Download Orthodontic referral Protocol for Secondary Care

Orthodontic referral Protocol for Secondary Care
This referral protocol has been produced with the collaboration of
Doncaster PCT.
Aims and Objectives of the service:
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To provide an orthodontic service for the residents of Doncaster and
Bassetlaw NHS Trust
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Consultation and advice for GDPs and GPs
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Orthodontic Treatment of multidisciplinary cases when appropriate.
Referral Guidelines:
Patients referred for orthodontic treatment or advice must have:
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A good level of oral hygiene and good periodontal condition.
Dental caries should have been treated.
Patients must be aware of the reason for the referral and, if appropriate, be
prepared to wear orthodontic appliances.
An Orthodontic referral proforma must be completed for every referral
although a letter may accompany the proforma if wished.
Referrals are accepted for:
 Diagnosis and treatment planning of NHS patients.
This service is provided for practitioners who have received some postgraduate orthodontic training and who wish to provide NHS treatment for
their patients in primary care and have UOAs available. Help and support is
always available to GDPs.
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To qualify for NHS treatment patients must have a Dental Health Component
of IOTN of 4 or 5, representing Great or Very Great treatment need, or IOTN
3 with an aesthetic score of 6 or above.
The IOTN score should be indicated, if possible, on the referral proforma.
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Only potential orthodontic patients falling into grade 5, together with
those in those who require multidisciplinary treatment, can be taken on
for treatment in secondary care although treatment plans can be provided
for NHS patients of GDPs with UOAs.
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Adults [patients over 18 years], are accepted for treatment if they require
multi-disciplinary care but not for ‘routine’ orthodontic treatment.
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Patients with a diagnosis of Obstructive sleep apnoea can be treated but are
usually referred via the chest physicians’ since they require a sleep study for a
positive diagnosis of OSA.
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A treatment planning service for private patients is not available.
Early referrals:
The majority of orthodontic treatment is undertaken in the permanent dentition and
consequently early referrals are unnecessary but in some cases early referrals are
indicated:
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Patients requiring interceptive orthodontic treatment in the mixed dentition or
where orthodontic advice may be required:
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Failure of/delayed eruption of teeth, particularly incisor teeth possibly due to
dilacerations or supernumerary teeth.
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Inability to palpate upper canine teeth in a child of normal dental development
by the age of 10.
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Infra occluded [submerged] primary molar teeth.
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Missing permanent teeth [hypodontia].
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Hypoplastic or grossly carious first molar teeth which have a poor long term
prognosis. Urgent referrals may be necessary if the patient is in pain and
extractions are required.
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Class III malocclusions
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Severe Class II division 1 malocclusions.
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Patients requiring functional appliances are usually treated when the first
premolars have erupted to enable good retention of the appliance. Patients
need to be seen before their pubertal growth spurt.
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Patients with hard or soft tissue trauma resulting from the malocclusion.
Treatment under the NHS will not be arranged for:
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Mild malocclusions.
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Adults requiring routine orthodontic treatment.
18 Week referral pathway
Referral from GDP/CDS or GMP
Following referral protocol
Inappropriate/incomplete referrals
referred back to GDP
Choose & Book
Or
Paper referrals on
Orthodontic proforma
Paper triage
New patient clinic
Treatment plan provided
Refer back to DWSI with UOAs
for NHS orthodontic treatment
or
referred on to orthodontic specialist
practitioner in primary care.
Patient taken on for
orthodontic treatment in the hospital
IOTN 5:
Impacted teeth
Retained deciduous teeth
Extensive hypodontia
OJ > 9mm
Reverse OJ > 3.5mm with
speech/functional problems
Cleft lip & Palate
Infra occluded deciduous teeth
IOTN 4 -multidiciplinary cases
Hypodontia
Reverse OJ > 3.5mm
Severe crossbites
Extreme lateral or anterior openbites
Supernumerary teeth
Traumatic overbites
Patients who for medical or other reasons
have problems associated with their
management.