REFERRAL FORM

REFERRALS

Use the form to the right to submit a referral or Click Here for a PDF referral form. Thank you.

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Chicago, IL 60602
(312) 782-4068

periodontist referral
periodontal referrals chicago

Who Is A Qualified Periodontal Dental Referral?

Patients that have the following conditions:

• 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
• Any patient with periodontal diseases, regardless of severity, who the referring dentist prefers not to treat
• Any patient that needs an extraction, bone graft, sinus bone graft, implants services, or help with one of these conditions.

Patients That May Benefit From A Referring Dentist or Periodontist

Any patient with periodontal inflammation/infection and the following systemic conditions can get a dental referral:

• Diabetes
• Pregnancy
• Cardiovascular disease
• Chronic respiratory disease
• Any patient who is a candidate for the following therapies who might be exposed to risk from periodontal infection, including but not limited to the following treatments:

• Cancer therapy
• Cardiovascular surgery
• Joint-replacement surgery
• Organ transplantation

Patients With Periodontal Disease That Are Likely To Benefit From A Second Opinion

Any patient with periodontitis who demonstrates at reevaluation or any dental examination any of the following risk factors/indicators known to contribute to the progression of periodontal diseases:

• Early onset of periodontal diseases (prior to the age of 35)
• Unresolved inflammation at any site (e.g., bleeding upon probing, pus, and/or redness)
• Pocket depths >5 mm
• Vertical bone defects
• Radiographic evidence of progressive bone loss
• Progressive tooth mobility
• Progressive attachment loss
• Anatomic gingival deformities
• Exposed root surfaces
• A deteriorating risk profile