Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)

Date

Dr. Periodontist
Address
City, State  Zip

Dear Dr Perio:

I have referred [patient] to you for comprehensive perio/restorative/implant evaluation.  FMX from 2/9/2010 enclosed; you may keep.

Joe has been a patient since 1994.  He is 52 years old.  He has always been very sporadic with his recalls.  Last scaling/root planing was in 2008.  Last cleaning/exam was 3/2009.

He has always had a high caries rate.  He is a controlled diabetic, but he drinks lots of soda pop.  I have warned him many times in the past that it is destroying his mouth.  His decay always seems to be deeper than expected when we get into it clinically; dentin seems softer than normal.  He quit smoking last month.

Problems identified at 2/9/10 exam:

1. Caries 2DB, 4D & B, 5B, 7F & L, 9F, 13B, 14L, 15L, 29B.
2. Periapical radiolucencies on 3 (fractured root?), 9, 22, 30; possibly 5.
3. Chronic generalized adult periodontitis

Options for upper arch are:

1. Restoring with all new crowns, bridges, and implants;
2. Saving some teeth; crown abutments; making removable partial denture;
3. Full upper denture, possibly with implant retention.

On lower arch, the 21-22 cantilever bridge might be lost after 22 RCT; may need implant.  Otherwise the lower arch is savable with a crown on 29.

Joe was undecided on which course of action to take.  I suggested a consult with you so we could formulate some treatment plan options to present to him.  Let’s get together to discuss this case.

Sincerely,

Dr. ______