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

DATE

Patient Name
Address
City, State  Zip

RE:  Jane Doe; dob 2/31/1989

To Whom It May Concern:

Jane Doe fell while roller skating on August 14, 2010 and hit her lower jaw, slightly fracturing her jawbone (the right condyle), knocking out an upper front tooth (#8), and fracturing another (#9).  The avulsed tooth was immediately replanted and stabilized.  It required subsequent root canal treatment.

Future dental care will be required over the next few years.  First, orthodontic care probably will be needed to correct the malocclusion; the extent will be determined by the Orthodontist.

Once the occlusion is corrected and her growth has slowed, she will need crowns placed on the two upper front incisors (teeth #8 and 9) to restore where they were broken in the fall.  Immediately prior to this, she will likely need some surgical recontouring of the gums to even out the gumline around the teeth where the gums were torn by the avulsed tooth.  This would be performed by a Periodontist.

Although this is all the treatment that is anticipated, there are other possible scenarios that might develop in the future:

• Abscess of any teeth that received excessive force from the fall.  This would necessitate root canal treatment, build-up, and crown on the affected tooth or teeth.
• Loss of one or more of the front teeth due to external resorption, root fracture, or untreatable abscess.  This would necessitate replacement of the missing tooth or teeth with implants, fixed bridges, or removable partial dentures.

This is certainly not an inclusive list.  The timing of these events is unpredictable; it could occur at any time in her lifetime.

Sincerely,

Dr. _____