Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

1

Please fax referrals to The Alfred Specialist Clinics on 9076 6938. The Alfred Specialist Clinics Referral Form is available to print and fax. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service. Advice regarding referral for specific conditions to the Alfred Dental Service can be found here. Notification will be sent when the referral is received. The referral may be declined if it does not contain essential information required for triage, if the condition is not appropriate for referral to a public hospital, or is a condition not routinely seen at Alfred Health. The clinical information provided in the referral will determine the triage category. The triage category will affect the timeframe in which the patient is offered an appointment.

COVID-19 Impact — Specialist Clinics

As part of Alfred Health’s COVID-19 response plan, from October significant changes have been made to Specialist Clinic (Outpatient) services. All referrals received will be triaged; however, if your patient’s care is assessed as not requiring an appointment within the next three months, the referral may be

declined.

Where possible, care will be delivered via telehealth (phone or video consultation).

The Alfred Dental Unit provides specialized dental treatment of medically complex patients. Medically fit patients are not seen at The Alfred except in emergency circumstances. The Alfred Dental Unit is unable to provide:

Crowns

Bridge work

Endodontic treatment (root canal treatment)

The following services are not provided unless in special circumstances:

Maintenance dentistry (cleaning, dental check-ups)

Restorative treatments (fillings)

Children under 18 years of age are not seen at The Alfred

Patients who are being treated for the same condition at another Victorian public hospital.

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

2

Please include in the referral:

Please note: The times to assessment may vary depending on size and staffing of the hospital

department.

If you are concerned about the delay of the outpatient appointment or if there is any deterioration in the patient’s condition, please contact the Dental Registrar on call on

9076 2000.

Demographic details:

Date of birth

Patient’s contact details including mobile phone number

Referring GP details

If an interpreter is required

Medicare number

Clinical information:

Reason for referral

Duration of symptoms

Relevant pathology and imaging reports

Past medical history

Current medications

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

3

Contents

Anticoagulants

Bone Marrow Transplantation

Diabetes

Head and Neck Malignancies

Haemophilia

Heart Valves

HIV/Infectious Diseases

Organ transplantation

Antiresorptive therapies

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

4

Anticoagulants Evaluation Key Points:

Medical history

Medications

Duration of dental problem

Warfarin dose

INR

Reason for anticoagulation

Management

Maintain Warfarin unless outside therapeutic guidelines.

Do not cease any anticoagulation medications

If the patient does not require dental extraction then not routinely seen at The Alfred Dental Clinic. Additional comments: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service. Return to Contents.

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

5

Bone Marrow Transplantation Evaluation Key points:

Medical history

Medications, bisphosphonates (including last dose and total number of doses)

Duration of dental problem

FBE

Management Refer Routine if post-transplant. Additional comments: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service.

Return to Contents.

Immediately contact the Dental registrar to arrange an urgent Dental assessment for:

Pre-transplant

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

6

Diabetes Evaluation Key points:

Medical history

Medications

Duration of dental problem

Insulin

HbA1c

Management

Patients can have normal meals and medications before all outpatient appointments.

Stable diabetics are not routinely seen at The Alfred Dental Clinic. Additional comments: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service. Return to Contents.

Immediately contact the Dental registrar to arrange an urgent Dental assessment for:

Unstable diabetes with oral infection (urgent dental attention is required)

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

7

√

Head and Neck Malignancies Evaluation Key Points:

Medical history

Medications

Duration of dental problem

Tumour type and histology

Details of radiotherapy

Management Refer Routine if post-operation Additional comments: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service.

Return to Contents.

Immediately contact the Dental registrar on 9076 2000 to arrange an urgent Dental assessment if:

Pre-operation

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

8

Haemophilia

Evaluation Key Points:

Medical history

Medications

Duration of dental problem

Additional comments: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service.

Return to Contents.

Direct to the Emergency Department:

If bleeding

Please call the Admitting Officer on 1800 ALFRED (1800 253 733)

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

9

Heart Valves Evaluation Key Points:

Medical history

Medications

Duration of dental problem

Warfarin dose

INR

Reason for anticoagulation

Management Patients post-surgery are not routinely seen at The Alfred Dental Clinic unless anticoagulated. Additional comments: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service.

Return to Contents.

Immediately contact the Dental registrar on 9076 2000 to arrange an urgent Dental assessment:

Any oral infection in a patient with heart valve

If pre-surgery

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

10

HIV/Infectious Diseases

Evaluation Key Points:

Medical history

Medications

Duration of dental problem

CD4 count

Other viral serology eg Hepatitis C

Management Patients with CD4 count >150 are not routinely seen at The Alfred Dental Clinic. Additional comments: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service.

Return to Contents.

Immediately contact the Dental registrar on 9076 2000 to arrange an urgent Dental assessment:

If immunocompromised with oral infection (urgent dental attention is required)

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

11

Organ Transplantation

Evaluation Key Points:

Medical history

Medications

Duration of dental problem

Degree of immunosuppression

Type of therapy

Management Stable patients are not routinely seen at The Alfred Dental Clinic. Additional information: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service. Return to Contents.

Immediately contact the Dental registrar on 9076 2000 to arrange an urgent Dental assessment for:

Immunocompromised with oral infection (urgent dental attention is required)

Pre-transplant

Specialist Clinic Referral Guidelines

Dental

Issued March 2006 Last reviewed October 2021

12

Antiresorptive therapies

Evaluation Key Points:

Medical history

Medications including last dose of bisphosphonate or Denosumab and duration of

medication

Duration of dental problem

Additional information: Please include the essential demographic details and clinical information in the referral. Where appropriate and available, the referral may be directed to an alternative specialist clinic or service. Return to Contents.

Immediately contact the Dental registrar on 9076 2000 to arrange an urgent Dental assessment for:

If suspected medication-related osteonecrosis of the jaw