IMPACT OF MICROBIOLOGICAL CONSULTATION ON CLINICAL DECISION-MAKING - A CASE-CONTROL STUDY OF CLINICAL MANAGEMENT OF RECURRENT PERIODONTITIS

DATA OBTAINED FROM DIAGNOSTIC TESTS may influence the clinician's perc eption of the patient's state and in some instances may alter subseque nt choices of therapeutic interventions. To determine if microbiologic al consultation influences the clinical management of patients with re current periodontitis, an observational, case-control study was conduc ted to measure the amount and type of periodontal treatment provided b y periodontists (n = 13) who had referred patients with recurrent peri odontitis for microbiological consultation. The control group consiste d of periodontists (n = 10) who had not referred recurrent periodontit is patients for testing. Patients (n = 31; 20 females, 11 males; mean age 49.8 +/-10.0 years) treated by the case group of periodontists wer e matched for age and sex to patients (n = 48; 22 females, 26 males; m ean age 49.9 +/- 8.5 years) treated by the control group of periodonti sts. Questionnaires were administered to quantitatively assess the amo unt and type of treatment before and after receiving the microbiologic al report. Specific analyses were performed as a function of the time of receipt of the microbiology report. Case-control differences prior to the receipt of the report indicated that the amount of surgery/year was 43% greater for controls (P <0.04), in spite of control patients exhibiting fewer deep pockets than case patients (P <0.05). Case-contr ol differences after the receipt of the report indicated that case pat ients were provided with 45% greater number of appointments/year (P <0 .005), 46% greater scaling/year (P <0.02), and 79% greater antibiotics /year (P <0.01) compared with controls. The report influenced 9 (69%) case periodontists to change treatment. Case patients who received a c hange in treatment (n = 21) exhibited greater number of deep pockets a t the time of entry into the study (P <0.05) as compared with case pat ients who did not receive a change in treatment. Paired t-tests of dif ferences within groups before and after the report demonstrated that c ase patients had a significant increase in treatment after the report as shown by 22% greater number of visits/year (P <0.05) and 54% greate r number of antibiotic prescriptions/year (P <0.01), In contrast, cont rols demonstrated no significant change in treatment. Further, contras ts of change in treatment before and after the report again indicated that case patients exhibited a significantly higher number of visits/y ear (P <0.04) and number of antibiotic prescriptions/year (P <0.02) co mpared with control patients. These data indicate that the increased n umber of visits and antibiotic prescriptions provided by the case peri odontists was due, in part, to the impact of the microbiology report o n the decision-making process and in part to the initial pocket depths .