The importance of referring patients to the most suitable practitioner

I remember when I first started out with the London Smile Clinic, we used to refer out all of our orthodontics and implants and I remember finding it very difficult to get the exact results I wanted. The people I was referring to were very skilled practitioners, but the systems to communicate effectively were not in place so there were times when irreversible steps had been taken – such as braces being removed – before I gave final approval. Or, it was very difficult to agree anything during the planning stage, because there was no tangible way of saying, 'Where are we actually heading with this case?'

Now, times have changed and referring dentists should expect the practices and clinics to which they are referring to behave as if they’re an extension of their own team. For example, some referral clinics will do set-ups on models for demonstration purposes. They take impressions, cast the models and reset the teeth where they will be positioned following treatment, so the dentist can decide whether or not to proceed. Or the dentist can send that model to his own ceramist and get them to wax up the final case. Referring dentists get a really clear idea of the treatment plan, be it for orthodontics, implants or a mixed restorative case.

Some dentists may be cautious of referring orthodontic work because they believe it is primarily extraction based, but modern emphasis is very much towards expansion orthodontics. It takes more skill, but you end up with much wider and more beautiful smiles. Another misconception relates to poor retention. For example, patients being told to wear night time retainers for six months and then throw them away. All orthodontics can relapse no matter how the treatment’s done. We need to think of retention as something that is done for life and be up front with patients about it. This way, they’ll get lasting results and they’re not going to be disappointed further down the line.

So, if you have a fixed retainer bonded on and the patient’s aware that it’s got to stay on, you’re not going to run into retention problems. The latest systems make fixed orthodontics a lot more attractive to patients, and to adults in particular. Options such as Incognito provide patients with custom made brackets that are fixed on the inside of the teeth, so they’re completely out of sight. Adult orthodontics invariably require additional treatment by the referring dentist. Uneven teeth get a degree of uneven wear so once the teeth are aligned, their outline won’t be completely straight. Or, the patient may be keen to make even more improvements to their smile. Because of this, a good referral practice will make sure that the patient is booked with the referring dentist for a post orthodontic assessment. The dentist can then help the patient to decide what needs to be done next, such as whitening or bonding.

It’s not only orthodontics of course; dentists can refer implant work, too. When planning implants, the referring dentist and the referral practice will plan the case as a whole. For example, if a dentist refers a patient with a very gummy smile and a tooth that needs to be removed, they would need to consider loss of bone or gum. The practice would discuss this with the referring dentist, asking them if they had considered options such as a gum lift. Naturally, it’s up to the referring practice to decide exactly which aspects of the work they wish to refer out, and which aspects they wish to perform themselves.

Some referring dentists may worry if they refer a patient to another practice, they will never see that patient again. I would urge those dentists to get to know the practice and it will put their minds at rest. A practice that specialises in referral patients will be happy to discuss any aspect of the referral process and will have literature and websites for more information, or even invite the dentist to the practice to see how it all works.

With referrals, dentists are ensuring their patients get access to the best possible treatment and care. By making use of another practices’ expertise, it transforms a difficult case into a straightforward one, which the referring dentist can then complete. Certainly, thinking back to a few cases I struggled with early on in my career, I wish I could’ve found someone to help me out like this.

Referral practices such as the London Smile Clinic provide you with set-up models that lay everything out in front of you, and agree with you every stage of the treatment, making it a much more predictable process. The clinic also provides ‘before’ and ‘after’ photographs for every single case, so you will always have complete records of the beautiful smiles you have created for your patients. For more information, please contact 020 7255 2559 or visit

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