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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Reviews
Full Version
To Refer or Not to Refer Periodontally Compromised Patients- What Does Literature Suggest?
Correspondence Address :
Dr. Laboni Ghorai,
6, Ram Gopal Ghosh Road, Cossipore, Kolkata-700002, West Bengal, India.
E-mail: dr.labonidey@gmail.com
Periodontal disease is one of the most common diseases worldwide. Hence, regular and thorough periodontal screening and care is imperative and should be a basis of all oral examinations. General dental practitioners often being the first to diagnose periodontal disease, might play a significant role in the management of periodontally affected patients. It is also necessary to focus on management of the risk factors and modifying factors which might affect periodontal disease and its treatment plan. Irrespective of the treatment being administered by a specialist or general practitioner, it should be ensured that the patients receive the same and best quality treatment. The level of speciality education being limited in the curriculum for undergraduates, general dentists need to be well acquainted with the criteria of timely and appropriate referrals to periodontists. The speciality of periodontology is growing in diverse aspects and various advancements in this field of dentistry have given success predictability level to previously considered unsalvageable periodontal issues. The present article provides useful guidelines for periodontal referral. It elaborates the levels of complexity associated with periodontal treatment and care of periodontally compromised patients in a secondary care setting.
Periodontal disease, Periodontist, Referral
“A better life starts with a beautiful smile”- but this smile may get compromised due to various oral health diseases; one of the most common diseases worldwide being ‘periodontal disease’ (1). Periodontal disease refers to an inflammatory condition involving the periodontium i.e., the structures supporting the tooth. Its sequelae involves pathological apical migration of gingival soft tissues, alveolar bone resorption and subsequent loss of the tooth (2). Hence, a foundation of periodontal health is absolutely important to ensure overall patient health and to enable success of subsequent dental treatments (3). The discipline of periodontology involves the practice of prevention, diagnosis and management of periodontal disease, and also maintenance of periodontal health, thereby restoring the function and aesthetics of the tooth supporting tissues (4).
General dental practitioners often being the first to diagnose periodontal disease, might play a significant role in the management of periodontally affected patients (5). However, the level of speciality education among them being limited, they should be aware of when and why these patients have to be referred to a periodontist. Referral, defined as taking over care from one healthcare provider to another, is hence crucial and should be an integral part of the present-day dental practice. Knowledge and clinical skill of the referring dentist and the unique needs of the patient should be the basis of such referrals (6).
Components of Referral Process and their Inter-relationship
The referral process includes a triad of components, made up of the referral doctor, referral patient, and the specialist. Active participation of each of these components of the triad is imperative for its success and it requires teamwork, mutual understanding and respect among the team members. In this context, the following should be considered during the referral process (6),(7),(8),(10):
i. Selection of appropriate periodontist: Availability, technical competence, previous treatment success record, previous patient satisfaction level, previous positive experience of referral doctor with specialist, good communication skills and ethical practice are considered some of the prime criteria in choosing a specific periodontist.
ii. Pre-referral communication from the referral doctor to the specialist: The referral doctor should pass on every possible information to the specialist through a referral letter regarding patient’s attitude towards oral health maintenance, any significant medical history that may complicate a proposed treatment, relevant long-term family history and any treatment undertaken so far with response to that treatment. Such communications will help the specialist to hasten the treatment of new patients.
iii. Communication from the referral doctor to the patient: The referral doctor should first suitably explain the patient or patient’s legal guardian regarding the reason for the recommended referral. He can further help making a specific appointment with the specialist or can provide information about the specialist’s fee for the consultation.
iv. Communication from the specialist to the patient: The prime role of the specialist periodontist is to make diagnoses and plan the management of referred cases. It is also his responsibility to elaborate the treatment procedure to the patient along with its cost. He should further provide an explanation of its clinical significance, preferably using digital mock-ups in an attempt to motivate the patient to undertake the treatment procedure.
v. Post-referral communication between the specialist and the referral doctor: There should be a both-way communication between the specialist and the referral doctor. On one hand, the specialist may provide the referral doctor with an expert opinion and treatment plan while on the other hand, referral doctor should make an attempt to get any input back from the specialist regarding the ongoing treatment. However, each specialist should have a professional responsibility to refer the patient back to the referral doctor so that a healthy give and take relationship is established.
Situations that Demand Periodontal Patient Referral
The British Society of Periodontology and Implant Dentistry has put forward state-of-the-art referral guideline for periodontal treatment and maintenance (11). It elaborates three levels of complexity depending on several factors, including:
i. Knowledge, experience and training of oral health care professionals to manage patients with a range of periodontal conditions.
ii. Evidence of genetic and lifestyle/behavioural risk factors.
iii. Grade of the disease based on Basic Periodontal Examination (BPE) score and complexity of treatment required.
