Otolaryngologist Dental Referral: Building Your Interdisciplinary Airway Team

As a dental professional, how often do you hear: “I sent the kid to an ENT and they said, ‘Let’s put them on a nasal steroid and see how they do.’ The kids’ tonsils were touching, and he snored all night long. I just can’t get ENTs to remove the tonsils and adenoids!”

Since I began teaching about airway issues, especially in children, this has been a common complaint. Creating an interdisciplinary team — and specifically getting an otolaryngologist referral — can be challenging. Creating an awareness of some of the mistakes we make in our referrals, providing an understanding of the different types of ear, nose, and throat specialists, and giving some simple solutions to finding the right team will help streamline this process for you and your patients.

How is an otolaryngologist referral different?

In dentistry, when we refer a patient to an oral surgeon, periodontist, or orthodontist, we assume they all do the same things in their office. Some but not all oral surgeons take out teeth and place implants; some do only joint surgeries; others may do only orthognathic surgery. Even that subspecialty can be divided into esthetic, sleep apnea, or reconstructive from trauma or cancer. Yet, we refer the child in our office to a local ENT under the false assumption that they’re all the same.

That is simply not the case. ENTs all have very specific specialties. For example, the most popular ENT in my area has not done an adenotonsillectomy in 25 years; his practice is built around doing balloon sinuplasty for people with chronic rhinitis. And still, dentists refer children to him every day, only to become frustrated when he elects not to do surgery.

We also need to understand that there are very few general ENTs. Before choosing an ENT, look a little deeper into their practice and their area of expertise to make sure it fits with the goals of your referrals. You may need to have multiple ENTs within your interdisciplinary team.

What are the different types of ENT practices?

There are many different variables in the types of medicine otolaryngologists treat. According to the American Academy of Otolaryngology, theirs is the oldest medical specialty in the United States. ENTs treat everything from ear disorders to allergy issues to infectious diseases. Ensuring an ENT’s specialty aligns with your patient’s specific symptoms is essential for the best outcome.

A few examples of ENT specialties:

• A facial plastics ENT does plastic surgical procedures with a heavy emphasis on rhinoplasties. They are also trained in orthognathic surgery.
• Sleep apnea ENT surgeons work with medically compromised patients in trying to improve points of obstruction, including the nasal septum, soft palate, uvula, tonsils, and the base of the tongue.
• Many pediatric ENTs deal with genetic and cranial abnormalities rather than airway issues.
• An ENT can focus on the nasal portion rather than the throat. Some limit their surgery to interventions in the nasal cavity.

With such a broad scope of specialties and treatment options, finding the right ENT is crucial. If you refer a child to the wrong practice, you won’t receive the best support or expected outcome. Taking the time to build a partnership with an ENT who specifically treats airway issues is an important step.

How do you find the right ENT?

When looking for an ENT to add to my interdisciplinary team, I use these three steps to find and determine whether the ENT is the right one for my patients.

Ask your patients

Your hygienist should be encouraged to look for signs of airway issues in children and adults and begin conversations with patients. When they find a child with no tonsils, ask the parent or guardian if they had them removed. If so, find out the name of the surgeon. Most importantly, ask if the experience had been a good one. If they feel comfortable sharing, ask why it was done and how the child is fairing now. If the experience was good, that might be the right ENT for your team.

Create introductions

Now you have a name, and you know they take out tonsils and adenoids — but more importantly, you know that they treated the child and family well. They’re a like-minded clinician who probably shares your mindset about airway issues. In addition, you have a connection with the doctor because you share the same patient. This can be the introduction you need to start building a relationship.

Engage your study club

After you choose an ENT, you’ll find yourself discussing cases at study club meetings or with colleagues. This is an opportunity to bring the ENT into your circle and share treatment progress and outcomes. By engaging them in your greater community, you’re also adding value to their practice.

Now that you’ve found an ENT and made them a part of your interdisciplinary team, remember that the medical profession has challenges with insurance companies that are far more difficult to handle than in dentistry. Many times, they want to do surgery but are restricted by the insurance game they must play. Those conversations are also important so you can assist in any way possible.

By following the steps outlined in this article and building a relationship with a like-minded ENT, “I just can’t get ENTs to remove the tonsils and adenoids!” could actually be, “I just keep referring to the wrong ENT for removal of the tonsils and adenoids!”

Children needing these referrals are routinely craniofacially deficient. Never quit on care because you can’t get tissue removed. Correction of the skeletal issues will always improve breathing and can, on occasion, shrink the tonsils and adenoids. Find the right ENT referral to create an ideal team for the best patient care.