Referrals are, of course, hugely necessary. They enable patients to get specialised and appropriate care that may not be able to be provided in primary care. Working in a hospital means a lot of the patients I see in my speciality teaching are patients that have been referred. I’ve mentioned before that I find it odd how us as undergraduates are seeing cases that are too complex for qualified dentists to see; however, many of these patients actually present relatively simple cases that should be managed in-practice.

An appropriate referral

The biggest question is: what is an appropriate referral? Some are obvious – a suspected malignancy or more serious condition that has presented orally. However, I have seen many a referral that seems too simple to require secondary care. I’ve heard stories of molar endodontic cases being referred into the dental hospital. Of course, molar endodontics is a complex procedure and some may need specialist treatment. Yet, many of these are relatively ‘simple’ and could be managed in the primary care setting. The question with regards to these cases is – are they due to a lack of confidence/training in the procedure, or are they being referred because of financial reasons? Either way, something needs to be done to ensure that the people who really need the secondary care appointments are getting them.

Another area I have seen inappropriate referrals is in the oral medicine clinic. I’ve only had a few oral medicine clinics and we as a group see around six patients a session. Already there have been three cases of periodontal disease referred into these clinics. All of these referred patients had a complaint of ‘bleeding gums’.

Although there are other more serious, differential diagnoses for bleeding gingiva, such as acute leukaemia, these patients had no other symptoms that would indicate this and presented with deep probing depths. I think anyone reading this would agree that this referral is completely inappropriate and although we need to take into account differing levels of skill and abilities amongst dentists, this really is the basics of dentistry and this case should perhaps never have been referred.

Is there an answer?

So how can we filter out these inappropriate referrals? There is talk of everyone going over to an electronic referral system where by a criterion needs to be fulfilled in order for a referral to be accepted by a secondary care centre. This sounds like a good solution but the practicalities of it could be difficult. Ensuring it is introduced into all practices and making a criterion that will pick up on every concerning symptom may be tricky. It is important to ensure there are no loopholes in which patients, who may need complex care, can fall through. As well as this, loopholes in the system may mean that we still see inappropriate referrals for practitioners. Therefore, the system needs thorough planning in order to be effective.

There is no perfect solution and a completely perfect referral system most probably doesn’t exist. However, with an already tight NHS budget it is vital that it is being optimised and spent on the patients that really do need the secondary care.

A new report has shown that being afraid of the dentist can affect your oral health and be damaging to your quality of life. The International Dental Journal study shows that that form of anxiety can impact someone psychologically and socially, leading you to feel ashamed, low in confidence and socially isolated.

Income and education were also factors negatively affected by dental anxiety. Those questioned were almost twice as likely to be on a lower income if they feared dental visits. The same group are also twice more likely to suffer from poor oral health.

The study estimates that more than 10 million adults in the United Kingdom have some level of dental anxiety, with an approximate six million suffering from dental phobia.

The Oral Health Foundation is working hard to emphasise the importance of overcoming dental anxiety and preventing anything that happens as a result of it.

Dr Nigel Carter OBE, CEO of the OHF said: “About one in five Brits admit to being afraid or anxious about visiting a dentist in Britain.

“This is an incredibly widespread anxiety and is one of the key reasons why people don’t visit the dentist as often as they should. This can put you at risk of significant oral health problems and, as this research shows, other important areas of your life.

“Avoiding a visit to the dentist due to fear puts you at greater risk of missing oral health problems, such as early signs of tooth decay or gum disease, until it gets too late to treat effectively, and you have no choice but to have extensive treatment.

“It can also have knock on effects on self-confidence and other elements of psychological wellbeing, which can impact you socially in your relationships or even career.

“It can also lead to potentially significant health issues as untreated gum disease has been linked to systemic diseases such as heart disease and diabetes.

“Modern dentistry is very different to the scare stories which you may base your dental anxiety on and, with modern techniques, all dental treatment is now virtually painless. There really is no need to fear a visit to the dentist.”

The BDIA has announced the passing of Douglas F Cochrane, who many across the profession will remember from his time at KaVo, and as the BDIA President during 1977-1978 and 1988-1989.

Everyone at The Probe joins people from across the profession in offering our deepest sympathies and condolences to Douglas’s family at this difficult time.

The funeral is being held today (Wednesday 18 April) at 12:45pm at West Wing, Breakspear Crematorium,​ Breakspear Road, Ruislip HA4 7SJ. The wake will be held at Moor Park Golf Club, Rickmansworth, WD3 1QN.

The University of Central Lancashire (UCLan) is celebrating a decade of training the next generation of dentists.

Ten years ago, UCLan’s School of Dentistry was one of only two new dental schools to be created in England for over 100 years. UCLan have treated more than 23,000 patients during their training and has produced 224 dentists who have made life-changing contributions to the profession.

With £5.25 million invested its state-of-the-art dental school in Preston, UCLan has one of the most sophisticated ‘phantom head’ rooms in Europe where students learn their skills on simulators. The University also has its own Dental Clinic.

At their 10^th anniversary event, which welcomed graduates and former staff to celebrate, NHS England’s Deputy Chief Dental Officer and UCLan Honorary Professor Eric Rooney commented: “Over the last ten years many of the initial aims of the School have been fulfilled, helping patients and creating a vibrant dental academic community. Our population, their needs, and the way we care for them is changing and UCLan is well placed to develop and adapt over the next ten years and beyond.”