Contributing Writer 
Letter To Periodontist; Referral For Comprehensive Evaluation
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 periodontal treatment. FMX taken 4/27/2010 enclosed. Dr. OralSurgeon took a recent panelipse radiograph.
Jane was new to me last month. She presented with #31 root fracture. She was referred to Dr. OralSurgeon who extracted the tooth.
Today we did our new patient exam.
- Last dental work was about 4 years ago.
- She said she has had periodontal surgery many years ago.
- Many 5 & 6mm pockets; generalized attachment loss.
- #8-x-10 has a temporary bridge made about 5 years ago; recurrent caries; perforated.
- She had a nightguard in the past. Dog chewed it up; she now wears an over-the-counter sports guard.
- Very heavy black tobacco stain.
My preliminary restorative treatment plan:
- #8-x-10 fixed bridge
- #15 crown (has fractured cusp)
- nightguard
You might uncover more restorative needs during her initial therapy.
I explained to her that she has very active periodontal disease, and might need aggressive treatment to avoid further tooth loss; importance of 3-month cleanings for the long term; possibility that even with treatment she will still lose some teeth.
Sincerely,
Dr. _____
