The Definitive Guide To

Writing Referral Letters

By

@DentistGoneBadd

Basic Referral Writing

Let’s start with the essentials. Referral letters should contain the basics; name, sex (if any – I don’t like to ask really), date of birth and reason for returning….oh sorry, that’s sending a parcel back to Amazon. Long gone are the days of “Please see and treat,” so try and give the specialist you are referring to, a bit of a clue as to the reason for your referral. Throw in a couple of vague differential diagnoses if you can, just to demonstrate you aren’t completely gormless, with proper medical terms like ‘epidermolysis bullosa’ or ‘squishy lump.’ It’s probably best not to refer a patient just because you don’t like the look of them, tempting though it is.

Choice of Specialist

If you are worried about a lump, it’s best to send to a consultant lumpologist. But beware, some specialisms do cross over and consultants can get a bit elbowy and will fight over interesting lesions. I once witnessed a near fist-fight between an oral medic and an oral surgery registrar – both convinced they could write a paper about it. Every time, make sure you are referring to the most appropriate department. One department will treat a lesion with a spray and ineffective mouthwash, while another will cut it out and put an implant in its place.

Oral Surgery Referrals

Oral surgery referrals are probably the most common type made. It’s not quite clear why this should be. Fewer dentists get into trouble over oral surgery than perio neglect or root-treatments. I think that oral surgery is probably all a bit too gooey for a lot of dentals and the anticipation of complications is overthought. Because oral surgery departments are absolutely swamped, you have to make a convincing case. Warfarin patients are no longer a bar to treatment in practice, so throw in ‘difficult access’ and ‘a history of difficult extractions’ for good measure. ‘Proximity to the antrum’ doesn’t often wash. Since many oral surgery departments insist on you supplying a supporting radiograph, they can justifiably throw out the referral and tell you where to stick your jpeg when they realise it’s a lower molar you are talking about.

Orthodontic Referrals

These are probably a little more clear-cut, if you completely ignore IOTN, which I did. I doubt very much if it’s done now, but the acronym ‘FLK’ (Funny Looking Kid) in the margins of the old paper files, acted as a reminder to refer to the orthodontist once the overcrowding started to hurt your aesthetic sensibilities. I find FLK’s generally DO get orthodontic treatment, so providing they are reasonably competent with toothbrushing, and generally look as if they’re using the hairy end, send that referral. Again, don’t just ask to ‘see and treat’. Throw in ‘well-motivated,’ ‘optimal oral hygiene’ and ‘very stroppy mother’ to emphasise the need for action. Chuck in a couple of measurements if you can, and try and crowbar in a stab at a ‘division’ to show to the orthodontist you’ve given it some careful consideration.

Periodontal Referrals

This type of referral is usually done in panic five minutes after you have just unexpectedly lost a BPE probe down a previously scoring ‘1,’ so do try and keep the panic out of your letter. Make it sound like you’ve been closely monitoring things for a considerable period of time and really emphasise that when you first saw the patient, most of the damage was already done. ‘Despite my oral hygiene instruction’ also shows that you have been caring, but don’t get too down about having to refer and being condemned by the periodontist. The specialist will probably only see the patient for twenty minutes max anyway, and will never see them again, immediately throwing the patient into the ‘Pit of Hygienists.’

Endodontic Referrals

Endodontic referrals are becoming incredibly popular and you are highly unlikely to get one rejected, since they are often made to private specialists. Don’t bother trying to refer to your local dental hospital. The sun will have died well before your patient gets to the top of the list. Besides, dental hospital endodontists are exceptionally picky about what they treat. My local dental hospital won’t treat any tooth beyond a first molar. They aren’t that clear why, though I suspect it’s because trying to get to a seven is a bit ‘too fiddly.’ Failure in endodontics is a growing area of litigation and if you are an NHS dentist in particular, don’t risk ANY root-treatment – refer. You can throw a lot of information into your referral letter – sclerosis, unusual anatomy or “There’s a prominent squiddly-do on my radiograph” – but it doesn’t matter. These are endodontists. They have to pay for swanky microscopes and German Sportwagen. They’ll accept anything.

Implant Referrals

See Endodontic Referrals. Patients think they are the same thing anyway.

Prosthetics Referrals

Tricky. Prosthetics specialists are a dying species. Their natural habitat in the 60’s and 70’s was gummy, but since forestation with teeth, the need for them has diminished. The few prosthetists left, tend to pack together at dental schools, desperately attempting to procure close relationships with implantologists, borne out of their innate instinct to survive. Having said all that, I have had more referrals rejected by prosthetics specialists than any other type. To be absolutely honest with you, whatever you say in your referral to a denture specialist, they’ll write back with “We would recommend extending the flanges and see no reason why this cannot be carried out in practice. Now leave me alone. I need to bury my nuts for the winter.” Good luck.

