Sir, I read with interest the letter by N J Milner and N A Smithson (BDJ 2004, 197: 372) for bringing to light the continuing problem of inappropriate referrals of wisdom teeth to oral and maxillofacial departments. Removal of wisdom teeth is one of the most common operations carried out in the U.K.; hence incorrect referrals have an impact on waiting times.

I also carried out an audit of inappropriate wisdom teeth referrals, based on the NICE guidelines, whilst working in the Oral and Maxillofacial department at Pinderfields Hospital Wakefield, in 2002. At that time, there was already a local referral protocol (predating NICE) and a referral proforma circulated to local general dental practitioners, to use when referring such patients. We decided to evaluate the impact of this protocol following the recommendations by NICE.

Consequently a prospective audit over a two month period, following Royal College of Surgeons guidelines, was carried out. This included 59 patients. In our study, the majority of referrals were found to be appropriate.

However, despite the advice, 63% of referring practitioners did not use the proforma, instead opting for written referral letters. Interestingly, the number of referrals that were inappropriate was 6.8% and in all these cases the proforma was not used.

Such an audit not only highlighted the benefit of setting guidelines for referring practitioners to follow, but also the benefit of using tools, like a proforma, that will assist in reducing the number of inappropriate referrals.

Perhaps a standardised system of referral, using a proforma (with the current guidelines printed on it), may be helpful in reducing the wastage of NHS resources in this area.