root canal treatment for a front tooth (incisor): $360.00 - $700.00. Root canal treatment for a back tooth (molar):$600.00 - $910.00. Porcelain, porcelain over metal and gold crowns average between $600 to $3100 each in total cost. The cost of tooth extraction varies based on how difficult the oral surgery procedure is. In most cases, this dental surgery runs about $125 to $150. Typically dental bridge cost ranges from $500-900 per tooth. Dentures made by traditional means typically cost from $800 - $1,500 per plate (upper denture or lower denture). Neuromuscularly fitted dentures are more expensive, often $5,000 to $7,500 for a full set. While a basic implant is typically $1,250. to $3,000., depending on your circumstances additional costs for things such as in the case of a posterior mandible, bone regeneration, sinus elevation, and wide diameter or narrow diameter implants quickly escalate to as much as $15,000 to $30,000 for the complete procedure for the upper or lower jaw.]

4.
Just Bad Information-"Periodontists shouldn't do exams. They don't need to look for cavities, I do that." or "They are not allowed to take or examine Xrays." This is absolutely false and should raise a big red flag. Xrays are required for a complete periodontal diagnosis and for insurance purposes. Radiographs should be current and of diagnostic quality. They are used for proper evaluation and interpretation of the status of the periodontium and dental implants. Abnormalities are noted.

5.
Intimidation/Fear Of The Repercussions For Seeing A Periodontist-The quality and timeliness of dental work should not be used as a means of influencing patients.

6.
Any combination or all of #s 1-5.

Below is a description of proper referral criteria which was created to address the problem:

Periodontics (treating gum disease) is one of the first steps to any complete dental treatment plan.

*Guidelines For The Management Of Patients With Periodontal Disease- Academy Report- AAP link on Patient Resources page

"Is the Academy implying a medicolegal standard with the dissemination of these guidelines?- Clearly, each dentist has an obligation to render treatment in the best interest of the patient. It is hoped that this document will help dentists identify patients at greatest risk for periodontal disease so that these patients receive appropriate and timely periodontal care."

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

J Perio Sept 2006

*Academy of General Dentistry-"General Guidelines for Referring Dental Patients to Specialists and other Settings for Dental Care"- Situations or Conditions Necessitating A Referral:

-level of training and experience of the dentist

-extensiveness of the problem

-complexity of the treatment

-desire to share responsibility for patient care

I encourage the ADA , AAP , state representatives and other policy makers to establish a system that makes periodontal specialty involvement in the diagnosis of periodontal disease and treatment mandatory. Both surgical and non-surgical periodontal treatment should be covered by both private and state insurances.