When you’re referring a patient to a specialist, communication is crucial. Just making sure the patient brings their referral slip to their visit is half the battle. The next battle is making sure the referral slip is filled out with the information we need to be successful. I’ve got multiple stories to share about patients who were really unhappy with their referring dentist and the tough conversations about restorability we had to have.

This is an important topic to discuss, because it would be nice to know how these upsets could have been prevented, don’t ya think?

Here’s a tooth story to illustrate my point.

Let’s start with this first example of a gentleman who was referred to me for root canal therapy. 

Here’s the referral slip.

And here are the preoperative radiographs:

Referrals and restorability radiograph 1

Referrals Radiograph 3

The referral slip doesn’t really match the periapical radiograph. The referral slip says to perform a root canal on tooth #31, but the tooth has already been treated with a root canal. And in my opinion, teeth #29 and #30 look like the teeth with questionable restorability.

So what do I do in this situation? 

As I continued to talk with the patient, my assistant called the referring dentist for clarification. It turns out that this patient was supposed to be seen for tooth #30, NOT tooth #31. 

But there was another problem — clinically, tooth #30 did not look very good, and #29 looked even worse. It was very possible that, just to restore the teeth, crown lengthening might be necessary. And even after crown lengthening, they may still be questionable.

My interaction with the patient

After speaking to the patient, I came to realize he did not really understand his treatment options. I had to go over the root canal, the possible crown lengthening, the crown, and then the alternatives like an implant.

This was a tough conversation to have because there were so many options he didn’t understand. He and his general dentist had talked, but the patient was still confused by the time he came to me.

Restorability — whose responsibility is it?

How many of you send patients to your endodontist to check for restorability? I only ask because I feel that this is something that the referring dentist should assess. 

The reason? Because every referring dentist of mine is different, and what Dr. A may choose to restore, Dr. B may say to extract.

So, if a tooth has questionable restorability from a tooth structure standpoint, then I think the tooth is best excavated by the restoring dentist and restorability should be assessed by them. If there is a question of restorability because of a potential crack, then absolutely send the patient to a specialist. But every evaluation costs our patients money and time, and if they keep getting bounced back and forth, our patients wind up unhappy.

This is a great opportunity to have a conversation with your specialist

That way, you know how to work best with one another. See, some may assume that if you are referring the tooth to an endodontist then you want the root canal performed, especially since we can root canal a root tip if we needed to. We need to know if you feel like you can restore the tooth once you have imagined it without any decay and after the crown prep. It takes more of the patient’s time and money if the specialist is the one excavating and determining restorability than if the GP did the same.

If you are worried about a pulp exposure, don’t be. Simply do a pulpotomy or just place a sedative filling. Your patient will be fine for a few days until they can be seen for treatment by an endodontist. If you find out the tooth is not restorable during the caries excavation, then you can simply extract the tooth right then and there, in your office.

Referral slips from general dentists

Now, I am sure a lot was reviewed with this patient we’re discussing, but he was not the best historian. So, in this situation, a little more information on the referral slip would have been great. It may have prevented some of the patient’s frustration.

This is when I pulled out my “general dentist” hat and went over the treatment options with the patient. In this case, I also made use of the time and really evaluated tooth #31, since it looked like that tooth would end up back in my chair someday. But, since tooth #30 was bothering him, I wanted to make sure we addressed that tooth first.

My question is, do you fill out your own referral slip, or do you have your assistant do it?

There is nothing wrong with having your assistant fill out the referral slip — I totally get it, we’re all busy. But you can (and should!) review and initial that referral slip before you send it out the door. If you aren’t doing that yet, you may want to start. This patient was not happy about the miscommunication and he felt like his general dentist dropped the ball. 

This scenario happens quite a bit in my practice, so I thought it would be an interesting case to share because it is so easy to fix. Hopefully, this helps you keep more of your patients, as well as keep your relationships solid with your specialists.

-Sonia

 

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