Dental Referrals

Situations or Conditions Necessitating a Referral

Patients may need to be referred for several reasons. Any one or combinations of the following situations or conditions may provide the Dentist with appropriate rationale for referring a patient. Some of these situations include but are not limited to:

  • Level of training and experience of the Dentist;
  • Dentist's area of interest;
  • Extensiveness of the problem;
  • Complexity of the treatment;
  • Medical complications;
  • Patient load;
  • Availability of special equipment and instruments;
  • Staff capabilities and training;
  • Patient desire;
  • Behavioural concerns;
  • Desire to share responsibility for patient care; and
  • Geographic proximity to the recipient of the referral.

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Guidelines for Patient Referral

Clear and effective communication between all parties is essential in the referral process. The following guidelines are intended to clarify the various elements and responsibilities needed to provide the referred patient with the required level of professional care.

Patient Referrals - A Professional Responsibility

The Alberta Dental Association Code of Ethics, under a "Dentists' Responsibility to Patients”, Article A4: Competence, Consultation and Referral states: “A dentist shall provide assessment and/or treatment for a patient only when currently competent to do so by reason of his or her education and training, experience, or demonstrated continued competence; otherwise the dentist should consult with another dentist or dental specialist with the appropriate competencies and/or refer the patient to an appropriate care provider for assessment and/or treatment.

In those cases warranting it, timely and appropriate referral is an ethical imperative which fulfills a professional duty to a patient. Failure to inform a patient of the need for consultation and/or referral could place the dentist in breech of the Code of Ethics.

Communication between the Referring Dentist and the Patient
  • The patient (parent or guardian if appropriate) should be informed of the nature of the problem necessitating referral.
  • Referral to a specific specialist is recommended. This decision should take into account any patient preference.
  • The patient should be informed that all relevant information will be sent to the Dental Specialist in advance of the consultation appointment.
  • The patient should be given information which will assist in the introduction to the Dental Specialist, such as preconsultation instructions (where indicated), educational material and directions to the specialist's office.
Communication between the Referring Dentist and the Dental Specialist

The referring Dentist should convey, in advance, all information which will assist the Dental Specialist in providing a complete consultation service to the patient. This includes:

  • Name, age, address and telephone number,
  • Reason for the referral,
  • Any medical history which may require antibiotic coverage in advance of the consultation or other precautions to allow oral examination,
  • Pertinent records such as radiographs, models and any contributing previous medical and/or dental history,
  • Projected treatment needs beyond the referral, and
  • Assessment of the patient's level of awareness, interest or concern regarding oral health and projected treatment.
Communication between the Dental Specialist and the Patient

Prior to the consultation, the Dental Specialist's office should provide the patient with details of the appointment time, date and the office location.

After the consultation, the Dental Specialist should provide the patient with information adequate to make an informed decision including:

  • A diagnosis, recommended treatment and prognosis;
  • Discussion of the advantages and disadvantages including costs of treatment alternatives;
  • The need for future treatment with emphasis follow-up and maintenance; and
  • The expectation that the patient will return to the referring Dentist for on-going dental care.
Communication between the Dental Specialist and the Referring Dentist
  • The Dental Specialist's office should confirm receipt of a referral made through correspondence and relay the timing of the scheduled consultation appointment to the referring dentist.
  • In the event that the patient fails to keep the consultation appointment, the referring Dentist should be informed.
  • When a consultation is provided on the basis of a self-referral by the patient, the patient's general Dentist should, with the patient's permission, be sent a report in order to keep the patient's records current.
  • After consultation, a report from the Dental Specialist indicating a diagnosis and proposed treatment should be sent to the referring Dentist.
  • In those situations where the Dental Specialist determines the need for dental care outside his/her specialty, the Dental Specialist should confer with the referring Dentist to determine whether the patient's need will be met by the general Dentist or by another Dental Specialist and, if the latter, which Dental Specialist.
  • Progress reports should be communicated when treatment had been delayed or interrupted or significantly modified.
  • A final report should be sent at the end of active treatment when the patient is returned to the general Dentist's care.
  • On occasion, the patient may not wish to return to the referring Dentist, and request referral to a new general Dentist. In this situation, the Dental Specialist should inform the patient that professional ethics prevent further referral until the patient has discontinued the existing professional relationship with the original Dentist.