I would like to highlight an ongoing challenge in the management of patients with impacted maxillary canines: the considerable variation in the quality and timing of orthodontic referrals. Despite longstanding guidance on the early detection of ectopic canines, we continue to see patients referred at a stage when treatment options become limited and the risk of adverse outcomes is increased – including root resorption of adjacent incisors.

A recent audit we conducted at St George's Hospital identified two recurrent issues. First, referrals were often submitted after the optimal window (average age at referral of 15.1 years) meaning the potential for benefits from interceptive treatment such as extraction of the deciduous canines reduces. The Royal College of Surgeons in England recommend that patients with suspected impacted maxillary canines are referred by age 12.1 Secondly, many referrals for suspected impacted canines were made without radiographs. The British Orthodontic Society advises radiographs are taken from age ten for suspected impacted canines.2 This can lead to delayed diagnosis and onward referral.

To address this, we have corresponded with all local referrers outlining key clinical indicators, age expectations, and radiographic requirements. Early findings from cycle 2 suggest clear improvements in referral timing. These gains rely primarily on consistent communication between general dental practitioners and specialist services.

Given the prevalence of impacted maxillary canines and the significant implications of delayed diagnosis, I would encourage colleagues to review their local referral processes and ensure that essential radiographic information accompanies all suspected cases. Earlier, well-structured referrals not only support more predictable outcomes but also reduce inefficiencies across both primary and secondary care.