The task
Assume that today's date is 22 October 2026. You have just reviewed Mr Aumua.
You are a dentist in general dental practice. Using the information in the case notes, write a letter of referral to Dr Akosua Amarasinghe, an oral medicine specialist, requesting urgent assessment and biopsy of Mr Aumua's tongue lesion. Address the letter to Dr Akosua Amarasinghe, Oral Medicine Specialist, Oral Medicine Unit, Dental Hospital, 150 Grattan Road. In your answer: expand the relevant notes into complete sentences; do not use note form; use letter format. The body of the letter should be approximately 180–200 words.
Length: the body of the letter should be about 180–200 words. You have 45 minutes in the test: 5 minutes to read, 40 to write. Letter type: Referral letter.
Case notes
Patient details
- Name: Mr Sione Aumua
- DOB: 14/03/1970 (56 yrs)
- Address: Unit 4, 27 Harbour Street
- Mobile: 0491 570 156
- Pt of practice since 2019; irregular attender
Social background
- Long-haul truck driver; often away 3–4 days at a time
- Divorced, lives alone; adult daughter lives interstate
- Smoker: 25 cigarettes/day since age 18 (approx. 47 pack-years)
- Alcohol: approx. 4–5 standard drinks most evenings
- Enjoys fishing on days off
- Mentioned ongoing dispute with ex-wife over sale of house
Medical history
- Hypertension: amlodipine 5 mg daily
- Type 2 diabetes: metformin 500 mg BD; pt unsure of last HbA1c
- Low-dose aspirin daily (GP-prescribed since TIA 2023)
- Allergies: penicillin (rash)
- Father died of lung cancer aged 64
- Appendicectomy 1995
Dental history
- Missed 2 recall appts in past 18/12; DNA hygiene appt 05/26
- Heavy calculus, generalised gingival recession; multiple restorations
Initial visit 24/09/26
- C/o roughness R side of tongue, noticed approx. 2/52
- Fractured, sharp lingual cusp 46 adjacent to lesion
- Non-wipeable white patch R lateral border tongue, approx. 15 × 8 mm
- 46 lingual cusp smoothed and polished; review in 2/52 advised
- Smoking cessation advice given; Quitline details provided — pt 'not ready'
Review 22/10/26
- White patch R lateral border tongue persists 4/52 after cusp smoothed; unchanged, approx. 15 × 8 mm; predominantly white, slightly raised; small red area at anterior margin
- Mild discomfort with spicy food; non-tender to palpation; no induration
- No cervical lymphadenopathy palpable
- No other mucosal lesions
- Pt very anxious; asked repeatedly 'Is it cancer?'; worried because of father's death
- Complained reception staff were 'rude and unfair' for charging fee for missed appt
- Review originally booked 08/10/26 — DNA; practice phoned pt same day; rebooked for first date pt available (today) as away for work
Plan
- Urgent referral to oral medicine for assessment and biopsy
- Need for biopsy explained; pt agreed to referral
- Pt asks to be contacted by phone on mobile — rarely checks post while away for work
- Definitive restoration 46 to be planned after specialist review
- Practice to phone pt in 1/52 to confirm he has received specialist appt
Who is reading, and what do they need?
Dr Amarasinghe is an oral medicine specialist who does not know Mr Aumua. She must prioritise and plan a biopsy, so she needs the lesion description, duration, what was already tried, risk factors, medical issues affecting a procedure, allergy and how to contact him. She does not need the practice's administrative history.
What to include
Selection is the skill the Content and Conciseness criteria reward. These notes earn their place:
| Case note | Why it belongs |
|---|---|
| White patch R lateral border tongue, about 15 × 8 mm, slightly raised, small red area at anterior margin | Core description of the lesion; size, site, colour and the red area are what justify urgency and biopsy. |
| Non-wipeable; unchanged and persisting 4/52 after fractured lingual cusp 46 smoothed | Shows the likely local irritant was removed and the lesion did not resolve, which is the reason for escalating. |
| Noticed about 2/52 before first visit 24/09/26; mild discomfort with spicy food | Gives the history and symptoms; the duration needs careful dating from the two visits. |
| Non-tender, no induration, no cervical lymphadenopathy, no other mucosal lesions | Relevant examination findings the specialist can use; state them as findings only. |
| Smoker 25/day since 18 (about 47 pack-years); 4–5 standard drinks most evenings | Established risk factors the specialist will need when prioritising the lesion. |
| Father died of lung cancer aged 64; patient anxious, asked 'Is it cancer?' | Family history and the patient's level of anxiety help the specialist plan her consultation; keep it brief. |
| Aspirin daily since TIA 2023; type 2 diabetes on metformin; hypertension; penicillin allergy (rash) | Medicines and allergy bear on a biopsy and any later prescribing; aspirin and diabetes are directly relevant to planning. |
| Pt asks for contact by mobile 0491 570 156; rarely checks post while away for work | Practical request that affects whether the appointment reaches him; the practice will also phone him in 1/52 to confirm receipt. |
What to leave out or compress
| Case note | Why it goes |
|---|---|
| Ongoing dispute with ex-wife over sale of house | Personal matter with no clinical relevance. |
| Complained reception was 'rude and unfair' about missed-appointment fee | A complaint about the practice, not information the specialist needs. |
| Missed recalls, DNA on 08/10/26, rebooked for today | Trap: the 08/10 delay looks relevant, but it was followed up and rebooked, so it needs no more than a brief mention, if any. |
| Heavy calculus, generalised recession, multiple restorations | Background oral health not relevant to biopsy of the tongue lesion. |
| Fishing, divorced, adult daughter interstate, appendicectomy 1995 | Social and surgical detail that does not affect assessment or procedure. |
| Definitive restoration of 46 to be planned after specialist review | Internal practice plan; the smoothed cusp is enough. |
A paragraph plan for this case
Start with the request for urgent assessment and biopsy and the lesion's key features. Then give the history of the lesion and what has been done, the risk factors and medical background including allergy. Close with the contact arrangements and the practice's follow-up call.
Where candidates slip on this task
- Do not name a diagnosis or state or imply that the lesion is cancer; describe it and say urgent assessment and biopsy are requested. His anxiety can be noted without reassurance or conclusion.
- Calculate timing carefully: lesion noticed about 2 weeks before the 24/09/26 visit and unchanged 4 weeks after the cusp was smoothed. State the review date as today, 22 October 2026.
- Include the phone request prominently, with the mobile number, because he is often away 3–4 days and rarely checks post. Do not leave out aspirin or the penicillin allergy.
No model letter is published here. Write for the named reader from the case notes in the timed editor, then get it marked.
Write it in the timed editor and get marked on the 6 criteria
More Dentistry letter tasks
- Orthodontic assessment for increased overjet referral letter
- Impacted lower wisdom tooth in a patient on warfarin referral letter
- Update to the regular dentist: periodontal abscess drained in a patient with poorly controlled type 2 diabetes update letter
Your profession's guide: OET Dentistry. Layout and structure: OET letter format.
Questions about this task
Should I mention the missed appointment and fee complaint?
No. The missed review was followed up and rebooked, and the fee complaint is administrative. The specialist needs clinical risk and how to reach him, not the practice's dispute, which also uses limited words.
How much of his anxiety should be included?
One brief mention is enough: he is very anxious and his father died of lung cancer. This helps her plan the consultation. Do not repeat his questions or suggest what the diagnosis is.
Sources
Last checked 22 Oct 2026. Rules and prices change: confirm on the official page before you book or apply.
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