Dr Andrew Chandrapal limits his practice to cosmetic and prosthodontic dentistry at the London Smile Clinic. He discusses his role when treating referred patients
At times practitioners face a dilemma… to refer or not to refer. General dental practitioners (GDPs) can feel reluctant to refer patients to other clinicians for more specific care due to fear of losing the patient. However, referral services today are highly ethical and professional, offering constructive working relationships with a high level of involvement and communication to the referring dentist.
The referral process should be seen as a way of expanding your own professional expertise and services to enable you to offer more comprehensive care to your patients.
I personally limit my practice to prosthodontics; fixed and removable dentures, crowns and bridges and implant-based work. I accept referrals from other dentists or self-referrals from patients who have, or perceive they have, high levels of dental need but require treatment that is not covered at a general practice level. Although the clinic focuses on cosmetic dentistry I believe that the most important element of dentistry is the function of the teeth, so this is always my priority.
In my experience most GDPs are totally honest with their patients, showing professionalism, integrity and skill. They may have worked with a patient for many years, but when they have taken treatment as far as they can, they may then consider referring for more specific treatment. Perhaps further changes to the dentition mean that more comprehensive treatment is now necessary, which is outside their remit to provide. For example, they may have a crown that keeps de-bonding or teeth that are progressively wearing despite the use of a night guard. It is not a case of incompetency, but of recognition of the limitations of their familiarity with certain processes and procedures.
Generally the treatment I offer is for a small minority of patients and involves complex case restoration or rehabilitation. Many patients I see have complicated needs and requirements and most have some degree of poor dental health or weak function. This situation is sometimes self-inflicted or, in a very small number of cases, their general dentist has not been able to achieve the results or encourage the level of compliance needed.
Frequently patients have high levels of anxiety and their confidence is very low, so the first thing my team do when patients arrive at the clinic is to listen. Every patient has their own story to tell and I meet them on two or three occasions either with or without their existing dentist, to enable them to explain their problems. This type of treatment is what I term ‘journey dentistry’ and involves a number of stages, not all of which are pleasant or are completed smoothly first time, so patient counselling is essential throughout.
From initial consultation, I carry out investigations and report back to the patient with written synopses of their current situation. I then provide different options of how they might wish to proceed, discussing the procedures involved including pros/cons, and gaining informed consent before carrying out the treatment in a series of phases.
Most projects as mentioned are a journey, which can take between six and 18 months to complete. There are times along the way that we have to allow the patient to supply some of the answers; particularly in prosthodontics, we provide a provisional solution and the patient must offer feedback on whether or not it works.
While referring dentists want the best possible solutions for their patients, some fear that their patients will not return to them once treatment is complete. As reassurance for referring practitioners, I always make sure that lines of communication are open and effective. Referring dentists are kept up to date with letters during each phase of the treatment plan, ensuring they are always aware of their patient’s progress. When the treatment is complete I sign off and provide extensive after-care details to both the patient and the referring dentist to encourage long-lasting results. The dentist is made aware of exactly what to look for in order to prevent any complex problems from arising and I also follow up with 12-monthly review examinations for extra reassurance. I strive to support referring dentists and their patients every step of the way, as well as throughout post treatment. The patient is safely returned to their normal dentist’s care. So from that perspective, I strive to work symbiotically with other practitioners.
The London Smile Clinic has a long-standing, prestigious reputation for providing specialist referral services in endodontics, orthodontics, prosthodontics and implants. The specialists aim to become part of the referring dentist’s team by extending professional skills and technology to add extra value to the patient experience.