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General dental practitioner referral letters: a service evaluation on the reasons for rejection

British Dental Journal (2025)Cite this article

Abstract

Introduction Periodontal disease affects a large proportion of the patient demographic. General dental practitioners (GDPs) refer patients for periodontal treatment in secondary care in instances where periodontal disease has not been stabilised with at least two rounds of initial periodontal treatment and reassessment. The referrals made to secondary care are not always accepted. This service evaluation examined the reasons for rejection of referrals from primary care to Eastman Dental Hospital.

Aims The aim of this evaluation was to evaluate the reasons for referrals being rejected following triage at the Eastman, and to assess the quality of the referrals against the current standard taken from the British Society of Periodontology referral criteria.

Method Retrospective data were collected from 673 referrals, between 1 September 2022 and 1 February 2023. A standardised data collection form was used to record information on the reasons why referrals were rejected.

Results From the 673 referrals assessed, 160 referrals (23.8%) were rejected at the triage stage; 148 referrals (93%) were rejected due to a lack of clinical information provided by the GDP; five referrals (3.1%) were rejected as the management could be completed in primary care; two referrals (1.3%) provided an incorrect basic periodontal examination score that did not match the clinical information provided; two referrals (1.3%) required endodontic referrals; and three referrals (1.9%) required referrals to other specialties or was duplicated.

Conclusions A large proportion of referrals sent to our referral centre are being rejected at the triage stage due to a lack of necessary clinical information being recorded in the referral or inaccuracy in the information provided. GDPs are sending referrals to our centre that are not conforming to current standards for referring periodontal referrals. This study highlights that referrals need to conform to the standards to be accepted.

Key points

  • One-third of periodontal referrals received from general dental practitioners are rejected at triage.

  • The most common reason for this is inadequate clinical information in the referral letter/pro forma.

  • The quality of periodontal referral letters from general dental practitioners does not meet the required standards at our centre.

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Data availability

The datasets generated and analysed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Dental Core Trainee, Restorative Dentistry, Eastman Dental Institute, London, United Kingdom

    Sophie Antoniou & Ronan Lee

  2. Consultant, Restorative Dentistry, Eastman Dental Institute, London, United Kingdom

    Ulpee R. Darbar

Authors
  1. Sophie Antoniou
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  2. Ronan Lee
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  3. Ulpee R. Darbar
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Contributions

SA and RL conceptualised this study. SA and RL collected the data, analysed and interpreted the results. SA and UD prepared the manuscript. All authors approved the results and the final version of the manuscript.

Corresponding author

Correspondence to Sophie Antoniou.

Ethics declarations

The authors declare no conflicts of interest. Ethics approval was not required as this was a service evaluation but approval was obtained from the Hospital Audit and Governance Committee. Consent was not needed from the participants as data were collected retrospectively from patient records and no patient identifiable data were included.

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Antoniou, S., Lee, R. & Darbar, U. General dental practitioner referral letters: a service evaluation on the reasons for rejection. Br Dent J (2025). https://doi.org/10.1038/s41415-025-9047-y

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