#LINICAL0RACTICE

4REVOR "URKE
2UTH &REEMAN

2EFERRALS
!BSTRACT )T IS BEHOLDEN TO THE GENERAL DENTAL PRACTITIONER TO REFER PATIENTS FOR WHOM S HE FEELS THAT TREATMENT COULD BE CARRIED OUT TO A
HIGHER STANDARD OR MORE EFFICIENTLY AND EFFECTIVELY BY ANOTHER DENTIST )N ADDITION PATIENTS ARE ENTITLED TO A REFERRAL FOR A SECOND OPINION AT
ANY TIME 4HIS PAPER DISCUSSES THE RESPONSIBILITIES OF THE REFERRING DENTIST AND THOSE OF THE DENTIST TO WHOM THE PATIENT HAS BEEN REFERRED
#LINICAL 2ELEVANCE 4HE EXPERIENCE OF CLINICIANS VARIES SO REFERRAL TO ANOTHER DENTIST MAY BE APPROPRIATE IF THE PATIENTS DENTAL PRACTITIONER
CONSIDERS THAT TREATMENT MIGHT BE MORE EFFECTIVELY CARRIED OUT BY ANOTHER DENTIST
$ENT 5PDATE    

)T IS THE AIM OF THIS PAPER TO INTRODUCE DENTISTS OWN SKILLS ! PATIENT IS ENTITLED TO A SHOULD FIRST HAVE MADE A DIFFERENTIAL
A SHORT SERIES ON REFERRALS OF PATIENTS TO REFERRAL FOR A SECOND OPINION AT ANY TIME AND DIAGNOSIS OF THE PATIENTS CONDITION ANDOR
DIFFERENT SPECIALTIES THE DENTIST IS UNDER AN OBLIGATION TO ACCEDE TO ON THE TREATMENT REQUIRED IN ORDER TO MAKE
! SENSIBLE DENTIST IS ONE WHO THE REQUEST AND TO DO SO PROMPTLY A DECISION ON I WHETHER S HE WILL BE ABLE
KNOWS HISHER LIMITATIONS )T IS THEREFORE TO CARRY OUT THE NECESSARY TREATMENT AND II
BEHOLDEN TO THE GENERAL DENTAL PRACTITIONER !S PATIENTS MAY CHOOSE THEIR WHETHER REFERRAL IS NECESSARY /N THE OTHER
'$0 TO REFER PATIENTS FOR WHOM S HE FEELS '$0 ON THE BASIS OF CONVENIENCE OF HAND THERE MAY ALSO BE OCCASIONS WHEN
THAT TREATMENT COULD BE CARRIED OUT TO A LOCATION A REFERRAL SHOULD BE DISCUSSED WITH THE PATIENTS DENTAL PRACTITIONER IS UNABLE TO
HIGHER STANDARD OR MORE EFFICIENTLY AND THE PATIENT IN TERMS OF EASE OF ATTENDANCE FORM A DIAGNOSIS AND REFERRAL FOR THIS WILL BE
EFFECTIVELY TO A SPECIALIST )N THIS RESPECT AT A SURGERY OR HOSPITAL WHICH MAY BE NECESSARY
EVERY DENTIST SHOULD BEAR IN MIND THAT LOGISTICALLY MORE PROBLEMATIC AS WELL AS 4HE REFERRAL LETTER SHOULD BE
FOR THE BENEFIT OF PATIENTS ALL POSSIBLE THE COST IMPLICATIONS AND THE POTENTIAL FOR DATED SHOULD IDEALLY BE TYPEWRITTEN OR AT
TREATMENTS SHOULD BE MADE AVAILABLE WITH A SUCCESSFUL OUTCOME &URTHERMORE THE WORST HANDWRITTEN LEGIBLY AND SIGNED BY
THE ASSISTANCE OF OTHER QUALIFIED DENTAL OR REFERRING '$0 SHOULD ADVISE THE PATIENT THE REFERRING DENTIST !S MANY HOSPITALS NOW
