Do you need a referral to see an endodontist?: Unpacking referral do’s and don’ts

Do you need a referral to see an endodontist? It’s a question that we field at my practice quite often. And the short answer is: yes.

Why? Because specialists benefit from a whole lot of background on the situation. Which means  when a dentist is referring a patient to a specialist, communication is crucial. Getting that referral slip and making sure it is filled out is important because, as an endodontist, I need the information it contains to be as successful as possible.

I can’t tell you how many stories I have about patients who were really unhappy with their referring dentist and the tough conversations about restorability we had to have in my practice.

This is a critical topic to discuss, because it would be nice to know how these upsets, miscommunications, and bad feelings could have been prevented, don’t ya think?

Do you need a referral to see an endodontist? The referral process illustrated through one Tooth Story

Let’s start with this first example of a gentleman who was referred to me for root canal therapy.

Here’s the referral slip.

Ok, so far so good. Here are the preoperative radiographs:

But here’s the thing when it comes to this referral, the slip doesn’t really match the periapical radiograph. The referral slip says to perform a root canal on tooth #31, but the tooth has already been treated with a root canal. And in my opinion, teeth #29 and #30 look like the teeth with questionable restorability.

So what do I do in this situation? And would you need a referral to an endodontist here?

As I continued to talk with the patient, my assistant called the referring dentist for clarification. If the referral slip had been thorough and clear, this call wouldn’t have been necessary (and my team and the referring dentist’s wouldn’t need to tie up phone lines getting clarification. They could’ve used their time scheduling new patients). It turns out that this patient was supposed to be seen for tooth #30, NOT tooth #31.

But there was another problem — clinically, tooth #30 did not look very good, and #29 looked even worse. It was very possible that, just to restore the teeth, crown lengthening might be necessary. And even after crown lengthening, the teeth may still be questionable.

Oof.

A candid conversation

After speaking to the patient, I came to realize he did not really understand his treatment options. I had to go over the root canal, the possible crown lengthening, the crown, and then the alternatives, like an implant.

Needless to say, this was a tough conversation to have because there were so many options he didn’t understand. He and his general dentist had talked a bit, but the patient was still confused by the time he came to me.

I get it, patient education isn’t the easiest thing we do as dentists. But it’s important to make sure our patients truly understand what’s going on, so they can make decisions about their health from a place of empowerment.

Restorability — whose responsibility is it?

So your patient has a referral to see an endodontist, but when it comes to restorability, is that a conversation you should have with your patient, or should I have it with them?

I honestly feel that this is something that you, the referring dentist, should assess.

The reason? Because every referring dentist of mine is different, and what Dr. A may choose to restore, Dr. B may say to extract.

So, if a tooth has questionable restorability from a tooth structure standpoint, then I think the tooth is best excavated by the restoring dentist and restorability should be assessed by them. If there is a question of restorability because of a potential crack, then absolutely send the patient to a specialist. But every evaluation costs our patients money and time, and if they keep getting bounced back and forth, our patients wind up unhappy.

And none of us want that!

Have a conversation with your specialist

When you have open communication with your specialist, you know how to work best with one another. You may assume that if you are referring the tooth to an endodontist, then you want them to perform the root canal, especially since we can root canal a root tip if we needed to. We endos need to know if you feel like you can restore the tooth once you have imagined it without any decay and after the crown prep. It takes more of the patient’s time and money if the specialist is the one excavating and determining restorability than if you did that.

If you are worried about a pulp exposure, well—don’t be. If they have experienced no preoperative pain, simply do a pulpotomy or just place a sedative filling. Your patient will be fine for a few days until they can be seen for treatment by an endodontist. If you find out the tooth is not restorable during the caries excavation, then you can simply extract the tooth right then and there, in your office. This ultimately saves your patient time and money since they won’t be going to a specialist—and they can instead invest that money in treatment done at your office.

Referral slips from general dentists

Since you need a referral to see a specialist like an endodontist, why not make the referral slip worthwhile? While I am sure his dentist reviewed a lot with him, this particular patient was not the best historian. And most patients don’t have the breadth of knowledge we do, so why not add a little more information on the referral slip?  It may have prevented some of the patient’s frustration.

This is when I pulled out my “general dentist” hat and went over the treatment options with the patient. In this case, I also made use of the time and evaluated tooth #31, since it looked like that tooth would end up back in my chair someday. But, since tooth #30 was bothering him, I wanted to make sure we addressed that tooth first.

Here’s my last question: Do you fill out your own referral slip, or do you have your assistant do it?

There is nothing wrong with having your assistant fill out the referral slip — I totally get it, we’re all busy. But you can (and totally should!) review and initial that referral slip before you send it out the door so you can add any additional info that your assistant might have missed. It’s a good habit to get into since a referral slip can be the deciding factor in making sure your patients feel well taken care of (and come back to your practice time and time again!).

I’m writing this blog because this scenario happens quite a bit in my practice. But it’s also a problem with a quick fix. Hopefully, this helps you keep more of your patients, as well as keep your relationships solid with your specialists.

As for me, this is what I like to see on a referral slip: your clinical findings at the patient’s last visit; the treatment plan; that the correct tooth is indicated; and the treatment you would like performed (and if the tooth has already had a root canal—please make sure the retreatment box is checked!). It’s not hard to do, and it really makes a world of difference.

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– Sonia

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