When to treat: when to refer.

For each patient with periodontal disease, the general dentist must decide when to treat and when to refer. The outcome of this decision is critical to the long-term control of progressive bone and attachment loss. In order to make this decision, the dentist must consider patient related factors, dentist related factors, and the entire range of periodontal therapy available. The purpose of this paper is to review the key factors inherent in this decision making process. The range of therapeutic modalities which should be considered by the dentist are presented for specific periodontal diseases. A rationale for treatment or referral of each specific periodontal disease is given.