GP Referrals by Dr. Thomas Giacobbi

Orthotown Magazine 

Dentaltown’s editorial director shares the dentist’s perspective about deciding which orthodontists he refers patients to—and why

by Dr. Thomas Giacobbi

[Editor’s note: When the topic of dentist referrals came up during a recent story-planning meeting, we thought it might be instructive to hear firsthand from dentists about how they decide which orthodontist to send patients to. We happened to have a dentist in the room at the time: Dr. Thomas Giacobbi, editorial director for Dentaltown magazine. What began as just picking his brain for ideas eventually turned into a request for him to write an article from the dentist’s perspective, explaining what informs his decision to send a patient to a particular orthodontist, especially in a competitive market such as Phoenix.]

Each holiday season brings an assortment of treats to my dental practice from our referral partners. Though these thoughtful tokens of appreciation play only a minor role in the relationship between general dentist and orthodontist, they serve as a simple reminder of the connection between our patients and our teams.

For a variety of reasons, I believe some orthodontists receive far more patients through self-referral and referrals from existing patients than they do from their local general dentists. Others do a very good job of cultivating great relationships with their referring doctors and see a corresponding larger segment coming via professional channels. In either case, a referral from a general dentist is impactful and will usually result in the patient following through on treatment. When I was asked how I choose where to send my orthodontic patients, my answer had many intertwined reasons to explain a process that represents some portion of an orthodontist’s practice.

FACTOR #1: Personality (yours and the patient’s)

One of the first considerations in a thoughtful referral to an orthodontist is all about personality and relationships. In the case of many adult patients, the referral to an orthodontist doesn’t happen at the new patient exam: We may discuss how an orthodontist can help improve their bite and smile, but many older patients aren’t ready yet. When we have the conversation again at a future hygiene visit, I know the patient enough to have an idea which orthodontist they might be most compatible with. Some adult patients can be particularly persnickety, and I’ll occasionally give them a couple of names so they can schedule an initial consultation to find the right fit.

FACTOR #2: Practical matters like location and insurance

Some patients are driven by more practical matters, such as location and insurance. When they’re going to see an orthodontist for the next one or two years, having a location that is close to school or work can be an important consideration. Similarly, participation with a particular insurance company can be important for patients who have financial limitations. I have found that most orthodontists can work with any insurance plan, and some will make accommodations to help a patient bridge the gap between an in-network fee and the out-of-network cost. There are times when other factors take precedence over the restrictions of insurance coverage, and some special cases warrant a call from the referring dentist to alert the orthodontist about a special circumstance. Which brings us to our next factor for consideration.

FACTOR #3: Communication

Communication between referring dentists and orthodontists is important throughout the patient’s treatment and, frankly, some orthodontists do a better job than others. Some will send only the bare minimum—a letter after the initial consultation and a letter indicating treatment is complete (hopefully with before-and-after treatment photos).

That can be enough in routine cases, but there are times when a conversation or follow-up correspondence sends a clear message that we are in this together. Some examples include: coordinating the position of peg lateral incisors before removal of brackets, setting up restorative space for patients planning to get implants, informing the dentist that the patient isn’t demonstrating good hygiene habits between appointments, and making the dentist aware when a patient has stopped coming for treatment.

Sometimes patients will come to my office with clear aligner attachments on the teeth and want them taken off. I always tell them to go back to their orthodontist, but it would be helpful in some cases to know what’s happening before I make that suggestion. Another example of great communication is when the orthodontist detects decay at a visit and sends word to the dentist to get the patient in for an exam and treatment.

FACTOR #4: Your past work

The final, and perhaps most important, criteria for patient referrals to one orthodontist over another is the outcomes we see over time.

After working with an orthodontist for more than two years, a general dentist will have the opportunity to see many mutual patients in various stages of treatment. I ask patients at their recare exams how they’re doing, or I’ll comment, “Looks like everything is going well with the braces,” which opens the door for patients to share any thoughts they have with treatment.

Additionally, after seeing many patients complete treatment, there are certain qualities in the finished cases that will point back to a particular orthodontist’s style; some cases remain very stable over time, while others will show relapse. (Yes, patient compliance with retainers is a major factor here.)

One final indicator of quality observed over time is the breakdown of lingual retainers; I’ve seen some patients from the same office frequently have debond issues, while others have retainers that rarely fail.


Referral relationships are complex, communication-dependent and often are between two professionals who don’t spend much time together in person. I hope my insights and opinions will provide some valuable perspective for readers, and perhaps provide a topic of conversation the next time you have a chance to visit with one of your referring dentists.

I’ll close by saying that one of the greatest compliments we can receive as general dentists is the referral of a new patient in your practice who needs a dental home. Thank you for having the patience to develop stable occlusions and beautiful smiles!

If you’d like to contact me via email, please send a message to If you’d like to share a referral story or comment on this article, post it online under this article below.

Author Bio
Author Dr. Thomas Giacobbi, a full-time general dentist, co-owns his private practice in Chandler, Arizona, with his wife, Dr. Grace Giacobbi. A 1995 graduate of SUNY at Buffalo School of Dental Medicine, he moved to Arizona in 1998.

Giacobbi has been a part of Dentaltown since its inception; he officially joined the team in 2003. His responsibilities include selecting editorial content for the magazine, moderating webinars, writing the monthly poll and producing a dental news video called Townie News Wire. He travels throughout the year visiting dental companies and attending all of the major trade shows to keep up to date with the dental news of the day.
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