{"id":28584,"date":"2025-02-25T09:00:06","date_gmt":"2025-02-25T15:00:06","guid":{"rendered":"https:\/\/www.aae.org\/specialty\/?p=28584"},"modified":"2025-02-27T14:47:04","modified_gmt":"2025-02-27T20:47:04","slug":"wtf-referrals-wyd","status":"publish","type":"post","link":"https:\/\/www.aae.org\/specialty\/wtf-referrals-wyd\/","title":{"rendered":"WTF Referrals, WYD?"},"content":{"rendered":"

\"\"By Ross Rosenblatt, DMD<\/em><\/p>\n

You never know when they\u2019ll show up. They can strike first thing in the morning, the last walk-in you decide to squeeze in, or any time in between. No appointment slot is safe. Your patient arrives and you wait on your all-important pre-operative imaging. In the meantime you mull over the referral the patient brought in. \u201cEval and treat as needed\u201d you decipher from the scribblings on the page. Maybe it\u2019s just a circled tooth number alone without any hint of what\u2019s to come. You play through what it could be in your head. A nice straightforward case would be so welcomed right now, wouldn\u2019t it be? Finally! The x-ray is up. You take a look and your mouth drops open. Like drops of chloroform dissolving a rubber dam, the comforting idea of a straightforward case melts away. \u201cWhat is going on here?\u201d You ask yourself. \u201cWhat is that<\/em>? What\u2026the\u2026(insert choice word that starts with ‘F’ here)\u2026?\u201d.<\/p>\n

If you\u2019re in this endodontics game, you\u2019re bound to get referrals that make you scratch your head. You know the ones I\u2019m talking about. There isn\u2019t any discussion to be had. This tooth had to go yesterday. <\/em>Maybe even last year. Anything from the long past restorable to the obviously fractured can show up on any given day, and we endodontists are tasked with dealing with these situations as tactfully as possible. I\u2019ll never claim to know everything about any topic (being an endodontist has a natural way of keeping you humble) but I\u2019ve been known to have amassed a bit of a collection of these cases- and I know you all have too. Let\u2019s delve into handling these\u2026we\u2019ll call them \u201cunfavorable\u201d referrals.<\/p>\n

Get It.<\/em><\/strong> Through years of studying and experience, you and I merely have to glance at an x-ray of an unfavorable referral before immediately deciding on a plan- send to your favorite (or least favorite) oral surgeon colleague. Now you need to explain that to the layperson. This is a great time to go over imaging with your patient. Show them what caries into the furcation looks like, or what a fracture line looks like relative to a healthy tooth. Go over the borders of a theoretical carious lesion that would be treatable, or an illustration of a crack limited to the clinical crown versus a vertical root fracture. In today\u2019s healthcare landscape patients are told things all the time. Where to go, what to do, what they have, and what they need. Take a little time to show <\/em>them what\u2019s going on. Once they are empowered with the knowledge of what makes their case unique the impending news of inevitable extraction becomes a much more logical train of thought to follow.<\/p>\n

Everybody Stay Calm.<\/strong> <\/em>If a patient doesn\u2019t take all of this news particularly well they may be looking to lay blame on someone. \u201cThe tooth was fine before so-and-so touched it.\u201d You know the usual lines. I personally have a very strict policy of never throwing a colleague under the bus. More often than not, an unfavorable referral got to that point from factors far outside of the control of a dentist. Poor oral hygiene, a lack of regular dental visits, traumatic occlusion that went unchecked, and a host of other issues may result in what now sits in front of you. Even in the event of an iatrogenic error (or errors) it\u2019s still important to let the patient know that previous providers surely tried their best. Healthcare and dentistry specifically can sometimes be unpredictable despite our best efforts. It\u2019s quite easy to judge an x-ray but once you lean the patient back and realize they\u2019re about as compliant as a feral cat the whole picture gets painted. It\u2019s never the filling, crown, or root canal that failed, but rather the tooth itself. After all, we\u2019ve all seen cases that have no business being successful last far longer than some of us have been alive! Try as we might to minimize unfavorable outcomes, they are bound to occur. Emphasizing those points to a patient can go a long way.<\/p>\n

Talk To Me<\/em>.<\/strong> Communication is key when it comes to the relationships between general dentists and specialists. A counter-referral with imaging and a detailed narrative is a standard response when dealing with an unfavorable referral. When time permits I try to find time to reach out personally to the referring doctor to discuss the case. You\u2019ll find a whole spectrum of reasons as to how the patient arrived in your chair. Some patients strong-arm their dentist into sending them your way for a second opinion on an unfavorable tooth that was already condemned. You\u2019ll find plenty of general dentists who sent the patient out after squeezing them into an already jam-packed schedule for a limited exam. Maybe a previously shallow crack even progressed in the time it took for the patient to schedule with you. No matter what, a good-natured discussion about the case with the referring doctor highlighting the factors that make the case unfavorable is always a good idea. Making a good faith effort to ensure everyone is on the same page moving forward goes a long way for all parties.<\/p>\n

As much as we want to avoid unfavorable referrals, they will find their way to our chairs. Sometimes due to our advancements and high success rates it\u2019s hard to remember that we\u2019re the last line of defense to a tooth getting extracted. We do root canals day in and day out, many of which are predictable and quite frankly forgettable. We take for granted the fact that success is not a forgone conclusion but a chain of events that rely on the expertise and skill of a number of players along the way. While it\u2019s easy to get caught up in the \u201croot canal\u201d part of \u201croot canal doctor\u201d, we mustn\u2019t forget that \u201cdoctor\u201d derives from the Latin word meaning \u201cto teach.\u201d We have an obligation to educate; our patients, our referrals, the next generation of dentists, and the general public. If nothing else the occasional unfavorable referral is certainly an opportunity for a teachable moment. That said, there still isn\u2019t anything wrong with hoping they don\u2019t show up on your schedule.<\/p>\n

Ross Rosenblatt, DMD, is a Board-certified endodontist practicing in Virginia and runs @Evidence_Based_Endo_Memes <\/a>on Instagram.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

By Ross Rosenblatt, DMD You never know when they\u2019ll show up. They can strike first thing in the morning, the last walk-in you decide to squeeze in, or any time…<\/p>\n","protected":false},"author":12,"featured_media":28643,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"content-type":"","_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[160],"tags":[],"feature":[236],"class_list":["post-28584","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-problem-solving-in-endodontics","feature-paperpoint"],"yoast_head":"\nWTF Referrals, WYD? - American Association of Endodontists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.aae.org\/specialty\/wtf-referrals-wyd\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"WTF Referrals, WYD? - American Association of Endodontists\" \/>\n<meta property=\"og:description\" content=\"By Ross Rosenblatt, DMD You never know when they\u2019ll show up. 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