Are patients with impacted canines referred too late?

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Abstract

Objective To establish the appropriateness of timing of referrals for patients referred for the management of ectopic maxillary canines, and to evaluate the success of previous recommendations to educate referrers.

Design Retrospective clinical re-audit.

Setting Royal Surrey County Hospital NHS Foundation Trust.

Subjects and methods Data were collected retrospectively for 220 consecutive patients between January 2013 – December 2014 and compared to the gold standard based on the clinical guidelines for management of the palatally ectopic maxillary canine published by the Royal College of Surgeons of England in 2010 which states that all patients with an impacted canine should be referred by 12 years of age.

Results Ectopic maxillary canines represent a significant number of referrals to district general hospitals. One hundred and sixty-seven patients (76%) were referred late (>12 years) at a mean age of 14.1 years, >2 years later than the recommendations made in the Royal College Guidelines. Seventy-six percent of patients were not referred by 12 years of age compared to an audit in 2002 which found 45% delayed referral.

Conclusion Timing of referral was delayed compared with the Royal College Guidelines. An increase in delayed referral suggests that local education programmes introduced after the previous audit did not have a lasting effect.

Key Points

  • Reminds us that general dental practitioners are responsible for the detection and referral of patients with impacted canines.

  • Highlights that early diagnosis at 10 years of age facilitates interceptive extraction of primary canines, which can allow normalisation of eruption.

  • Highlights that early diagnosis can avoid the risk of damage to adjacent teeth.

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Acknowledgements

The authors would like to acknowledge the support of the Royal Surrey County Hospital NHS Foundation Trust Research & Development scheme.

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Correspondence to D. Patel.

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Refereed Paper

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Patel, D., Taylor, N. Are patients with impacted canines referred too late?. Br Dent J 221, 561–564 (2016) doi:10.1038/sj.bdj.2016.816

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