Professional Referrals Between Primary Care Physicians and Dentists

Insufficient training in the identification of oral lesions leaves many physicians in the dark about needing to refer patients to dental care providers

An American Dental Association (ADA) study revealed physician dissatisfaction with the physician-to-dentist referral process.

The 2016 study asked primary care physicians and specialists from the University of Illinois academic tertiary care hospital in Chicago about limiting factors for medical referrals to dentists. Just over 25 percent of physicians reported referring fewer than five patients to dentists each year. The largest respondent group referred 10 to 50, and only one physician reported greater than 50 referrals.

“Physicians reported they were dissatisfied with the referral system to dentists, the coverage of dental care services for patients and their ability to distinguish a worrisome oral lesion from a variant of normal,” the ADA’s Health Policy Institute (HPI) said in a statement.

The study data points to tooth pain, general oral hygiene and intra oral soft tissue legions as the three leading drivers for primary care physician referrals to dentists. However, responses indicated challenges with oral lesion referrals. Just over 55 percent of physicians indicated they were comfortable identifying a lesion that requires a referral for further assessment by a dentist or a specialist, according to the study.

“Over half of responding physicians (52 percent) reported not referring a patient to a dentist in the past year due to lack of an adequate dental referral system,” the researchers said.

Researchers also identified a lack of oral lesion identification training as a major factor limiting physician comfort. They argued that formal guidelines could help physicians effectively identify dental-related issues and increase quality of care through referrals.

Primary care physicians most commonly referred patients with oral legions to Otolaryngologists (ENTs). Oral surgeons received 32 percent of referrals, but oral pathologists did not receive any. Physicians behaved similarly when referring patients with diabetes and cancer therapy complications. More than half referred these cases to ENTs, less than 10 percent to oral surgeons and none to oral pathologists or oral medicine specialists.

“Sixty-five percent of physician offices reported not having any information, such as pamphlets or website contact information, in order to facilitate referrals to dentists,” researchers added.

As a result, most physicians did not refer patients to a specific dentist and instead allowed patients to contact one independently.

The study notes that the ADA has formal systems for referrals between dental professionals. The American Medical Association (AMA) also has similar guidelines in place for referrals between medical professionals. However, the study reveals that these models do not overlap to include communication between medical and dental professionals.

Ninety percent of physicians preferred electronic referrals over paper systems. Researchers suggested that an app used at either the federal or state level via a professional organization — such as the ADA — allows physicians to contact dentists, triage patients and schedule appointments. They further indicated potential benefits of such a system, including reduced healthcare costs and improved patient care.