Appropriate and inappropriate referrals to a unit of conservative dentistry

Inappropriate referrals to secondary care are an unnecessary cost, notwithstanding the effect on waiting lists. It is essential therefore that only those patients whose referrals are appropriate are actually referred for secondary care. This project aimed to determine whether referrals to a unit of conservative dentistry are appropriate. The records of 120 consecutive new patient referrals who had been examined by one consultant in the unit of conservative dentistry at Glasgow Dental Hospital and School were obtained. A pro forma was designed on which synopses of the relevant clinical findings were written. These synopses were examined by four general dental practitioners (GDPs). A referral was considered appropriate if three or four of the GDPs considered it to be so, a referral was considered inappropriate if three or four of the GDPs concurred. Of the 120 cases examined, a majority of the GDP assessors agreed that 54 warranted referral, with 23 of these being referrals for toothwear. Agreement was not reached in 35 cases, while 31 referrals were considered inappropriate. Of the 31 cases which were considered inappropriate, 27 were thought to be within the scope of general practitioners. In conclusion, the results suggest that around one quarter of referrals to a unit of conservative dentistry are inappropriate. It would appear that a number of GDPs are unable or unwilling to treat a variety of simple conditions in practice and it may be that the development of referral guidelines is necessary to ensure that only those patients who merit a specialist opinion are referred for this service.