What to do when referring a patient
Take a new medical history.
Examine the radiographs and clinical findings.
Explain to the patient why you want to refer them and to whom.
Referral letters
The following information is required:
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Name, title and address of person to whom you are referring the
patient.
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Patient's name, address and Date of Birth (DOB)
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Reason for referral.
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The history of the complaint
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Request for advice and/or treatment.
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Any previous relevant treatment carried out with dates.
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Relevant medical/social history.
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Details of enclosures such as radiographs
Specific referrals require further information:
Orthodontic referrals
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Diagnosis
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Patient's attitude to treatment
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Oral hygiene
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Caries rate
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Previous orthodontic treatment
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Radiographs and study models
Oral surgery referrals
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History of complaint
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Suggested diagnosis
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Indication of urgency
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Relevant radiographs
Periodontal Referrals
Example orthodontic referral letter
Mr Jones
Consultant Orthodontist
St John's Hospital
Chelmsford
01/01/04
Re: Miss Jane Smith
10 Main Street
Danbury
CM3 7YR
DOB: 31/01/91
I should like to refer this 12-year-old girl for advice on the management
of her upper canine crowding. She is unhappy about the appearance of her
teeth and is prepared to wear an appliance.
She is a regular attender, and her oral hygiene is good. She is caries
free. All teeth are present on radiograph. She has a 3mm overjet with a
complete overbite.
The lower arch is well aligned. The upper arch has moderate anterior
crowding with insufficient space for the canines, which are erupting
buccally.
Would it be reasonable to?
1. Extract upper 4's
2. Fit URA to retract upper 3's?
Jane has asthma and regularly uses a ventolin inhaler.
Thank you for seeing Jane.
Yours sincerely
John Dentist BDS
Enclosures: 1 set study models, 1 panoral radiograph
Orthodontic waiting lists are long in some parts of the country, so refer
as soon as the problem becomes apparent and inform the patient that they
may have to wait some months for an appointment with an orthodontist.
Oral Surgery referral letter
Mr White
Consultant Oral Surgeon
St John's Hospital
Chelmsford
01/01/04
Re: Mr Peter Jenkins
24 Willow Avenue
Bicknacre
CM4 8RT
DOB: 11/06/49
This letter follows our telephone conversation earlier today.
This gentleman presented at the practice last week complaining of a
persistent ulcer on the side of his tongue. He reported that the ulcer has
been present for at least four weeks. It has caused intermittent
tenderness.
On examination, the ulcer was located on the left lateral border of the
tongue and was 7mm in diameter. The edge of the ulcer was rolled and hard
to the touch.
Extra orally, there was no detectable enlargement of the sublingual or
submandibular lymph nodes. A sharp cusp from the nearby lower left
first molar was smoothed and an appointment made to review the ulcer a
week later.
The patient attended for the review appointment today and there has been
no alteration in the appearance of the ulcer.
The patient suffers from hypertension and takes captopril daily. He
smokes 20 cigarettes a day and has done for 40 years. He drinks around 20
units of alcohol a week.
In view of these findings, I believe the ulcer may be associated with oral
carcinoma. I have communicated my concerns to Mr Jenkins.
Yours sincerely
John Dentist BDS
If an urgent referral, such as the one above, is required, the oral
surgery department should be contacted by telephone (as soon as possible)
and informed of your concerns. The hospital can then arrange an urgent
appointment. Some hospital departments might ask you to send the letter by
fax.
More routine referrals (for example: a partially erupted wisdom tooth
causing repeated pericoronitis) follow the same pattern but obviously
there is no need to telephone the hospital. When informing the patient of
such a referral, warn the patient that the waiting time may be lengthy.
If possible, always type your referral letters (but don't forget to sign
them).
Some orthodontists and oral surgery departments use printed referral
forms. These forms request the relevant information and are an efficient
way of communicating information.
Communicating with General Medical Practitioners
You will regularly have to request advice from a patient's doctor
(especially in regard to antibiotic prophylaxis, steroids and warfarin).
Always get this advice in writing. (Note: doctor's surgeries are very busy
and often you may have to 'chase up' a response by called the surgery to
inquire whether your request has been dealt with). Also, do not assume
that a doctor will know what the recommended procedure is when a medically
compromised patient needs dental treatment, so if you receive advice which
you know to be incorrect, question it, and if in doubt seek further
advice.
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