MEDICAL COLLEAGUES IF AND WHEN NECESSARY REGARDING HISHER RESPONSIBILITIES TO THE PROVIDE FORMS ON WHICH REFERRALS SHOULD BE
)T IS NOT APPROPRIATE TO REFER A PATIENT DENTIST TO WHOM S HE IS REFERRED SUCH AS MADE IT IS BEHOLDEN TO THE REFERRING DENTIST
BECAUSE THE REQUIRED TREATMENT IS DEEMED ATTENDING FOR APPOINTMENTS AND SETTLING TO OBTAIN THESE 4HE REFERRAL SHOULD BE SENT
FINANCIALLY UNREWARDING 4HE 'ENERAL THE ACCOUNT 4HE PATIENT WILL THEN BE ABLE TO BY POST OR FAX IF THIS IS A SECURE NUMBER
$ENTAL #OUNCIL IN THE -AY  REVISION OF MAKE AN INFORMED DECISION ON WHETHER TO USED ONLY BY THE SPECIALIST  ! TELEPHONE
@-AINTAINING 3TANDARDS STATED IN 0ARA  AGREE TO THE REFERRAL AND IF SO TO DECIDE THE REFERRAL CAN BE MADE IF THE DEGREE OF
QUESTIONS THAT S HE WILL ASK THE SPECIALIST URGENCY WARRANTS THIS %MAIL REFERRALS
7HEN ACCEPTING A PATIENT SHOULD BE USED WITH CAUTION TAKING CARE TO
A DENTIST ASSUMES A DUTY OF CARE WHICH PROTECT THE CONFIDENTIALITY OF THE PATIENT
INCLUDES THE OBLIGATION TO REFER THE PATIENT FOR 2ESPONSIBILITIES OF THE REFERRING 4HE REFERRAL SHOULD CONTAIN THE FOLLOWING
FURTHER PROFESSIONAL ADVICE OR TREATMENT IF IT DENTIST INFORMATION
TRANSPIRES THAT THE TASK IN HAND IS BEYOND THE 2ESPONSIBILITY FOR MAKING AN „ .AME ADDRESS DATE OF BIRTH AND
APPROPRIATE REFERRAL LIES WITH THE REFERRING TELEPHONE NUMBER OF THE PATIENT AND THE
DENTIST AS AN INAPPROPRIATE REFERRAL IS A PATIENTS AVAILABILITY
&*4 "URKE $$3 -$3 -3C 0RIMARY WASTE OF THE SPECIALISTS TIME AND IN TURN „ 4HE PATIENTS RELEVANT DENTAL AND MEDICAL
$ENTAL #ARE 2ESEARCH 'ROUP 5NIVERSITY OF A WASTE OF REVENUE IF THERE IS THIRD PARTY HISTORY
"IRMINGHAM 3CHOOL OF $ENTISTRY 3T #HADS FUNDING LET ALONE THE INCONVENIENCE TO „ 4HE DATE OF THE REFERRAL
1UEENSWAY "IRMINGHAM " .. 5+ AND THE PATIENT .OTWITHSTANDING THIS HOWEVER „ ! BRIEF HISTORY OF THE REFERRING DENTISTS
2UTH &REEMAN 0H$ -3C --ED3C "$3 ONLY A QUARTER OF REFERRALS TO A UNIT OF EXAMINATION OF THE PATIENT THE PATIENTS
$ENTAL (EALTH 3ERVICES 2ESEARCH 5NIT CONSERVATIVE DENTISTRY WERE CONSIDERED COMPLAINT AND SPECIFIC NEEDS
5NIVERSITY OF $UNDEE -ACKENZIE "UILDING WHOLLY APPROPRIATE WHEN ASSESSED BY A „ 7HETHER THE PATIENT IS BEING REFERRED FOR
+IRSTY 3EMPLE 7AY $UNDEE $$ "& 5+ PEER GROUP OF '$0S 4HE REFERRING DENTIST TREATMENT ADVICE OR A SECOND OPINION
 $ENTAL5PDATE *ULY!UGUST 
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 #LINICAL0RACTICE

