Dr. Name
Office address
City, State ZIP
(or preferably print on letterhead)

Date

Dr. Orthodontist
Address
City, State  Zip

re:  patient John Doe

Dear Dr. Ortho:

Thank you for discussing John’s case with me yesterday.  To recap our conversation:

1. We decided to leave primary tooth #H in place.  It has a long, healthy root and good bone support.  I will modify it as needed cosmetically.  If it is removed, John will be committed to either an implant or a bridge.  If possible, please avoid bracketing #H; orthodontic forces on this tooth would increase the risk of root resorption.
2. Impacted malformed #11 will be left in place, and monitored periodically with radiographs.  If #H needs to be removed, then #11 can be removed at that time also.
3. Impacted #29 will need to be removed; there is little chance of it being brought into normal position.  We will leave the timing up to John’s parents, but I will recommend not delaying, as the tooth is very close to the mandibular canal, and continued root formation could increase the risk of nerve damage from the surgical procedure.
4. I will give the parents an Oral Surgeon referral for removal of B, I, and 29.
5. I removed the orthodontic band on #3 to place her filling.

Sincerely,

Dr. ________

Copy: Mr & Mrs Parents