Department of Restorative Dentistry Referral Protocols
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Department of Restorative Dentistry Referral Protocols Section Page General Information for General Dental Practitioners 1 1 Referral Criteria 1 2 Post-operative Discharge Patient Information (leaflets) 1 3 Referral Criteria - Minimum Dataset 2 3.1 Introduction 2 3.2 Referrals for suspected cancer 2 3.3 Making a referral 2 3.4 Referrer details 2 3.5 Patient details 2 3.6 Medical History 2 3.7 Clinical Information 3 3.8 Receipt of X-rays 3 3.9 18 weeks 3 Mono-specialty Information 4 4 Periodontology 4 4.1 Referral Criteria 4 4.2 Post-op Discharge Patient Information (leaflets) 5 5 Prosthodontics 6 5.1 Referral Criteria 6 5.2 Post-op Discharge Patient Information (leaflets) 6 6 Endodontics 7 6.1 Referral Criteria 7 6.2 Criteria for acceptance for treatment 7 6.3 Endodontics Undergraduate Criteria 8 General Information for General Dental Practitioners 1. Referral Criteria The Birmingham Dental Hospital Restorative Dentistry Department provides a consultant led service to examine patients, give advice and formulate appropriate treatment plans. Treatment in most instances should be undertaken in the Primary Care Sector. Treatment for patients at the Dental Hospital will only be arranged if deemed appropriate. The Restorative Dentistry Department is unable to provide ‘primary dental care’ treatment to all patients who are referred to us or indeed to individual patients who may request it. A limited number of suitable patients may be accepted for treatment for training purposes. Patients cannot be accepted simply because they cannot or will not pay NHS charges in the General Dental Service. The same applies to patients who are normally treated in the private sector. It should be noted that providing the medical history does not dictate otherwise the following are not considered appropriate reasons for referral: • Untreated caries • Untreated periodontal disease • Manufacture of soft and hard acrylic occlusal guards • Patients who cannot or will not pay NHS or private charges • Endodontic treatment: • Second and third molar teeth unless there is an unusual or compelling clinical need. • Where the long-term viability of the tooth is in question. Our undergraduate waiting lists currently remain open. If you feel that the patient would be suitable for undergraduate teaching. Then referrals will be accepted. The reason for this referral must be clearly stated. Advice will be given and treatment may be provided for the following priority groups. The following groups are considered appropriate for referral for advice and, if necessary specialist treatment: • Head and Neck Oncology patients • Development defects such as cleft lip and palate, hypodontia and complex dental anomalies • Trauma: severe trauma involving the dentoalveolar complex • Patients whose treatment fulfils training needs • Medically compromised patients. Referral letters are expected to comply with a minimum data set that has been previously identified to general dental practitioners. Failure to comply will result in the referral letter being returned with a request for the missing information. 2. Post-operative Discharge Patient Information (leaflets) The care of patients within the Restorative Department is generally shared between the Department and the Primary Care sector. Patients who are generally discharged back to the Primary Care sector with full information as to the plan for follow up and maintenance. The relevant discharge information is provided, tailored and focused to the individual patients needs with regard to their disease and treatment modality. Relevant post-operative instructions and information leaflets are available and are attached. 1 3. Referral Criteria - Minimum Dataset 3.1 Introduction Referrals for specialist services can be made by a dental practitioner or medical practitioner in primary or secondary care. Self-referrals by patients are not accepted for specialist services, with the exception of the primary care unit which provides a full dental casualty service for the relief of pain. Patients whose treatment is considered within the scope of a general dental practitioner would only be offered treatment on the undergraduate teaching programme, not with a member of specialist staff. Referral letters are requested to comply with a minimum data set outlined by Birmingham Dental Hospital to ensure adequate information is available for assessment to support an effective patient pathway. Failure to comply will result in the referral letter being returned with a request for the missing information. 