Refer or not to refer ....

To Refer or Not to Refer?

This is the decision that has the greatest impact on the quality of patient care during endodontic treatment is the decision whether or not to refer.

  1. Most importantly to refer difficult cases means you may prevent treatment errors which cause patients unnecessary complications.
  2. To refer means you will remain on time and keeping your patients happy.
  3. To refer means your patient is seen swiftly and efficiently by an expert in Endodontics.

What constitutes as a difficult Endo case? Well - you decide: you the practitioner have a legal and ethical obligation to determine, based on the case at hand, whether you possess the skills necessary to predictably manage your patient’s endodontic needs. ..If unsure - just refer.

Check the guidelines: 

The AAE has developed a Case Difficulty Assessment Form, available on the AAE Web site at, that helps general dentists catalogue and characterize cases prior to treatment.

“The dentists who chooses to consistently refer patients to a specialist don’t find themselves in emergency situations – it just doesn’t happen,” says endodontist James Abbott, D.D.S., M.S., of Santa Rosa, Calif. “The Case Difficulty Assessment Form is a valuable tool to help dentists decide whether a referral should be made.”

We are here to help, guide and serve you - call us directly or email

How I work with dentists by Jonathan Lee

 I would say that we have a special relationship with all our referrers!  The relationship between dentist and referrer is mutually respectful one and very distinctively different from the dentist-patient relationship.

Patients do not always look to assess their dentist’s clinical skills, so their choice of dentist is usually an emotional one and one of trust.

Meanwhile, the dentist usually chooses a specialist for their clinical skills.  When patients are referred to a specialist who has been specifically chosen by their dentist, the patient has no prior knowledge or experience, but the trust they have developed with their own dentist is usually transferred to the specialist.

As a referral practice we are aware of this responsibility. Our role is not just to develop our relationship with the patient, but to become an extension of the practice they are used to attending.

The referring dentist can entrust us to ensure we gain the patient's trust right at the start.  How do we do this?

We will be in direct communication with you to discuss the case..

The kind of things that come up in our conversation would be the prognosis of the tooth, how best to treat and then how best to restore after the endodontic treatment has been completed.  I usually recommend that any posterior tooth which undergoes root canal treatment should have cuspal coverage placed unless both marginal ridges are intact and in good health. Inevitably, if the root treatment fails, it will be the endodontist who is blamed, not the dentist.  We rarely turn down a referral – but we would discuss the restorative options with the referring dentist prior to undertaking the treatment.

Specialists and dentists have to work closely together and if the relationship isn’t based on mutual trust and respect, then the patient’s interests are not being served.

Why? It is widely documented that a well-fitted coronal restoration is a major determinant in the outcome of any endodontic procedure. ‘Our position here is that all dentists should be able to carry out all treatments within their ability, but we also respect those colleagues, who believe that complex treatments are best carried out by specialists. ‘Specialists and dentists have to work closely together and if the relationship isn’t based on mutual trust and respect, then the patient’s interests are not being served. Being able to call the patient’s dentist and have a full and frank discussion about the best way to proceed is hugely important.