When should I refer a patient to a periodontist or oral medicine specialist?
Refer a periodontal case when the findings sit beyond what routine non-surgical care manages predictably, and refer a mucosal lesion when you cannot confidently explain it or it does not resolve on its own. A referral is a request for a clinical opinion, not a transfer of the patient — we treat the specialist component and return the patient to your routine care.
At Blignaut · Kotze, both Dr Leande Kotze and Dr Christa Blignaut hold the same combined specialist qualification in periodontics and oral medicine (in South Africa this is one registrable specialty, a four-year MChD), so either doctor can take a periodontal or an oral-medicine referral across the full scope below. You can refer interchangeably.
Which periodontal findings warrant a referral?
A reasonable threshold is the point at which a case stops being a routine maintenance problem and becomes a diagnostic, surgical, or prognostic one. Consider referral when you see any of:
- Pocketing of 5–6 mm or deeper, particularly where it persists after initial therapy. The 2017/2018 World Workshop staging system uses probing depth, interdental attachment loss, and radiographic bone loss to classify periodontitis severity, and the more advanced stages typically need specialist-level non-surgical or surgical management (Tonetti, Greenwell & Kornman, 2018).
- Progressive attachment or bone loss despite reasonable hygiene and routine scaling — a sign the disease is outpacing first-line care.
- Furcation involvement, where access for cleaning and the prognosis are both more complex.
- Tooth mobility or drifting that is new or worsening.
- Gingival recession with sensitivity, root exposure, or an aesthetic concern, where root coverage or soft-tissue grafting may be an option.
- A periodontal abscess, especially recurrent.
- Peri-implant mucositis or peri-implantitis — bleeding or suppuration on probing around an implant, with or without bone loss. Peri-implantitis affects a meaningful proportion of implant patients over time (Derks et al., 2016), and early specialist review gives the best chance of stabilising the tissues.
- An unclear prognosis, or where a second specialist opinion would help you and the patient decide between retaining and replacing a tooth.
- Complex implant planning — multiple or full-arch cases, limited bone volume, or sites likely to need augmentation. The AAP lists these among the scenarios where periodontal involvement adds value (AAP, Dental Implant Procedures).
You do not have to wait until a case is advanced. Referring earlier, when the prognosis is still favourable, often widens the treatment options available to the patient.
Which oral-medicine findings warrant a referral?
Oral-medicine referral is driven less by a number and more by a lesion that does not behave as expected. Refer when you see any of:
- Any ulcer that has not healed within two to three weeks. Persistent, unexplained oral ulceration is a recognised threshold for an urgent suspected-cancer referral (NICE NG12). Painlessness is not reassurance — many significant lesions are painless.
- White or red patches that cannot be wiped off and do not have an obvious cause (such as a sharp cusp or a cheek-biting habit you can identify and reverse).
- Suspected lichen planus or other autoimmune or immune-mediated mucosal disease, where the diagnosis and long-term surveillance plan benefit from specialist input.
- Pigmented lesions that are new, changing, or otherwise unexplained.
- Burning mouth with no visible mucosal cause, where a structured oral-medicine work-up is appropriate.
- Persistent dry mouth that is affecting comfort, function, or oral health.
- Any lesion in a higher-risk patient — for example a tobacco or heavy-alcohol user — where the threshold to investigate should be lower.
- Any lesion where a biopsy would settle the question. If you are uncertain whether a lesion needs histology, that uncertainty is itself a reason to refer.
The guiding principle is conservative: a lesion that has not resolved, or that you cannot fully account for, is worth a specialist look. Most turn out to be benign, and a clear diagnosis is reassuring for the patient.
What happens after I refer?
We see the patient, carry out the specialist assessment, and send you a written report with our findings, diagnosis, and the proposed plan. We treat the specialist component and return the patient to you for routine care; where ongoing specialist follow-up is warranted — periodontal maintenance, oral-lesion surveillance, or peri-implant review — it runs alongside your care rather than replacing it.
Common questions
Do I have to try treatment first before referring? No. For periodontal cases, completing initial non-surgical therapy and re-assessing is reasonable, but you can refer at any point — including before treatment — when the prognosis is unclear or the case is beyond routine scope.
How urgent is a non-healing ulcer? Treat any oral ulcer or unexplained patch persisting beyond two to three weeks as a priority referral (NICE NG12). Phone the practice and flag it as urgent; we aim to see urgent oral-medicine referrals within a few working days.
Should I refer to the periodontist or the oral medicine specialist? Either. Both doctors hold the same combined periodontics-and-oral-medicine qualification, so a single referral covers both fields and we direct it internally.
Will you take over my patient's general dentistry? No. We treat the specialist work and return the patient to you. Routine restorative care, check-ups, and recalls stay with you.
These thresholds are general guidance for clinical decision-making, not a substitute for assessment of the individual patient. If you are weighing a specific case, phone the practice and one of us will talk it through with you — a consultation gives a clinical answer for that patient.