Referral Patterns of General Dental Practitioners for Oral Surgical Procedures

Purpose: The health maintenance organizations (HMOs) in the United States continue to be a powerful force in the field of medicine. Their infiltration into dentistry has placed an emphasis on having the primary care provider (general practitioner [GP]) function as the central orchestrator from which patient care cascades. The purpose of this study is to determine the self-perceived threshold and referral tendencies for the GP to a specialist for oral surgical needs. Materials and Methods: Six hundred dentists were randomly selected to receive a questionnaire containing 16 clinical cases. These randomly arranged cases consisted of a brief case history and appropriate radiographs. Each case differed in complexity and was grouped according to surgical difficulty as follows: group I-simple dentoalveolar surgery, group II-complex dentoalveolar surgery (including any third molar case), group III-cases requiring placement of an implant, group IV-simple surgery for a medically compromised patient, and group V-complex surgery for a medically compromised patient. Results: Differences in the referral patterns of cases were noted comparing age, gender, and years of practice of the GP. A higher referral rate to the specialist was also observed in patients with remarkable medical conditions. Most general dentists referred the complex dentoalveolar surgery cases. There exists a gender difference in the referral patterns of female dentists compared to their male counter parts in similar age groups and years of clinical practice. Most dentists referred the implants procedures to oral and maxillofacial surgeons or periodontists. Referrals for simple and complex surgical procedures were most often made because of inadequate surgical experience. Conclusions: When designing dental health policy with regard to exodontia, dentoalveolar surgery and management of the medically compromised patient, insurance companies and public health administrators should consider the existing competencies and level of comfort of the GP.