Referring Doctors

Referring Forms

The frenectomy/tongue-tie forms are designed to be filled out BY THE PARENT. Based on the responses, providers can determine whether a referral is recommended. Please feel free to call us if you have questions.

Dear Colleague,

Thank you for your trust in allowing us to be a part of your team. We look forward to working together to achieve optimal oral health for your patient!

There are several components we investigate to formulate the appropriate, individualized plan for each child. Specifically, we thoroughly assess the medical health of the child, including:

Medical conditions
Medications
Weight/BMI
Tonsillar assessment
Special needs
Caries risk (including oral hygiene and dietary habits)
Growth and development patterns
Extent of treatment needed
Behavior/ability to tolerate treatment needed
Any other contributing issues (bruxism, oral habits, hypoplastic enamel, etc)

Based on the cumulative findings above, we may propose:

No treatment/monitor conditions
Treatment with nitrous oxide
Treatment with oral conscious sedation
Treatment with IV sedation

Learn more about our Relaxation Treatments >
Learn more about our Safety Protocols >

Again, we thank you for the privilege of working with your patients!

Please email x-rays, referral forms, or additional information to info@irvingchildrensdental.com.