Patient information (self-referral)
Please complete this form if you would like to be considered for dental care at the RCSI School of Dentistry, Sandyford Dental Education Centre.
Treatment is provided by undergraduate dental students under the supervision of registered dental care professionals. Appointments may last up to three hours and follow the academic timetable.
Important information
Submitting this form does not guarantee a telephone pre-screening assessment, a clinical screening appointment, acceptance for treatment or access to dental care.Additional information
Please confirm that you have read and understood each statement:
- I understand that a screening appointment is not a full dental examination. It is a preliminary assessment to determine whether my dental needs may be suitable for treatment by undergraduate dental students.
- I understand that all treatment is provided by undergraduate dental students under the supervision of registered dental care professionals.
- I understand that appointments may take longer than appointments in a general dental practice and may last up to three hours.
- I understand that appointments follow an academic timetable and may be affected by timetable changes, examination periods and breaks during Christmas, Easter and the summer period.
- I understand that regular and reliable attendance is required. Repeated cancellations, failure to attend or inability to attend the available teaching clinics may result in discharge.
- I understand that only one defined course of treatment will be provided. When this course of treatment is completed, I will be discharged from the RCSI School of Dentistry.
- I understand that the service may change its eligibility criteria, treatment scope, clinic availability and waiting arrangements according to student learning requirements, staffing, facilities and clinical capacity.
- I understand that The RCSI School of Dentistry is not a replacement for care provided by your regular dentist.
- I understand that submitting this form does not guarantee a telephone pre-screening assessment, an in-person clinical screening appointment, acceptance for treatment or access to dental care.
The dental clinic currently provides selected routine, preventive and straightforward dental care. Clinical suitability can only be confirmed after assessment.
Patients may be suitable if they require:
- A routine dental examination and basic assessment.
- Oral health and preventive advice.
- Simple gum treatment.
- Cleaning, scale and polish.
- Small or straightforward fillings.
- Fissure sealants.
- Fluoride varnish or another preventive fluoride treatment.
- Routine dental X-rays where clinically indicated.
- Monitoring of straightforward oral health conditions within the students’ level of competence.
The clinic is not currently accepting patients who require:
- Large, complex or advanced fillings.
- Crowns, bridges or veneers.
- Root canal treatment.
- Dental implants.
- Complex gum treatment or periodontal surgery.
- Complex tooth extractions or oral surgery.
- Orthodontic treatment.
- Complex dentures or advanced restorative treatment.
- Treatment requiring conscious sedation or general anaesthesia.
- Emergency or urgent dental treatment.
- Care that cannot be safely or appropriately delivered within the time, supervision and educational requirements of the undergraduate clinic.
Urgent or emergency problems
Do not use this form if you have severe or increasing dental pain, facial swelling, difficulty breathing or swallowing, uncontrolled bleeding, a recent serious dental injury or another urgent dental problem. Contact a general dental practitioner, an appropriate emergency dental service or emergency medical services where required. The RCSI student clinic does not provide an emergency or out-of-hours dental service.Patient details
Your information will be submitted securely to the RCSI School of Dentistry.
Age requirement: This self-referral service is for patients aged 16 years or over. Please do not complete the form for a patient under 16. The date of birth entered below will be used to confirm age eligibility.