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Dental Practitioner
15-20 minutes

Specialist Dentist Referral Letter

The Referral Letter to a Specialist Dentist template by s10.ai is crafted for general dentists seeking to refer patients to specialist dental practitioners for advanced treatment. This template features sections for patient information, clinical history, and specific referral reasons, ensuring thorough communication between dental professionals. It is particularly beneficial for cases necessitating specialist intervention, such as oral surgery, endodontics, or periodontics. By utilizing s10.ai, this template optimizes the referral process, ensuring precise capture and communication of all essential information, thereby enhancing patient care and fostering collaboration among dental specialists.

2,469 uses
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Dr. Emily Carter
Template Structure

Organized sections for comprehensive clinical documentation

Referral Note to Specialist
[Clinician’s Title, Name & Surname]
[Clinician’s Qualifications] (if applicable)
[Clinician’s Clinic Name] (if applicable)
[Clinician’s Clinic Address] (if applicable)
[Clinician’s Phone Number] (if applicable)
[Clinician’s Email] (if applicable)
Date: [Date of Referral]
To:
[Specialist’s Name] (if known and applicable)
[Specialist’s Practice Name] (if known and applicable)
[Specialist’s Address] (if known and applicable)
[Specialist’s Phone Number] (if known and applicable)
[Specialist’s Email] (if known and applicable)
Re: [Patient’s Name]
Date of Birth: [Patient’s DOB]
Dear [Specialist’s Name],
I am referring [Patient’s Name] to you for expert evaluation and management concerning [Reason for Referral]. The patient visited our clinic with [chief complaint, symptoms, or condition requiring specialist care], and following a comprehensive examination, I believe specialist intervention is necessary for optimal care.
Reason for Referral
[Describe the primary reason for referral. Clearly state the reason for referral, including the patient’s symptoms, diagnosis, or suspected condition. Mention if the referral is urgent and why.]
Clinical History
- History of Presenting Complaint: [Provide details of the symptoms, duration, onset, and any progression or associated symptoms.]
- Relevant Medical History: [Mention any medical conditions that may impact treatment, including allergies, medications, and significant past illnesses or surgeries.]
- Dental History: [Summarize relevant past dental treatments such as restorations, extractions, periodontal therapy, root canal treatment, orthodontics, or prosthodontics.]
- Previous Interventions: [List any prior treatments or attempts at managing the condition before referral.]
Clinical Findings
- Extraoral Examination (E/O): [Mention any relevant findings such as facial swelling, lymphadenopathy, TMJ abnormalities, asymmetry, or trauma.]
- Intraoral Examination (I/O): [Document findings related to soft tissue, hard tissue, occlusion, gingival health, and any pathology present.]
- Periodontal Status: [Describe findings related to gingival inflammation, pocket depths, bone loss, mobility, or soft tissue lesions.]
Radiographic & Diagnostic Findings
- Radiographs Taken: [Specify the type of radiographs taken—Bitewing, Periapical, OPG, CBCT—and any significant findings such as caries, bone loss, impacted teeth, fractures, periapical pathology, or cysts.]
- Other Tests Conducted: [Mention results of pulp vitality testing, percussion, mobility, probing depths, biopsy results, or any relevant investigations.]
Diagnosis & Provisional Assessment
- Diagnosis: [State the primary diagnosis or differential diagnoses.]
- Provisional Assessment: [Include suspected conditions or concerns that require specialist evaluation.]
Requested Specialist Intervention
[Specify the type of treatment or evaluation requested from the specialist] (Clearly outline whether specialist assessment, treatment planning, surgical intervention, prosthodontic restoration, endodontic therapy, periodontal management, orthodontic opinion, or other services are required.)
Urgency of Referral
[Specify if the referral is urgent, semi-urgent, or routine] (Include justification if the case requires immediate attention due to infection, pain, or risk of deterioration.)
Attachments
[Include a list of attached records, radiographs, or clinical notes] (Specify if digital copies of radiographs or reports have been sent or if physical copies are being provided.)
Thank you for your assistance in managing this case. Please feel free to contact me if you require further details or clarification regarding this referral.
Kind Regards,
[Clinician’s Title, Name & Surname]
[Clinician’s Qualifications] (if applicable)
[Clinician’s Clinic Name] (if applicable)
[Clinician’s Clinic Contact Information] (if applicable)
---
(Never come up with your own patient details, assessment, plan, interventions, evaluation, and plan for continuing care—use only the transcript, contextual notes, or clinical note as a reference for the information included in your note. If any information related to a placeholder has not been explicitly mentioned in the transcript, contextual notes, or clinical note, you must not state that the information has not been explicitly mentioned in your output—just leave the relevant placeholder or omit the placeholder completely.)
(Use as many lines, paragraphs, or bullet points as needed to capture all the relevant information from the transcript and or clinical note.)
Sample Clinical Note

