Dental Referral Protocols August 2013 (updated 2015) Table of Contents



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Charles Clifford Dental Services

Wellesley Road

Sheffield S10 2SZ

Dental Referral Protocols

August 2013 (updated 2015)

Table of Contents


1. Introduction 4

1. Introduction 4

2. Referral Procedure 4

2. Referral Procedure 4

2.1 Referral forms 4

2.2 Referral responsibilities 4

2.3 Referral exclusions 5

2.4 Accepting a referral 5

3. ‘Did Not Attend’ (DNA) and Cancellation Policies 6

3. ‘Did Not Attend’ (DNA) and Cancellation Policies 6

3.1 Charles Clifford Dental Services DNA policy 6

3.2 Community and Special Care Dentistry DNA policy 6

4. Oral Surgery and Oral and Maxillofacial Surgery 7

4. Oral Surgery and Oral and Maxillofacial Surgery 7

4.1 Minor oral surgery 7

4.2 Management of abnormal bony and soft tissue lesions 8

4.3 Acute infections 8

4.5 Temporo-mandibular joint disorder (TMJ disorder) 8

5. Oral Medicine 10

5. Oral Medicine 10

5.1 Breadth of service 10

6. Paediatric Dentistry 11

6. Paediatric Dentistry 11

6.1 Referral Criteria 11

6.2 Assessment and treatment 11

6.3 Other information for referrers 11

7. Restorative Dentistry 12

7. Restorative Dentistry 12

7.1 Periodontal problems 12

7.2 Fixed and removable prosthodontics 13

7.3 Endodontics 14

8. Orthodontics 16

8. Orthodontics 16

8.1 Index of Orthodontic Treatment Need 16

8.2 Specific referral criteria 16

9. Dental Radiology 17

9. Dental Radiology 17

10. Oral Pathology 17

10. Oral Pathology 17

10.1 Background 17

10.2 Procedure for referral 17

10.3 Pathology reports 18

10.4 Charges for the service 18

10.5 Advice 18

11. Dental Implants 18

11. Dental Implants 18

11.1 Background 18

11.2 Inclusion criteria 18

11.3 General consideration 19

12. Special Care Dentistry 19

12. Special Care Dentistry 19

12.1 Background 19

12.2 Referral and acceptance criteria 19

12.3 Assessment and treatment 20

12.4 Patients with a moderate or severe learning difficulty and adults and children with autistic spectrum disorders 20

12.5 Adult mental health 20

12.6 Children with special needs 21

12.7 Patients with complex medical conditions 21

12.8 Adults with a severe dental anxiety/dental phobia 21

12.9 Frail elderly, physical disability and domiciliary care 22

12.10 Bariatric patients 22

12.11 Sedation and GA 22

13. References 24

13. References 24

14. Appendices 25

14. Appendices 25

REFERRAL LETTER FOR PAEDIATRIC DENTISTRY 33

REFERRAL LETTER FOR PAEDIATRIC DENTISTRY 33

ENDODONTIC REFERRAL FORM 36

ENDODONTIC REFERRAL FORM 36



1. Introduction

The Charles Clifford Dental Directorate has developed this handbook of referral protocols to provide a clinical framework to support the practitioner when referring their patients to Charles Clifford Dental Services (CCDS) Sheffield Salaried Primary Dental Care Service is now called the Community and Special Care Dentistry Service and is part of CCDS. Demand for salaried and secondary dental services is increasing significantly and referring practitioners should ensure that they adhere to the protocols. This handbook has been developed in conjunction with clinician leads, local general dental practitioners and a patient representative. It was based on a handbook developed in Leeds.


The Charles Clifford Dental Directorate continues to promote the principle of patient choice and chair side choice discussion. However, it is acknowledged that further work, particularly the IT infrastructure needs to be strengthened to support this.

2. Referral Procedure


2.1 Referral forms



The referring clinician should complete the relevant dental referral form (see appendices). All sections of the forms must be completed; failure to complete all sections will result in the return of the referral and subsequent delay in patient care.
The information on the forms should encapsulate the results of a referring practitioner’s examination and diagnosis.1
To minimise additional invasive procedures, any relevant test results, diagnostics, study models (packed securely) and radiographs should be included with the referral. Please ensure that radiographs are recent, relevant and of good quality and are marked appropriately, which must include the date the image was taken. Providing quality information will ensure that an accurate picture is obtained of the nature of the referral so preventing any unnecessary delays.
There are two types of referral:

  1. Routine referrals (see appendix 1 for referral form) with supplemental forms for orthodontics endodontics and community and special care dentistry referrals (appendices 3 to 8)

If you wish for any patient to be seen URGENTLY then this should be clearly stated on the referral form together with the reason(s) urgent treatment is requested

  1. Target two-week waits for suspected cancer (see appendix 2 for referral form) that will be seen within two weeks

These should be faxed to 01142717836 and a paper copy also posted. To confirm the referral has arrived please telephone 01142717838.
Following completion of treatment, and where possible, radiographs will be returned to the original source where relevant to future care.1
It is considered good practice for the referrer to retain a copy of the referral with the patient’s records in the practice.




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