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Referral for Treatment

Reasons for Referral
Referral form for DentistsReasons for referral are focused on collaborative efforts to improve treatment for the patient and include the following:

  • Concern for quality of patients’ oral health care
  • Management of advanced or complex cases, (i.e., to assist in defining prognosis and treatment plan and for the delivery of care)
  • Delivery of therapy that the general dentist may not perform, (i.e., implant placement or surgical therapy)
  • Enhancement of restorative/prosthetic results
  • Systemic health or patient management issues, (i.e., need for intravenous sedation)
  • Risk management considerations
  • Patient appreciation of the need for and benefit of referral

Criteria for Referral
Criteria for referral are based upon parameters related to case severity and complexity and should be fundamental and yet flexible enough to allow judgement based on science to be exercised. Case severity is based upon clinical and radiographic parameters and/or the PSR. Complexity is reflected by parameters such as: type of periodontal disease; medical status; other treatment needs; whether or not the disease is progressive; and patient management issues.

Examples of patients that are candidates for referral include those with:

  • Chronic periodontitis with moderate to advanced loss of support
  • Aggressive forms of periodontal disease
  • Periodontal disease associated with systemic conditions
  • Mucogingival conditions,
  • Refractory disease, and
  • Patients requiring conscious sedation

Referral Form

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