Objective To determine whether the use of referral letters with and without photography will make a difference to prioritising patients to the oral medicine department. Design Retrospective analysis. Setting Oral medicine department of Birmingham Dental Hospital. Method Forty-eight photographs were randomly selected using a database of clinical photographs. This was whittled down to 25 photographs after exclusion criteria were met. Referral letters that corresponded to the photographs were found and anonymised. Ten clinicians of varying experience ( from consultant level to house officers) then filled out three separate forms: the first form to prioritise patients with referral letters alone, the second to prioritise patients with both referral letters and their matching photographs and the third to prioritise patients with referral letters, photographs and the final diagnosis of the patient's condition. Results It was found that photographs made a difference to the appointment prioritisation of a patient in 37% of cases on average. 8.6% of the time, on average, photographs led to an inappropriate appointment prioritisation being selected. On average, 41.1% of the time the most appropriate appointment priority was chosen regardless of whether photography was used or not; on average 21.2% of the time, the most appropriate appointment priority was chosen only as a direct result of the clinician viewing the patient photography. In cases of malignancy, regardless of the experience of the clinician, not a single clinician was misled into making an inappropriate appointment prioritisation by the presence of a photograph. There is evidence to suggest that photographs lead to an increase in patient prioritisation regardless of whether this was appropriate or not. Conclusion From the results of this study the use of photographs in addition to a referral letter appears to be very useful in helping oral medicine consultants to prioritise new patient appointment for their initial consultation. This seems especially true in cases of oral cancer.