Referral Letter

A dentist must accept the obligation to refer the patient for further professional advice or treatment if needed or if the task in hand is beyond the dentist's own skills.

• When to refer

  A dentist should refer any patient if in the dentist’s own opinion the treatment required would be more appropriately carried out by another clinician. Referral for a second opinion may be at the patient's request or the dentist's suggestion. In primary dental care it is expected that the referred patient will be returning to the referring dentist for continuing care.

  • Periodontal referral

    Patients with complex periodontal conditions should be considered for referral.

  • Orthodontic conditions

    There is little advantage in referring unwilling or uninterested patients for orthodontic opinions, except perhaps for advice on extractions. Where a limited treatment plan is thought advisable owing to the background, this should be made clear in the referral letter.

  • Endodontic referral

    There are situations when the endodontic treatment required is beyond the scope of the general dental practitioner. Possible situations may include the removal of silver points or complex molar endodontic cases.

  • Implantology referrals

    The scope of the referral should be made clear at the onset. It might be for an opinion, surgical management or surgical and prosthetic management. All parties should be clear about the responsibility for maintenance care, monitoring and possible re- referral.

  • Other specialties

    The development of other indices is being undertaken and practitioners are encouraged to watch for such developments based on scientific research.

• How to refer
  • The referral letter

    The referral letter should contain adequate, accurate, administrative and clinical information.This includes

    • The patient's name, address (including the postcode), date of birth and gender. A contact telephone number is helpful.
    • A summary of the patient's relevant medical and dental history (including radiographic history). Disclosure of this information in the letter must be with the patient's consent.
    • A clear indication of the condition initiating the referral and patient's preferences with respect to treatment.
    • If treatment is not requested and the referring dentist is asking for advice only (or a second opinion) this must be clearly stated in the letter.
    • An indication as to the level of urgency of the condition.
    • The referring dentist's name and correspondence address must be clearly stated.
    • The referral letter should be dated and a copy retained in the patient’s notes.
    • To minimise further invasive procedures any relevant test results and radiographs should be included with the referral letter.
    • Any special needs of the patient e.g. assistance with access and the best time of day for an appointment in light of social or medical problems.
    • Any physical impairment such as loss of hearing or eyesight.
  • The receiving dentist

    The dentist accepting the patient on referral must ensure that the proposed treatment is fully understood and should not undertake treatment he/she considers inappropriate. The receiving dentist should send a copy of the initial assessment, report and treatment plan to the referring dentist to assist in the continuity of care for the patient.

  • The end-of-treatment letter

    On completion of the treatment, the receiving dentist should send a written report to the referring dentist confirming that the treatment has been completed and what follow-up consultations (if any) are required. Any complications associated with the treatment should also be disclosed along with any obvious concerns that the patient has as a result of the treatment. All radiographs sent with the original referral letter should be returned to the referring dentist with the report.

    The receiving dentist should retain the treatment records and associated radiographs. The referring dentist should also receive copies for future reference.