Objective To establish the appropriateness of timing of referrals for patients referred for the management of ectopic maxillary canines, and to evaluate the success of previous recommendations to educate referrers.Design Retrospective clinical re-audit.Setting Royal Surrey County Hospital NHS Foundation Trust.Subjects and methods Data were collected retrospectively for 220 consecutive patients between January 2013 - December 2014 and compared to the gold standard based on the clinical guidelines for management of the palatally ectopic maxillary canine published by the Royal College of Surgeons of England in 2010 which states that all patients with an impacted canine should be referred by 12 years of age.Results Ectopic maxillary canines represent a significant number of referrals to district general hospitals. One hundred and sixty-seven patients (76%) were referred late (>12 years) at a mean age of 14.1 years, >2 years later than the recommendations made in the Royal College Guidelines. Seventy-six percent of patients were not referred by 12 years of age compared to an audit in 2002 which found 45% delayed referral.Conclusion Timing of referral was delayed compared with the Royal College Guidelines. An increase in delayed referral suggests that local education programmes introduced after the previous audit did not have a lasting effect.

Orthodontic separators (commonly known as spacers) are elastomeric or metal auxiliary appliances, which are often used in Orthodontics to create space between teeth and allow fitting of an orthodontic band. Separators can also be used to create space for other reasons such as to facilitate interdental reduction. This paper describes common uses and a variety of other purposes that can be achieved with the separator including: management of ectopic teeth; the creation of attachments on teeth; uprighting molars and detection of cavitated carious lesions. Separators have many benefits, however, they can cause discomfort and also periodontal problems if they remain dislodged beneath the contact point. CPD/Clinical Relevance: Orthodontic separators can be used for a variety of clinical situations by both Orthodontists and General Dental Practitioners alike as a useful adjunct in the dental armamentarium.

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