Acceptance criteria for restorative dentistry - Barts Health NHS Trust

REFERRAL GUIDELINES
DEPARTMENT OF RESTORATIVE DENTISTRY
The Royal London Dental Hospital
We are a major Teaching Hospital and aim to provide the highest quality care for all our patients, as well
as providing teaching for undergraduate dental students and postgraduate trainees. The following notes
are intended as a guide to practitioners considering referring patients to us.
All referrals should be from a dentist to avoid referral to the wrong department and if a referral is made
to the incorrect department we will ask you, the patient’s general dental practitioner, to refer as
appropriate to avoid unnecessary delay for your patient, we are no longer permitted to refer to our
consultant colleagues internally. A completed referral proforma (obtainable by telephoning 020 737
77000 ext: 2142 or downloadable from www.bartshealth.nhs.uk) should be sent to:
The Royal London Dental Hospital, Appointments Centre, New Road, London E1 1BB
(Tel enquiries: 020 7601 8701; Fax: 020 7377 7687)
Most referrals will be accepted for advice and treatment planning only though if not indicated on the
proforma we may ask you to clarify this. Those patients who are accepted for treatment will be expected
to have a general dental practitioner who is willing to assume responsibility for their continuing dental
care and to participate fully in items of treatment as deemed necessary by a Consultant in Restorative
Dentistry. Patients will only be accepted where we have capacity to care for them. Most patients will be
discharged back to their general dental practitioners with a treatment plan or once that treatment we
have offered to undertake is completed.
1 PATIENTS CONSIDERED HIGH PRIORITY
Those who
a/ Have or have had oral cancer
b/ Have congenital dental abnormalities eg hypodontia, cleft lip & palate and amelogenesis imperfect
c/ Are medically compromised and who cannot be treated in the general or community dental services
eg. Those with severe haemophilia or significant inhibitors and patients with bacterial endocarditis with
positive culture for Strep Viridans and acute admissions for cardiac valve surgery with significant dental
disease. This does not include routine polypharmacy patients.
d/ Those who have suffered severe orofacial trauma
2 PATIENTS SUITABLE FOR POSTGRADUATE CARE
In addition to our priority groups, some patients are accepted in line with the immediate training needs
of our postgraduate trainees and students. Unfortunately this does not mean that all patients that are
suitable will be accepted as there are limitations to our treatment capacity.
a. Prosthodontics
Patients requiring complex fixed and removable prosthodontics which may include those with occlusal
problems and tooth wear, but excluding failing crowns and bridges.
b. Endodontics

Endodontic referrals should be accompanied by dated, current relevant and accurately (taken and
developed) peri-apical radiographs, stapled to the referral letter. When photocopies of electronic
radiographs are sent they need to be of a high quality and diagnostically useful. Only a small proportion
of such referrals will be accepted for treatment and may be drawn from the following:
a/ Those with complex or narrow root canal anatomy where the tooth is restorable or strategically
important
b/ Management of open apices, resorption and trauma in young teeth
c/ Separated instruments where the prognosis of the tooth is viable
d/ Surgery in the presence of excellent quality conventional obturation
e/ Non-surgical re-treatment of strategically important posterior teeth
c. Periodontics
Patients who have poor oral hygiene with gross deposits and primary dental disease will not normally be
accepted.
All referred patients must have an accurately recorded BPE and an additional description of
periodontal treatment provided to date, including an accurate plaque score.
Those who may be accepted include patients with:
a/ Pockets > 6mm (BPE 4) in patients < 35 yrs
b/ Severe chronic periodontitis in patients who have had a course of oral hygiene instruction with plaque
scores

3 PATIENTS SUITABLE FOR UNDERGRADUATE CARE
Treatment provided by undergraduates is generally of a routine, simple nature and includes plastic
restorations, simple root fillings, crowns and bridges, complete and partial dentures and non-surgical
periodontal treatment.
There is a very limited undergraduate sedation service for healthy anxious patients requiring simple
treatment. This care excludes root canal treatment, crown and bridgework and patients who are difficult
to sedate. Please note that we have no GA restorative facilities for anxious patients.
4 PATIENTS REQUIRING EMERGENCY DENTAL CARE
An emergency “walk in” service is available to provide relief of acute pain, swelling or following dental
trauma. Patients already registered with a dentist MUST seek care from their own dentist in the
first instance. Undergraduate students both examine and treat patients on the emergency clinic.
5 PATIENTS WHO ARE ROUTINELY NOT ACCEPTED FOR TREATMENT
Unfortunately, we are unable to accept patients for treatment on financial grounds alone. Acceptance is
based solely on clinical need.
We do not accept patients with failing crown and bridge work and those requiring immediate dentures.
We have a ‘zero tolerance policy’ for abusive behaviour to any of our staff.