„ 4HE DEGREE OF URGENCY OF THE REFERRAL „ /BTAIN INFORMED CONSENT FROM THE PATIENT TO PROVIDE IT HAVING HAD SUFFICIENT TRAINING
„ 7HETHER THE REFERRAL IS FOR TREATMENT „ -AKE ARRANGEMENTS FOR THE PATIENTS AND EXPERIENCE TO COMPLETE THE PROPOSED
UNDER THE .(3 OR PRIVATELY AND IF THE EMERGENCY CARE IF NEEDED TREATMENT SAFELY AND TO AN ACCEPTED STANDARD
LATTER WHETHER THE PATIENT IS COVERED BY „ 7RITE TO THE REFERRING DENTIST FOLLOWING
APPROPRIATE PRIVATE INSURANCE THE CONSULTATION WITH A TREATMENT PLAN AND )N RELATION TO REFERRAL FOR ADVICE
„ 4HE REFERRING DENTISTS CONTACT DETAILS AGAIN WHENEVER TREATMENT IS COMPLETED THE SITUATION IS VARIABLE )N SOME REGIONS
)F APPROPRIATE RADIOGRAPHS OF GOOD QUALITY 4HE SPECIALIST SHOULD NOT CARRY CONSULTANTS MAKE TIME TO SEE PATIENTS OR AT
HAVE BEEN TAKEN IDEALLY THESE OR COPIES OUT TREATMENT OTHER THAN THAT FOR WHICH LEAST THEIR STUDY CASTS AND RADIOGRAPHS WHO
SHOULD BE SENT WITH THE REFERRAL LETTER WITH THE REFERRAL WAS MADE IN PARTICULAR FOR THE ARE TO BE TREATED BY PRACTITIONERS /THERS
A REQUEST THAT THEY ARE RETURNED IN DUE GENERAL CARE OF THE PATIENT )F ADDITIONAL PREFER TO PLACE THE EMPHASIS ON TREATMENT
COURSE AS THIS WILL PREVENT THE NEED FOR TREATMENT IS INDICATED THIS MUST BE BY SPECIALISTS WHO DO NOT NEED ADVICE SO
THE SPECIALIST TO RE EXPOSE THE PATIENT TO DISCUSSED WITH THE PATIENT AND THE REFERRING OFTEN 'OOD ADVICE IS FOR PRACTITIONERS TO
RADIATION DENTIST .O FINANCIAL INCENTIVES SHOULD BE GET TO KNOW THE CONSULTANT AND SPECIALISTS
)T GOES WITHOUT SAYING THAT PAID TO ENCOURAGE REFERRALS IN THEIR REGION 4HEY WILL USUALLY HAVE AN
THE REFERRAL LETTER SHOULD CONTAIN CORRECT ESTABLISHED POLICY ON GIVING ADVICE
INFORMATION FOR EXAMPLE WHEN AN
ORTHODONTIST REFERS A PATIENT BACK TO HISHER %THICAL GUIDANCE FROM A DEFENCE
DENTAL PRACTITIONER FOR EXTRACTIONS ORGANIZATION #ONCLUSION
%THICAL GUIDANCE ON REFERRAL CAN ! COMPLETE EXAMINATION
BE FOUND ON THE $ENTAL 0ROTECTION WEBSITE AND IDEALLY THE MAKING OF A DIAGNOSIS OR
2ESPONSIBILITY OF THE DENTIST TO AND IN THEIR PUBLICATION #OMMUNICATING DIAGNOSES SHOULD BE COMPLETED PRIOR TO THE
WHOM THE REFERRAL IS MADE 3UCCESS REFERRAL OF A PATIENT 4HE MAJORITY OF CASES
4HE DENTIST TO WHOM THE PATIENT OTHER THAN THOSE THOUGHT TO BE SUFFERING
IS REFERRED WHO WILL BE TERMED THE SPECIALIST !NY DECISION TO REFER A PATIENT TO FROM A TUMOUR ARE UNLIKELY TO REQUIRE URGENT
FOR THE PURPOSE OF THIS ARTICLE SHOULD UPON A COLLEAGUE NEEDS TO BE CAREFULLY CONSIDERED REFERRAL 4HE GENERAL DENTAL PRACTITIONER HAS
ACCEPTANCE OF THE REFERRAL UNDERTAKE THE 4HE DECISION SHOULD ONLY BE TAKEN WITH THE FULL AN IMPORTANT ROLE TO PLAY IN THE MONITORING
FOLLOWING CONSULTATION OF THE PATIENT SO THAT THEY CAN OF PATIENTS SO THAT UNNECESSARY REFERRALS ARE
„ #ONTACT THE PATIENT GIVE HISHER CONTACT MAKE AN INFORMED CHOICE ABOUT THE PERSON MINIMIZED
DETAILS AND PROVIDE DIRECTIONS SUCH AS A TO WHOM THEY ARE BEING REFERRED )N ORDER TO
MAP TO THE PRACTICE OR HOSPITAL )NFORMATION GIVE CONSENT FOR A REFERRAL THE PATIENT MUST BE
ON CAR PARKING AVAILABILITY MAY ALSO BE PROVIDED WITH SUFFICIENT INFORMATION BEFORE 2EFERENCES
USEFUL $ETAILS OF THE DURATION OF THE FIRST THAT CHOICE CAN BE MADE 4HE TRANSFER OF THE  -AINTAINING 3TANDARDS 7HAT THE 0ATIENT
APPOINTMENT ARE ALSO RELEVANT DUTY OF CARE BETWEEN THE TWO PROFESSIONAL %XPECTS ,ONDON 'ENERAL $ENTAL #OUNCIL
„ %XPLAIN AT THE CONSULTATION APPOINTMENT COLLEAGUES SHOULD BE DEFINED 4HE REFERRAL 
OR WHENEVER THE NECESSARY INVESTIGATIONS MAY BE FOR A FULL RANGE OF CARE IN ONE CASE BUT  "URKE &*4 'OODALL #! (AYES &
ARE COMPLETE WHAT TREATMENT OR LIMITED TO THE TREATMENT OF A SPECIFIC CONDITION !PPROPRIATE AND INAPPROPRIATE REFERRALS
ALTERNATIVES IS PROPOSED ITS POTENTIAL FOR IN ANOTHER TO A UNIT OF CONSERVATIVE DENTISTRY
SUCCESS ITS COST AND WHEN PAYMENT SHOULD $ENTAL 0ROTECTION SUPPORTS THE 0RIMARY $ENTAL #ARE   ´
BE MADE VIEW THAT WHOEVER CARRIES OUT THE TREATMENT  WWWDENTALPROTECTIONORG
)F TREATMENT IS TO BE CARRIED OUT THE FOR A PATIENT WHETHER ON REFERRAL OR NOT #OMMUNICATING SUCCESS TO REFER OR NOT TO
SPECIALIST SHOULD WHETHER SPECIALIST OR NOT SHOULD BE COMPETENT REFER

