Category: Dental Templates

Dental referral dictation templates

Orthodontics Template

Scott McLaughlin

This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.

Why do you feel the patient needs hospital based orthodontic management?

  • Orthodontic / Minor oral surgery
  • Orthodontic / Restorative
  • Orthodontic / Orthognathic (jaw) surgery
  • Cleft lip / palate
  • Orthodontic / paediatric dentistry management
  • Special needs patient
  • Second opinion

Reason for Referral: [Text]

Priority: [Routine]

Date of Onset: [Date]

Has the patient previously attended the department to which they are being referred?

  • Yes
  • No
  • Don’t know

Has the patient previously attended any NHS Lanarkshire hospitals for treatment?

  • Yes
  • No
  • Don’t know

Please provide details of previous admissions or attendances: [Text]

Does the patient have any special requirements, e.g. disability, autism, etc.:

  • Yes
  • No

Please provide details of special requirements: [Text]

Orthodontics Referral Guideline

 

Oral Maxillofacial Surgery Template

Scott McLaughlin

This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.

Presenting Complaint

Main presenting complaint:

  • Other lump / swelling
  • Other oral mucosal lesions
  • Oral / facial pain
  • Salivary gland problems
  • Temporo-mandibular joint problems
  • Oro-facial disproportion / deformity
  • Requiring minor oral surgery

Based upon the answer to the question above, please select the appropriate option from the questions below.
If ‘Oral/Facial pain’ is selected, no further information is required here.
If ‘Temporo-mandibular joint problems’ is selected, no further information is required here.

If ‘Other lump/swelling’:

  • Oral
  • Facial
  • Neck

If ‘Other oral mucosal lesions’:

  • Long-term mucosal pigmented lesion
  • Other mucosal abnormality
  • Mucosal bullous lesion
  • ROAU

If ‘Salivary gland problems’:

  • Major gland
  • Minor gland
  • Salivary calculus
  • Dry mouth

If ‘Oro-facial disproportion / deformity’:

  • Skeletal growth abnormalities
  • Cleft lip palate
  • Post traumatic abnormalities

If ‘Requiring minor oral surgery’:

  • Third molar/impacted tooth
  • Other tooth/root
  • Peri-radicular
  • Pre-prosthetic
  • Pre orthodontic

Reason for Referral: [Text]

Priority:

  • Routine
  • Urgent
  • Urgent – Suspicion of cancer

Date of Onset: [Date]

Priority Reason: [Text – 98 character maximum]