Community Clinic/Paediatric Referrals

This is where you send all of your ‘challenging’ patients, or those that take an hour to do an enamel-only incisal edge composite on. Terms you should include in your letter are ‘wriggly,’ ‘anxious,’ ‘fearful,’ ‘phobic’ and ‘gagger,’ though be careful you don’t end up making it sound like a Facebook advert for happy hour at the local S&M Club. Make it absolutely clear that this patient needs sedation. Forget about suggesting GA. The clinicians at these emporia don’t stop talking about the risk of death from the time the patient enters the place having found it after previously mistakenly walking into the adjacent STD Clinic. If your local clinics have their own referral forms and it gives you the option to have the patient back if they refuse sedation, tick ‘NO!!!’

Restorative Specialist Referrals

Quite a few restorative specialists lurk in dental schools, but despite this, they try not to have anything to do with teeth. There is only one important, indeed, CRITICAL sentence you need to include in your referral letter, and that is: “I am ALREADY monitoring the diet and wear.”

Oral Medicine Department Referrals

You will normally refer to the oral medicine specialists as a means of backing up your diagnosis, which is almost certainly, atypical facial pain/burning mouth syndrome. Often, you would save a lot of time by giving a nightguard or benzydamine hydrochloride rather than wasting your time on a referral letter.

The most responsible elements of a dental professional’s remit is making effectual clinical decisions and planning appropriate dental care. Most often patients seek treatment to address comfort function and aesthetics but this can be compromised by fear, cost, time and access.

Practitioners are able to base clinical decisions on their professional knowledge, scientific evidence and experience. However, in order to preserve the trust and to serve patients well, dental professionals must take time to understand their expectations and limitations before any treatment begins.

Patients favour a personally active approach to dental treatment. A collaborative decision, with patient and dentist equally sharing responsibility for decision-making, is increasingly popular.[1]  As well as examination, diagnosis, determining aetiology and formulating appropriate treatment options, individual preferences and requirements should be tailored into the treatment plan. Additionally, well-informed, engaged patients are placed in a stronger position when deciding between treatment options and are more likely to take ownership of the final treatment decision and outcome.

Patient expectations should be considered carefully and practitioners need to recognise that the focus of the general population has shifted from ensuring teeth are healthy and pain free to an ever-stronger desire that they should also be aesthetically pleasing.[2] As a result, the demand for higher standards of treatment and cosmetic procedures are on the increase, but when both the practitioner and patient bring value and information to the treatment plan they can build an agreement together, which is more likely to result in patient satisfaction.

There will, of course, always be occasions when things happen that are beyond our control but by covering every eventuality, both patients and professionals can be aware of any factors or risks that could compromise the treatment outcome. When shared decision-making takes place, patient acceptance of any less desirable consequences increases and the likelihood of complaints and claims arising from clinical decision-making are also reduced.

Planning well is an attribute that all professionals aspire to achieve. It is particularly important in the dental practice because a detailed treatment plan is beneficial not only for the patient and practitioner but the dental team and laboratory. With forward thinking, realistic scheduling and organisation, the skills, services, materials and time can be communicated and allocated efficiently to ensure the most effective results.

At times, cases present that are beyond the technological parameters or skill set of the practice. This could be due to the complexity of the treatment or due to the patient needs and enhanced imaging, sedation or specialist clinical skills may be required. Whatever the circumstances, dental professionals need to recognise any limitations and make a decision to refer.

Calling upon the additional assistance will ensure the success and accuracy of treatment. Furthermore, it extends the professionalism of the referring dentist and practice. However, these professionals must be able to trust the people and services they chose to work with and have confidence in their expertise.

London Smile Clinic is able to provide a referral service that can be integrated into any treatment plan. Referring dentists can rest assured that they will remain informed throughout the treatment and feel confident that their patients will receive first class treatment to achieve the most successful results possible.

For more information, please contact 020 7255 2559 or
visit www.londonsmile.co.uk/refer

Dr Rashed Ala-Uddin from The Gardens Dental Centre has been referring implant patients to Ten Dental for over 18 months:

“Referring to Ten Dental is a straightforward and easy process, I just email over the patient’s details and X-rays and Ten Dental contact the patient straight away to arrange the initial consultation.