Example of completed documentation using this template

Referral Letter to Specialist
Dr. Emily Carter BDS, MSc (Dentistry) Bright Smiles Dental Clinic 123 Dental Avenue, London, UK +44 20 7946 0958 emily.carter@brightsmiles.co.uk Date: 1 March 2025
To: Dr. John Smith Oral Surgery Specialists 456 Specialist Road, London, UK +44 20 7946 1234 john.smith@oralsurgeryspecialists.co.uk
Re: Mr. James Anderson Date of Birth: 15 March 1985
Dear Dr. John Smith,
I am referring Mr. James Anderson to you for expert evaluation and management concerning a suspected impacted third molar. The patient visited our clinic with intense pain and swelling in the lower right quadrant, and following a comprehensive examination, I believe specialist intervention is necessary for optimal care.
Reason for Referral The primary reason for referral is the suspected impaction of the lower right third molar, leading to significant pain and swelling. The referral is urgent due to the potential risk of infection and further complications.
Clinical History - History of Presenting Complaint: Mr. Anderson has been experiencing severe pain and swelling in the lower right jaw for the past two weeks, with symptoms progressively worsening. - Relevant Medical History: No known allergies. Currently taking ibuprofen for pain management. No significant past illnesses or surgeries. - Dental History: Previous restorations and routine cleanings. No history of extractions or orthodontic treatment. - Previous Interventions: Attempted pain management with over-the-counter analgesics.
Clinical Findings - Extraoral Examination (E/O): Notable facial swelling on the right side, tenderness upon palpation. - Intraoral Examination (I/O): Swelling and tenderness in the lower right quadrant, partially erupted third molar visible. - Periodontal Status: Mild gingival inflammation around the affected area.
Radiographic & Diagnostic Findings - Radiographs Taken: OPG showing impacted lower right third molar with potential periapical pathology. - Other Tests Conducted: Pulp vitality testing indicates non-vital tooth.
Diagnosis & Provisional Assessment - Diagnosis: Impacted lower right third molar with associated periapical pathology. - Provisional Assessment: Suspected infection requiring surgical intervention.
Requested Specialist Intervention Surgical extraction of the impacted third molar and management of any associated infection.
Urgency of Referral Urgent referral due to risk of infection and severe pain.
Attachments OPG radiograph and clinical notes attached.
Thank you for your assistance in managing this case. Please feel free to contact me if you require further details or clarification regarding this referral.
Kind Regards,
Dr. Emily Carter BDS, MSc (Dentistry) Bright Smiles Dental Clinic +44 20 7946 0958 emily.carter@brightsmiles.co.uk
Clinical Benefits

Key advantages of using this template in clinical practice

  • Enhance your patient care coordination with our comprehensive "Referral Letter to Specialist" template, designed to streamline the referral process and ensure seamless communication between healthcare providers. This template is meticulously structured to include all essential details such as patient history, clinical findings, and diagnostic results, facilitating a thorough specialist assessment. By adopting this template, clinicians can efficiently convey critical information, ensuring that specialists receive a complete overview of the patient's condition and the necessary interventions. Optimize your practice's referral process today by exploring this template, which is tailored to meet the high standards of clinical documentation and improve patient outcomes.
Frequently Asked Questions

Common questions about this template and its usage

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Specialist Dentist Referral Letter