Are patients with impacted canines referred too late?

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.

The Prevalence and Categories of Impacted Maxillary Canines: A Radiographic Study

“…By the age of 12 years, the position of permanent maxillary canines can be assessed with panoramic radiographs. Also, early treatment of impacted maxillary canines can start at the age of 12 years [22]. Patients who had orthodontic treatment or were wearing orthodontic appliances at the time of taking the panoramic radiographs were excluded.…”

Hjørnetenner på avveie – kliniske og radiologiske vurderinger

“…Dersom pasienten har en tannalder tilsvarende 12 år eller eldre og fremdeles har en eller flere persisterende melkehjørnetenner bør man mistenke ektopisk erupsjon av den permanente hjørnetannen (7,19). Pasienter med ektopisk erupsjon som henvises til kjeveortoped før 12 års alder vil ha redusert risiko for resorpsjonsskader og lang behandlingstid, samt økt sannsynlighet for at en eventuell aktiv fremføring blir vellykket (20). Kliniske tegn til ektopisk erupsjon er illustrert i figur 5.…”

Eruption disturbances in the mixed dentition: orthodontic considerations for primary dental care

“…26 Late referrals can involve longer and more complicated treatment and might result in further root resorption of adjacent teeth. 20,27 Fig. 2 A dental pantomogram illustrating a supernumerary tooth impeding the eruption of the upper left permanent central incisor in the maxilla of a 9.75-year-old female.…”

“…It is imperative that the patient is referred to an orthodontist for assessment and management of a suspected PEMPC 26 . Late referrals can involve longer and more complicated treatment and might result in further root resorption of adjacent teeth 20,27 …”

“… 26 Late referrals can involve longer and more complicated treatment and might result in further root resorption of adjacent teeth. 20 , 27 …”