Contributing Writer 
Letter #2 Referral To Periodontist For Comprehensive Evaluation
Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)
DATE
Dr. Periodontist
Address
City, State Zip
Dear Dr.Periodontist:
I have referred [patient name] to you for restorative/implant/perio consultation. Perio charting and full mouth x-rays from 9/3/2011 enclosed (you may keep).
Today we completed a scale & prophy, exam, radiographs.
Problems noted:
- Generalized recession, especially 20 & 21
- Many areas of lack of attached gingiva
- Missing 19 (extracted over 30 years ago)
- Supraerupting 14; tipped 18
- Possible pin perforating root on 4 distal; old restoration encroaching biologic width
- Large failing restorations and/or fractures on 2, 3, 4, 13, 14, 18, 29, 30, 31
- Caries 2, 3, 12
- Abfraction 20 & 21 buccals
- Generalized occlusal/incisal attrition
- Generalized mobility
Preliminary treatment plan:
- Crowns #2, 3, 4, 13, 14 (to correct supraeruption), 18, 29, 30, 31.
(2 & 3 are first priority because of caries) - 12 Occlusal composite; 20 & 21 buccal composites
- 19 Implant-retained crown
- Nightguard
Possible specialist treatment: gingival grafting; #19 implant; upright #18; crown lengthening #4.
I would like to meet with you in person and discuss her treatment plan after you evaluate her.
Sincerely,
Dr. _______
