Download Orthodontic Referral

primary care orthodontic service in Sandwell
and Dudley: if you wish to refer to this
service then please indicate your intentions
on the referral form.
There will be cases where a referring dentist
has genuine concerns regarding a patient’s
malocclusion which does not easily fall into
the guidelines given. In such circumstances
it is still appropriate to refer the patient
for an opinion. The reasons for referral
should be clearly stated. If you wish,
it is quite appropriate to include an
accompanying letter.
Whenever the referral proforma is
used by specialist colleagues please
always include the details of the
patient’s general dental practitioner
on the form.
Radiographs
Please enclose recent hard copy radiographs
with the referral. Digital radiographs should
either be emailed to [email protected]
(which is a secure email service) or enclosed
with the referral on a DVD or CD. Paper
copies of x-rays are not sufficient and
will hold up the referral.
Patient requirements where
active orthodontic treatment
is contemplated
Treatment will only be offered to patients
in the above categories if he or she:
• Has a good standard of oral hygiene
and dental health
• Has a regular primary care dentist
• Is sufficiently motivated to support
orthodontic treatment
Where orthodontic referral has been
contemplated but discarded owing to a
low objective need, poor dental health
or poor potential compliance, it would be
prudent to document this in your notes.
Patient compliance where
active orthodontic treatment
is contemplated
Patient compliance is essential for
orthodontic treatment to be successful.
Patients for whom active treatment is
contemplated should be aware of
the following:
• The reason for referral
• The nature of orthodontic appliances
• The need to attend appointments
every six weeks for at least 18 months
Integrated Referral Pathway
Orthodontic
Referral Guidance
Notes
• Avoid hard and sticky foods.
Birmingham Dental Hospital
St Chad’s Queensway
Birmingham
B4 6NN
Reluctant patients or those with poor dental
health make a poor prospect for successful
orthodontic treatment.
Telephone: 0121 466 5000
Fax: 0121 466 5151
• The need to maintain meticulous
oral hygiene
• Is at an appropriate stage of
dental development
Birmingham Community Healthcare
Produced by Clinical Photography and Graphic Design Tel: 0121 466 5107 Ref: 43894 16.02.2015
NHS Trust
Aims and objectives of this guidance
These guidelines for orthodontic referral
are an attempt to make equitable and
appropriate use of the available resources.
The guidelines are intended to help
practitioners determine whether an
orthodontic referral is warranted and
who best to refer to for a specific problem.
They should also help practitioners avoid
making inappropriate referrals.
Referral to NHS orthodontic services is for
assessment in the first instance and does
not mean that treatment will automatically
be provided. Referral to one provider may
result in onward referral to another part of
the service.
Where GDPs with contracted orthodontic
activity are able to provide removable
appliance or simple fixed appliance therapy
in their practice, the hospital service will
provide a treatment plan and continuing
advice where required.
The Index of Orthodontic
Treatment Need
The NHS funds orthodontic treatment
based on the nationally recognised Index
of Orthodontic Treatment Need (IOTN).
This index was developed in Manchester
in the 1990’s and is based on a number of
preceding indices. The index was developed
and verified using the opinions of a wide
variety of colleagues across the dental
profession and orthodontic specialty.
The Index has two components: a dental
health component (DHC) and an aesthetic
component (AC). The dental health
component scores the severity of dental
malocclusion on a scale of 1 (no need for
treatment) to 5 (great need for treatment).
The aesthetic component scores the
malocclusion by appearance on a scale of
1 to 10.
Malocclusions that warrant a score of IOTN
4 or 5 are considered to have a definite
need for treatment and referral is indicated.
Patients falling into IOTN DHC categories
1 and 2 have little or no need for
treatment and NHS orthodontic treatment
is not available. Indeed the index can
protect patients from seeking
unnecessary treatment.
The aesthetic component of a malocclusion
is graded from 1 to 10. The assessor should
match the appearance of an individual
patient’s malocclusion with the aesthetic
scale in terms of severity but not try and
match the malocclusion.
NHS funding is available for patients who
have a DHC of 4 and 5 or a DHC of 3 where
the aesthetic component (AC) is 6 or above.
The Index of Orthodontic Treatment
Need (IOTN) is an index of treatment
need and not an indication of treatment
complexity. Therefore, where a patient
has a high objective treatment need but
the orthodontic management is relatively
straightforward, the patient may be directed
elsewhere for treatment by a colleague with
the appropriate skills.
Inappropriate referrals
There is some research evidence to show
that up to 45% of current orthodontic
referrals are inappropriate: such referrals
add to lengthy waiting times and reduce
the efficiency of the service. If the number
of inappropriate referrals could be reduced
then there would be a considerable
reduction in waiting times and a more
efficient service.
Advice to patients who are
inappropriate for orthodontic referral
Where it is deemed that referral to an
orthodontist is inappropriate colleagues
may wish to advise their patients as follows:
• Patient can confidently be informed
that the risks of treatment outweigh
the benefits
• Non-referral is not a rationing of care but
based on an assessment of the balance
between risks and benefits
• Where oral hygiene is poor or there is
active caries then there is a risk of further
damage to the teeth.
The orthodontic referral proforma
The assessment grid on the referral
proforma is designed to help practitioners
swiftly appraise a malocclusion for onward
referral or non-referral and also to direct a
patient towards the correct service.
BCHC has a secondary care orthodontic
service at Birmingham Dental Hospital and a