To refer or not to refer…

As I think back through dental school and all of my training, I don’t remember ever formally discussing when to refer patients. But it is a topic that deserves some open and honest discussion.

People refer patients to my practice for a whole host of reasons. I feel fortunate to have so many professionals who choose to work with me. I think it is safe to say that just like snowflakes, no two dentists are alike. Some refer only retreatments, others refer all of their endodontic treatment. Some refer only molars, some refer only for consultation and prefer to discuss the findings prior to committing to treatment. Every doctor has a different level of skill, comfort and interest in Endodontics. The nice thing is that because every referring doctor is an individual, it keeps me sharp. It allows me to focus on what their specific needs are, and to work to make sure their patients are well taken care of.

Over the years, I have found the Case Assessment Form available from the AAE to be helpful in determining the difficulty of any given case. This form allows the practitioner to look at the various categories of challenges that can increase the complexity of any given case. Using this form can assist the treating dentist in determining how they would like to proceed. It does so by ensuring that all of the foreseeable complications have been accounted for, allowing the practitioner to create a preoperative game plan. It is important to note that the decision to treat or refer any given patient, rests solely with the individual dentist.

The following retreatment case was treated by me earlier in the year, I have attached the completed case assessment form that would accompany this case as the first slide.

One post op radiograph and no interim radiograph were taken due to the patients severe gagging. The reliability of the apex locator in conjunction with an all metal restoration and a tooth full of irrigants was put to the test. Secondary to treating four canals, the sinus tract was closed at 2 weeks. The patient now has a new crown on tooth #3. At one year the patient will be seen for a recall visit.

Clearly this was a challenging case, one that would have been extremely difficult to treat without a dental microscope and micromirrors due to the restricted opening. When you add in the other factors that were outlined on the form, I was very proud of the final outcome.