Basic Periodontal Examination (BPE) (Table/Fig 1): The BPE is a rapid and simple screening tool that is used to provide basic guidance on treatment. The BPE should be recorded in the following way:
• The dentition is divided into six sextants and the highest score for each sextant is documented: upper right (17 to 14), lower right (47 to 44), upper anterior (13 to 23), lower anterior (43 to 33), upper left (24 to 27), lower left (34 to 37).
• Each sextant of teeth are thoroughly examined (with the exception of 3rd molars unless 1st and/or 2nd molars are missing).
• Each sextant must contain at least two teeth, otherwise it is considered disqualified for recording.
• A World Health Organisation (WHO) BPE probe is used. It has a ‘ball end’ having 0.5 mm diameter and a black band from 3.5 mm to 5.5 mm. 20-25 g of light probing force is recommended for use (12).
• Transgingival walking of the probe should be done around the teeth in each sextant. The highest score for a sextant should carefully be assessed and recorded before moving on to the next sextant.
Following are the levels of complexity linked to the appropriate referral of patients in need of periodontal treatment in a secondary care setting (11),(12):
A. Level 1 complexity: Patients who may benefit from general dental practitioner.
• A BPE score of 1-3 in any sextant
B. Level 2 complexity: Patients who would likely benefit from co-management by the referral doctor and the periodontist.
• A BPE score of four in any sextant
• Evidence of furcation defects and other complex root morphologies (delegated by a specialist)
• Requiring non-surgical management of gingival enlargement following consultation with medical colleagues
• Requiring pocket reduction surgeries, preferably under guidance of a specialist
• Management of non plaque induced periodontal diseases, such as virus mediated diseases, autoimmune diseases, abnormal pigmentation, vesiculo-bullous disease, systemic diseases and syndromes having periodontal manifestations under guidance of periodontist
• Peri-implantitis or mucosal inflammation around implant
C. Level 3 complexity: Patients who should be treated by a periodontist.
• A BPE score of 4 in any sextant along with Grade C or Stage IV periodontitis (bone loss >2/3 root length)
• Aggressive periodontitis
• Requiring complex periodontal surgery
• Evidence of furcation involvement in multi-rooted teeth and other complex root morphologies not suitable for surgery under guidance
• Requiring surgical procedure involving periodontal tissue augmentation or bone removal
• Non-plaque induced periodontal diseases that solely require specialist mediation
• Patients of level 2 complexity who do not respond to treatment
• Peri-implantitis
Other factors known as modifying factors may deteriorate the complexity level. Modifying factors related to periodontal treatment may enhance the complexity level by one grade. The potent modifying factors include:
• Use of regular intramuscular or intravenous medication for the treatment of underlying medical condition
• History of radiotherapy of head and neck region
• Immunosuppression
• Blood dyscrasias
• History of potential drug interactions
• Requirement of coordinated multi-disciplinary management
• Regular use of tobacco in any form
• Mentally challenged patient
• Known case of mandibular dysfunction
• Atypical facial pain or phantom facial pain
• Retching habit or limited accessibility
• Concurrent muco-gingival disease such as, erosive lichen planus
Factors that Evade Periodontal Patient Referral
In spite of having established guidelines for timely periodontal referral, lack of referral to a specialist prevails in the current dental practice.
Reasons for the same have been investigated in various studies, which have come up with the following probable conclusion (13):
i. Higher educational loans of younger graduates may refrain them from periodontal referral in an attempt to keep more patients in their own practice.
ii. Patient referral has been reported to be common among dentists who practiced with one other dentist compared to solo practitioners or dentists in larger group practices.
iii. More patient referrals have been reported with dentists employing more hygienists than those working with fewer hygienists.
iv. General dental practitioners having more periodontal patients tend to defer referral than those who have fewer patients with periodontal disease.
v. In cases where ignorance of general dentists prevents timely referral.
vi. A lack of communication between general practitioners and periodontists.
vii. Unavailability of periodontists close to the location of the general dentists’ practice in a rural area.
viii. Patient’s reluctance to undergo specialist care due to lack of dental awareness or financial constraints.
Negligence not only is defined by acts of commission but also includes acts of omission’- not only the general dental practitioners but the specialists of other dental disciplines should also be aware of the fact that a thorough periodontal screening should be performed on a regular basis and irrespective of the purpose of dental visit. They should be aware of the importance of periodontist in multidisciplinary dentistry and should refer the patients identified with periodontal needs to a periodontist in an appropriate, timely manner to curb the disease process at the earliest. However, none of these rules is hard and fast, but is instead a basis for starting a consultation. Understanding one’s limitations and expectations can only help guide all dental professionals in treating the patient most effectively and realistically.
DOI: 10.7860/JCDR/2023/65770.18558
Date of Submission: Jun 01, 2023
Date of Peer Review: Jul 15, 2023
Date of Acceptance: Aug 04, 2023
Date of Publishing: Oct 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? NA
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 02 2023
• Manual Googling: Jun 29, 2023
• iThenticate Software: Aug 02, 2023 (13%)
ETYMOLOGY: Author Origin
EMENDATIONS: 6
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
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- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com