!BSTRACT
#!5'(4 /54 "9 5. $)!'./3%$ 0/343 METALLIC POSTS MAY NOT BE )T HAS LONG BEEN
WERE LESS RADIO OPAQUE THAN DENTINE 4HIS
2ADIO OPACITY OF NON METALLIC ROOT CANAL ACCEPTED THAT RESTORATIVE MATERIALS SHOULD
IS NOT CLINICALLY ACCEPTABLE AND MAY LEAD
POSTS ( )BRAHIM / %L -OWAFY *7 "ROWN HAVE AT LEAST THE RADIO OPACITY OF ENAMEL
TO DIAGNOSTIC PROBLEMS WHEN TREATMENT
)NTERNATIONAL *OURNAL OF 0ROSTHODONTICS  4HIS WORK INVESTIGATED THE RADIO OPACITY
PLANNING USING RADIOGRAPHS OF ROOT CANAL
 n OF FIVE COMMON NON METALLIC POST SYSTEMS
TREATED TEETH -ANUFACTURERS OF SUCH POST
COMPARING THIS TO THE VALUES OF A TITANIUM
SYSTEMS SHOULD ENSURE THAT RADIO OPAQUE
4HE USE OF NON METALLIC POSTS HAS INCREASED AND A STAINLESS STEEL POST
MATERIALS ARE INCORPORATED IN THE POST AND
ENORMOUSLY IN RECENT YEAR AND POSTS )T WAS FOUND THAT ONLY ONE POST
CLINICIANS WOULD BE ADVISED TO ENSURE THAT
ARE NOW AVAILABLE WITH A WIDE VARIETY HAD A RADIO OPACITY GREATER THAN ENAMEL
THEIR CHOSEN NON METALLIC POST SYSTEM
OF COMPOSITIONS INCLUDING FOR EXAMPLE MAKING IT CLEARLY VISIBLE ON AN INTRA ORAL
SATISFIES ACCEPTED CRITERIA
MATERIALS SUCH AS ZIRCONIUM GLASS FIBRE RADIOGRAPH /NE POST HAD A RADIO OPACITY
0ETER #ARROTTE
RESINS AND CARBON FIBRES 7HILST METAL POSTS BETWEEN THAT OF ENAMEL AND DENTINE WHILST
'LASGOW $ENTAL 3CHOOL
ARE CLEARLY VISIBLE ON RADIOGRAPHS NON THE REMAINING THREE NON METALLIC POSTS

*ULY!UGUST  $ENTAL5PDATE 

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