3.2 Referrals for suspected cancer Any referral for suspected cancer must be faxed directly to the Safe Haven office using the Rapid Access proforma: Safe Haven Fax: 0121 466 5151 3.3 Making a referral To facilitate an effective assessment of referrals, the following information must be included as a minimum. The Referral Proforma should be used to ensure all the required information is included. The first sheet is generic and captures the minimum data set and a second sheet is specific to Restorative, Periodontology, Prosthodontics or Endodontics. 3.4 Referrer details • Referring General Dental Practitioner/General Medical Practitioner name • Referring Dentist Organisation/Practice Code (V Code) and General Dental Practitioner Code (D Code) • Date of referral • Telephone number 3.5 Patient details • Patient full forename and surname and title (i.e. Miss, Mrs, Mr) • Full postal address of your patient to include post code • Patient gender • Patient date of birth • Patient age • Patient home telephone and mobile telephone • Patient NHS Number (if known) • Details of the patient’s General Medical Practitioner. 3.6 Medical History • Current medication • Significant history, including previous consultations for the same condition, name of consultant seen previously • Active problems 2 3.7 Clinical Information • Referral priority (urgent/routine/2 Week Wait Cancer) • Reason for referral • Preliminary investigations and results, as well as management appropriate to reason for referral • Information regarding special/social circumstances (does patient have hearing, visual, mental health difficulties or mobility impairment? Is an interpreter needed?). 3.8 Receipt of X-rays • If a patient had an x-ray taken at your practice please forward the images with the referral letter to prevent the patient being over-exposed to radiation and the referral letter being declined. • How to send X-rays: • Paper copies of x-rays are not acceptable • Please include patient’s name, date of birth and post code for each • X-ray sent along with the date/s taken, so they are identifiable by our Radiology Department. • Via email - send to [email protected] - Please send in jpeg format and indicate in the email which department they are being referred to. • Via post with referral proforma - we will accept original x-rays or x-rays on a CD (jpeg format only) 3.9 18 weeks • Patients are required to be ready for consultation and treatment appointments within 18 weeks once the referral has been received at Birmingham Dental Hospital. Referrals should be sent to: Referral Team Birmingham Dental Hospital and School of Dentistry 5 Mill Pool Way Edgbaston Birmingham B5 7EG (Sat Nav code B5 7SA) UK Email: [email protected] 3 Mono-specialty Information 4. Periodontology Periodontology is concerned with the diagnosis and treatment of diseases and conditions of the soft and hard supporting tissues of the teeth, and the management of oral manifestations of systemic diseases. Some periodontal conditions, including where there is an association with systemic disease (e.g. Diabetes), require treatment within secondary care and some require tertiary care (e.g. HIV, Epidermolysis Bullosa, drug-induced gingival overgrowths, vesiculobullous/erosive gingival diseases, certain syndromes involving the mouth). 4.1 Referral Criteria Under normal circumstances we would only accept patients for secondary care if they fit one of the following criteria: 1. Patients with suspected malignancy or with soft or hard tissue lesions that require diagnosis and investigation. 2. Patients with suspected underlying systemic disease. 3. Children and adolescents with attachment loss (BPE code 3) are accepted. Children under 16 should initially be referred to Paediatric Dentistry. 4. HIV +ve patients who have soft tissue lesions. 5. Aggressive Periodontitis. 6. Significant periodontitis (BPE code 4 in all sextants) remains after primary care has been performed in practice (schedule 2, band 2 of NHS Dental Charges Regs 2005), with provision of pre and post treatment detailed pocket charts undertaken for code 4. 7. Patients should not normally be re-referred within 2 years of successful treatment within the department. This would imply that maintenance has not been performed adequately in practice. 8. Patients with desquamative gingivitis for investigation and treatment. 9. Patients with recurrent NUG or other necrotising diseases for investigation and treatment. 10. Patients with gingival overgrowth, whether drug-induced or not, for diagnosis and therapy if appropriate. 11. Patients with localised recession that may require periodontal plastic surgery; however sensitivity should be managed in practice. 12. Diagnostic radiographs (film or emailed digital views) need to be provided (paper copies will not be accepted) 13. Patients who are poorly compliant in practice should not be referred for protracted specialist care NB1 - The department is not in a position to accept patients with financial considerations or on the basis