We are always pleased to receive referrals from colleagues: however, we would like to take this opportunity to clarify that referral letters should include the following information:

1. Patient address and contact details

2. Reason for referral i.e. treatment, advice

3. Salient features of patient’s malocclusion

4. History of previous treatment

5. Recent relevant radiographs where available

If the above information is not provided the referral might not be accepted, but returned to the referrer to request the appropriate information.

To assist in this process, we are planning to introduce a standardised referral form. These will be distributed to you shortly and will also be available for download from our website.

It is important that patients are advised, on referral, that treatment may not be available under the new NHS guidelines.

Patients will not be accepted onto our treatment waiting lists if oral hygiene is poor or there is evidence of active dental disease.

When to refer in the mixed dentition

  • Lack of palpable canine bulges buccally at 10-11 years indicating possible palatal impaction of canines;
  • Asymmetry in the pattern of eruption (especially upper incisors) more than 6 months difference;
  • Anterior or posterior crossbites with associated mandibular displacements;
  • Hypodontia (missing teeth) or supernumerary teeth;
  • Submerging deciduous molars or impacted first permanent molars;
  • Severe incisor crowding;
  • Class II/1 malocclusion with an underlying skeletal II pattern. Most

functional appliances are easiest to wear when upper 4|4 are fully erupted. Such a

patient entering his or her pubertal growth spurt should be referred without delay;

  • Class III malocclusion in the mixed dentition;
  • Severely hypoplastic or carious first permanent molars with poor long-term prognosis.


Patients’ responsibilities during treatment

Orthodontic treatment depends on teamwork, and good patient compliance is essential to achieve a successful outcome. It is important therefore that the referring practitioner informs patients before they are referred that:

1. All appointments should be kept.

2. Appliances must be worn as instructed.

3. Dietary advice and oral hygiene instruction must be strictly adhered to.

4. Treatment generally takes between 18 to 30 months followed by a

period of retention.

5. Appliances will be removed and treatment discontinued if there is

persistent poor oral hygiene, broken appliances, poor compliance with

instructions or failed appointments.