“Overall my patient’s have found the process very good and are positive about their experience at Ten Dental.

“I feel completely confident in the ability of the Ten Dental team and it is extremely helpful to be able to refer patients into their expert hands to ensure they get the best treatment possible.”

Dr Martin Wanendeya and Dr Nik Sisodia at Ten Dental provide a comprehensive and thorough implant referral service for your patients. They are both renowned experts and are able to deal with all cases. Contact the knowledgeable team at Ten Dental today to find out more.

For more information about Ten Dental and The Implant Restoration Course visit Facebook/Implant Restoration Course-IRC, email: This email address is being protected from spambots. You need JavaScript enabled to view it., visit www.implant-restoration.com or call 020 7622 7610

Tim Bradstock-Smith from The London Smile Clinic shares his thoughts on the increasingly popular field of implant surgery and how dental referrals can help you and your practice...

Although traditional dentures still have a place, implant surgery is fast becoming an indispensible part of mainstream dentistry. Global forecasts suggest that Europe will continue to drive and dominate the area of dental implants and prosthetics until at least 2018.[1] What’s more, the current economic recovery is likely to see a further push and market expansion.

Successful restoration for an edentulous patient takes both functional and psychosocial adaptation, but their self-confidence is significantly enhanced[2]  by their resulting satisfaction with comfort, function, appearance and health. When compared to conventional complete dentures, data has provided scientific evidence of an improved quality of life after dental implant therapy.[3] Implants are much more convenient for patients and offer improved appearance, looking and feeling like natural teeth. Additionally, patients with positive self-esteem have been shown to experience significantly fewer physical health symptoms[4] and some researchers have gone so far as to suggest that the larger your smile, the longer you may live.[5] Whichever way you look at it, successful smile restoration has both physical and psychological benefits for patients.

The medical advantages of implants are that they help to prevent bone loss and actually stimulate growth to maintain the structure of the face. Also, well-maintained implants placed into adequate bone can be expected to last for many years.

Replacing or restoring missing or damaged teeth with virtually undetectable implants can be a complex procedure. However, it can be extremely rewarding for dentists who are able to not only produce a beautiful smile, but also raise patient self-esteem and confidence.

Successful implant surgery requires considerable attention to detail, outstanding accuracy and a comprehensive set of surgical skills acquired through on-going training and experience. Specialist technology and imaging is also needed to plan and execute implant treatment meticulously, ensuring optimal placement.

One clinician or indeed one practice may not have all the technology, space or the surgical skills required to provide the scope of treatment necessary for all implant surgery, particularly if a practice already provides specialist treatment in an alternative field of dentistry. Equally the patient demographics of the area may not make it financially worthwhile to support this provision. In addition, the training and education clinicians require to place implants successfully takes a significant amount of time as well as expense and often, if this knowledge is not used regularly, it is difficult for practitioners to maintain the skills required to achieve high quality work.

Even when a clinician is qualified to undertake implant surgery, there are still cases that require more specialist surgical skills with treatment sites that require advanced preparation or enhancement before implant surgery can take place. Some cases will require socket augmentation procedures, for example, or advanced regenerative procedures such as guided bone regeneration, bone condensation, ridge splitting, particulate grafting, autogenous block grafting, sinus augmentation, connective tissue grafting and further special methods such as inferior dental nerve lateralisation and distraction osteogenesis.

However, successful implant surgery can be still be delivered by suitably experienced clinicians or specialists in a team approach.

A centre of excellence such as London Smile Clinic provides a referral service to practitioners to undertake implant procedures on their behalf. Dr Zaki Kanaan is a highly trained implantologist, who will work closely with you to form a team, ensuring the best possible results for your patients. Whether you wish to refer more complex cases to Zaki or just refer out part of the overall treatment, the team at London Smile Clinic will keep you informed throughout the procedure. The patient will then return to you for continued treatment or on-going maintenance and care. London Smile Clinic prides itself on delivering a 5 star service and first class dentistry, and referring dentists can be confident that their patients will be in safe hands.

Keeping up in an ever-advancing industry can be both expensive and problematic. Equally, patient expectations are now much more forward thinking with an increase in people wishing to undertake corrective or cosmetic procedures.[6] It is not always possible to provide all services individually but by making use of the technology, facilities and skills offered by referral practices, it is possible to extend your areas of expertise and professionalism to enhance your treatment provision. In doing so, patient satisfaction and confidence is improved and as a result, these patients will return to your practice time and time again.

For more information, please contact 020 7255 2559 or
visit www.londonsmile.co.uk/refer