Guy's and St Thomas's NHS Foundation Trust (GSTT) adopts a standardised three-tier referral and selection process for NHS-funded dental implant therapy for highly prioritised groups. At the first tier, the referring clinician must disclose all relevant medical history, as well as ensure that all primary dental diseases are stabilised. Afterwards, accepted referrals will advance to the second tier, where patients' appropriateness will be further evaluated at a consultation clinic. During consultation, common conditions which deem the patient inappropriate for dental implant treatment either at present or indefinitely are as follows: active periodontitis/caries, active smoker, growing patients, and alternative treatments available. Should an application be made at the point of consultation, it will be forwarded to the third and final tier, where a decision on the provision of NHS-funded dental implant therapy will be determined by a panel of hospital consultants, known as the dental implant assessment committee. This retrospective audit has investigated the appropriateness of all three-tier referral and selection process, based on the criteria endorsed by GSTT.

Referral and selection data of 100 patients spanning over seven months were retrieved retrospectively from EPIC, GSTT's electronic health record software. The audit standards were based on GSTT criteria and the target was set at 100%. Data on whether an application for funding was made or not, and for what GSTT criteria it met or not, were recorded for each patient. For patients for whom applications were made, the outcome of the dental implant assessment committee was recorded as either approved or rejected.

One hundred referrals were from general dental practitioners (GDPs) and all had met GSTT criteria. However, only 35 patients had their funding applications made following the consultation clinic. Reasons for rejection in descending order are: active periodontitis (26), alternative treatment options available (19), others (9), active caries (5), growing patient (5), and active smoker (1). Alternative treatment options included the provision of no treatment, resin bonded bridges or conventional fixed dental bridges, while others constituted the need for additional orthodontic correction, intolerance to partial dentures. Of the 35 applications made, all were approved by the dental implant assessment committee.

Although all referrals complied with GSTT criteria, 26% had active periodontitis, which was found to be the main reason why applications for NHS-funded dental implant therapy were not made. This is somewhat concerning since active periodontal disease is a well-established risk factor for implant failure.1,2 In summary, this audit has highlighted the need for more accurate detection of active periodontitis by GDPs to ensure higher probability of patients being accepted for care.