Silver Diamine Fluoride (SDF): Enabling Referral to a Dental Home

Referral to dental care, while often difficult, is critical for caries disease management. SDF in the medical setting is considered an interim treatment for families until they can access dental care, establish a dental home or get to their regular dentist. 

Many families face barriers to establishing a dental home. Some general dentists are comfortable managing young children, but often children must see a pediatric dentist for definitive, comprehensive care. Depending on geographic location, transportation, ability to pay, and other factors, access to a pediatric dentist may be difficult or impossible. Some families will need your help to find and establish a dental home. 

Components of a Referral 

Creating a relationship with potential dental homes will result in more efficient and informative patient referrals. Below are suggested elements of a referral from medical to dental care. Dental colleagues with whom you have a relationship will be able to share requested patient information for referral. 

• Patient identifiers:
  • Date of birth
  • Pertinent medical history (active problem list, medications, allergies, surgeries) 
• Brief findings of oral exam:
  • Definite or suspected caries
  • Severity (rampant, localized) and location
• Identification of the following high risk factors:
  • Inability to effectively communicate pain
  • Presence of complex medical status that requires coordination with a care team
  • Dental pain for which acetaminophen and ibuprofen are ineffective
  • Report of quality of life factors such as inability to sleep, eat/drink, or attend school
  • Presence of congenital conditions (cleft lip/palate, etc.)
• Treatment:
  • Date of most recent SDF/fluoride varnish application 

Sample Referral Forms

• Smiles for Life Sample Referral Form
• Qualis Health Practice Transformation Oral Health Integration Implementation Guide 
• Structuring Referrals to Dentistry: Section 6 – See page 14 to download the following:
  • Referral Agreement Template (Word)
  • Referral Template for Primary Care Referrals to Dentistry (Word)
  • Sample Completed Referral (PDF)
  • Oral Health Referral Workflow Optimization (Word)
• AAP Protect Tiny Teeth Toolkit Prenatal Medical to Dental Referral Form: English  | Spanish