An audit of referral practice for patients with impacted palatal canines and the impact of referral guidelines

Delayed diagnosis of displaced and impacted canines - a prospective longitudinal study

Objectives: To assess the frequency and reasons for delayed diagnoses of displaced/impacted canines and to determine to what extent this causes complications. In addition, to assess whether any preventive measures were taken.Materials and methods: Patients with displaced/impacted canines that were diagnosed late; i.e. at an age ≥12 years, were consecutively collected during September 2015 to September 2018 in the County Region of Halland, Sweden. Additionally, patients who had undergone surgical exposure or extraction of an impacted canine during the same time period were identified.Results: Eighty-four individuals (58% girls, 42% boys, mean age: 13.75 ± 1.53 years) with 114 impacted canines were detected among 33,488 adolescents aged 12-20 years, resulting in a low-frequency rate: 84 cases per 100,000 persons. Eighty-six percent of the delayed canines were in the maxilla, the rest in the mandible. Deciduous canines were present in 80% of the cases. Most patients had a dental examination at 9-11 years of age but the position of the canine was not documented in many cases. Root resorption of adjacent teeth was noticed in 13% of the patients. No new clinical procedures or guidelines were developed.Conclusions: The frequency of delayed diagnoses of displaced/impacted canines was low. To minimize the frequency even more, documentation of the canine position during the dental examination should not be forgotten at ages 9-11. Presence of the deciduous canine can be used as a clinical indicator that the position of the permanent canine needs to be investigated.

Are patients with impacted canines referred too late?

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.