Requests from dentists

Addressing requests from dentists

You have told us that you often receive requests from non-physician health-care professionals, including dentists. Common requests from dentists include asking the physician to: 

  • assess the patient to clear them for a dental procedure
  • answer medication questions
  • complete forms
  • order tests, such as MRIs
  • provide the patient’s medical history

This resource is intended to guide you in appropriately addressing these requests.

Expectations of physicians 

  • The College of Physicians and Surgeons of Ontario (CPSO) expects physicians to work collaboratively with other health-care professionals, including dentists, in the shared care of patients. 
  • While physicians are not expected to assess patients to clear them for dental procedures, they are, upon request, expected to share patient information with the dentist for the benefit of patient safety.
  • This could include:

    • providing a patient’s relevant medical history
    • answering medication questions that are not directly related to dental care, but may impact the dental procedure and are outside the dentist’s scope of practice (such as questions about anti-coagulants being used to manage a medical condition)
    • ordering tests as appropriate, which should include communication and collaboration with dentists as required

Expectations of dentists

  • The Royal College of Dental Surgeons of Ontario (RCDSO) states that dentists should use their own clinical judgment for items that are within their scope; they should not request “authorization” or “sign-off” from physicians for dental care. 
  • Dentists may seek information from physicians to support their own patient assessments and clinical decision-making related to the provision of dental care; they should not ask the physician to do this for them (e.g., to “clear” the patient for a dental procedure). 

Managing requests from dentists

  • Physicians are expected to work collaboratively with dentists in the best interests of the shared patient.
  • Requests from dentists should be evaluated on a case-by-case basis.
  • Where appropriate, when the activity is within the dentist's scope of practice, it is within your rights to decline the request.
  • If you decline the request, you must communicate to the dentist the reason for the decision; this may also inform the future rationale for the requests and reduce declined requests in the future.  

Responding to common requests from dentists

The OMA has provided templated language that you can use when responding to these requests.

Information about specific requests

  • Physicians are not required to assess the patient to clear them for a dental procedure.
  • You can decline these requests.
  • While you are not expected to assess the patient yourself to clear them for a dental procedure, upon request, you must send the patient’s relevant medical history to the dentist to inform the dentist’s own clinical decision-making.

  • It is an expectation of the RCDSO that dentists manage medication directly related to dental care, such as pre-operative antibiotics.  
  • You can decline these requests. 

  • Sharing patient health information with other health-care professionals (e.g. dentists) for the benefit of patient safety is a professional responsibility.
  • It is appropriate for the dentist to ask the physician questions about medication management related to medical care, as this is out-of-scope for dentists.
  • The RCDSO states that dentists can refer to high-quality clinical guidance to answer questions about medication management related to medical care. Where high-quality clinical guidance exists, and when appropriate, you may encourage the dentist to contact a RCDSO practice advisor at practiceadvisory@rcdso.org who can direct them to the guidance.

  • It is important that you share relevant information about the patient with the dentist for the benefit of patient safety, upon request.
  • You can choose to either:
    • fill out a form upon request from the dentist, or
    • share the patient’s relevant medical history with the dentist to inform the dentist’s own clinical decision-making.

  • It may be appropriate in some instances for physicians to order tests on behalf of dentists.
  • Dentists are expected to practise to the full extent of their scope, which includes ordering tests, whenever they are able to do so. However, when the dentist has reached the limit of their scope, and/or there is no means of further advancing the patient’s care (e.g., by ordering a test), they may rely on the physician to take reasonable steps to ensure the best interests of the patient are being met.
  • Physicians should only order tests that they deem appropriate. You may need to assess the patient to determine if a particular test is warranted 

Regarding MRIs

  • While dentists cannot order MRIs, oral and maxillofacial surgeons (OMFS) can order MRIs when:
    • the MRI is needed for a dental procedure that is covered by OHIP, and
    • the MRI will be done in a public hospital.
  • If these criteria are met, then it is appropriate for the dentist to refer the patient to an OMFS to order an MRI.
  • If these criteria are not met (i.e., an MRI is needed for a dental procedure that is not covered by OHIP, or the MRI will take place outside of a public hospital), then an OMFS will not be able to order the MRI and it may be appropriate for the dentist to refer the patient to the physician to order the MRI.

  • Sharing relevant medical history with other health-care professionals in the patient’s circle of care in the best interest of a patient is an expectation of the CPSO.
  • You must accept these requests.
  • While you must share the patient’s relevant medical history with the dentist to inform the dentist’s own clinical decision-making, you are not required to proactively interpret diagnoses. However, if the dentist requests assistance and it is medically relevant, you are expected to collaborate with the dentist to ensure they understand the necessary medical information for the safety of the patient.

When is patient consent required to share information with the dentist?

  • Dentists are within the patient’s circle of care, so a physician can share personal health information with them without the patient’s express consent, unless there is reason to believe that the patient has not consented or withdrawn consent. This is known as assumed implied consent.
  • If you have reason to believe that any personal health information should not be released without the patient’s consent, then you should seek their consent to release the information. 

Template you can use to respond to requests from dentists 

This template is designed to assist you in responding to requests from dentists regarding medical clearance for dental procedures, advice about medications, or arranging tests related to dental care. You should customize the template based on the specific request received.

Submitting OHIP claims related to requests from dentists

What is eligible for OHIP payment?

If a patient assessment is medically necessary to inform your decision-making, you may submit a claim to OHIP for the assessment using the appropriate assessment codes, found in the Schedule of Benefits for Physician Services, such as:

  • Minor assessment: fee code A001 at a rate of $23.75
  • Intermediate assessment: fee code A007 at a rate of $37.95
  • General assessment: fee code A003 at a rate of $87.35

Note: The pre-operative assessment codes A903 and A904 were removed from the Schedule of Benefits for Physician Services in 2019. 

What is not eligible for OHIP payment?

Most services associated with requests from dentists are neither eligible for OHIP payment, nor billable to the dentist or the patient. They are considered a common element of all OHIP-insured services that physicians provide to the patient. 

You can find a complete listing of all of the common elements of all OHIP-insured services in the General Preamble section of the Schedule of Benefits for Physician Services. 

One element to all insured services includes "conferring with or providing advice, direction, information or records to physicians and other professionals associated with the health and development of the patient."

This common element is deemed to include such activities as:

  • answering medication questions for the dentist 
  • completing forms for the dentist
  • ordering diagnostic tests for the dentist
  • providing the patient’s relevant medical history to the dentist upon their request to inform the dentist’s clinical decision-making