Contents Page Summary of the 4 Referral Routes 3 Quick Reference Chart for Primary Care Patient Groups 5
1. Emergency & Out of Hours Dental Care (Part of the Unscheduled Dental Care Service ) 7 Accessing Emergency Dental Care: Information for the Public 9
2. Oral and Maxillofacial Surgery and Oral Medicine, 11 Oral/Head and Neck Imaging (inc X-rays) 13 Pathology Laboratory Services 15 Oral & Maxillofacial Surgery Referral Form 17 + Additional Fast Track Appendix for Urgent OMFS 19
3. Restorative Dentistry 21 Referral Form for Restorative Dentistry 23
4. Orthodontics 25 Referral Form for Hospital Service Orthodontics 31
5. NHSG Children’s Dental Services 33 Children’s Anxiety Management including general anaesthetic services 34 Referral Form for ADS Paediatric or NHSG Dental Services 35 Referral Form for Children’s Anxiety Management inc GA Service 36 Child Protection Service Contact Information 38
6. Dental Primary Care Intermediate Referral Service (DPCIRS) 40 6.1 Special Care Dentistry (including Anxiety Management) 40 Dental Treatment of Bariatric Patients 43 Referral Form for Special Care 45 Referral Form for Domiciliary Care 47 Referral Form for Adult Anxiety Management 49 6.2 Surgical Dentistry Services 53 Referral Form for Surgical Dentistry services 55
7. Aberdeen Dental School 57 7.1 Student Clinics 57 Advice on Dental Laboratory Topics 58 Minor Oral Surgery Clinic Referral Guidance 59 Referral Form for Adult Patients for Student Clinics 60 7.2 Paediatric Dentistry at Aberdeen Dental School 62
8. Smoking Cessation Referrals 64 Referral Form for Smoking Cessation 66 Smoking Advice Service 68
9. Guidance Notes for Referral Specialties & Other Information 70 Restorative Dentistry Referral Guidance 70 Risks and Benefits of Orthodontic Treatment 74 Management of Dento-Alveolar Trauma in Children 76 Children’s Dentistry General Anaesthetic Guidelines 80
10. Links & Other Information including use of CHI numbers 82 Last updated 30/07/2014 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality 1
Make sure you receive regular updates of this Guide
The content of this Guide will be reviewed by the NHS Grampian Oral and Dental Health Managed Clinical Network every 6 months (June & December) and updates will be available via email through the Referral Centre. Email [email protected]
For security purposes a nhs.net email address is required to send out this information electronically.
It is intended that all referrals will move to e-referrals as soon as practicable.
The advantages of sending high quality referrals
Good quality referrals allow patients to be referred to the most appropriate service as soon as possible. The use of forms in this Guide is designed to help with this process. If the Referral Accepting clinic does not receive adequate information, then the form will be returned to allow the referring clinician to submit clear details and a focused request. “Please see and treat ” is not adequate!
Development of e-Referral Services
With the provision in most Dental Practices of a PC with a secure NHS connection via the N3 IT infrastructure the opportunities for e-referral is being developed using the latest NHSG dental referral guidance. Various referral templates will be placed on the PC connected via N3 in your practice. The appropriate information will be typed in and the referral sent electronically to a central storage point where it will be picked up by the relevant department. It will be possible to attach files such as digital radiographs or clinical photographs. e-Referrals are • received by the referral department more quickly • legible • likely to be of better quality given the fields provided in the referral template, and should give the consultant a better idea of the degree of urgency for certain patients / conditions.
A “receipt” that the referral has been received will be sent to the referrer. A parallel system already exists for medical practitioners to refer electronically.
How to ensure you will have access to e-Referral Services.
All practices or dental clinics must have a current email account with nhs.net You can register via the www.nhs.net site.
Further information is available from Lorraine Smith, IT Facilitator 01224 553738. Or contact the Dental Advice and Referral Centre on 01224 556301 Email [email protected]
NHS Grampian IT Helpline Phone Number 01224 554444 Email: [email protected]
Comments Your comments and suggestions for improving any aspect of the guidance are welcome and should be sent to NHS Grampian Dental Advice and Referral Centre email [email protected]
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Where to send your Oral, Dental or Surgical Specialty Referrals There are 4 Referral Routes. Please refer directly through the appropriate one.
PRIMARY CARE
1. DENTAL ADVICE & REFERRAL CENTRE - WOODEND HOSPITAL
The primary care referral centre manages and distributes referrals to appropriate services throughout Grampian depending on where services are best delivered this may include any dental service in Grampian including the independent dental practitioners.
• Child patients requiring dental extractions and dental treatment, including general anaesthetics, sedation or anxiety management.
• Child and adult patients with Special Care Dentistry requirements including domiciliary care patients
• Adult failed extractions and routine surgical dentistry
• Children and adults requiring urgent and emergency dental care including in partnership with NHS 24 out of normal hours services.
• IF YOU HAVE ANY CHILD PATIENTS REQUIRING CONSULTANT-LED CARE, PLEASE REFER DIRECTLY TO PAEDIATRIC DENTISTRY AT ABERDEEN DENTAL SCHOOL (See Main Referral Guide for details)
2. INDIVIDUAL INDEPENDENT SPECIALIST PRACTICES Presently the only NHS referral services available are the orthodontic practitioner services Refer routine Orthodontic directly to individual practices (see detailed orthodontic guide)
SECONDARY CARE
3. ORAL & MAXILLOFACIAL SURGERY AT ARI
Aberdeen Royal Infirmary manage consultant referrals to the Maxillofacial Unit for:- Oral or Maxillofacial Surgery (OMFS) Services including head and neck cancer and oral medicine (see main text for detailed referral guide and for information on urgent referrals and how to contact a member of staff for advice.)
Exclude failed extractions & routine surgical dentistry - refer to Dental Primary Care Intermediate Referral Service (DPCIRS)
4. ABERDEEN DENTAL SCHOOL & HOSPITAL
Aberdeen Dental School and Hospital manage consultant referrals for:- • Restorative Dentistry services including periodontal and prosthetic problems
• Orthodontic Services; complex cases (see detailed referral guide in main text ) Exclude routine cases which are referred to specialist practitioners
• Paediatric Dentistry services for specialist child care or student care
Exclude routine child patients referred for extractions – refer to NHSG Children’s Dentistry (see detailed referral guide)
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If in doubt about making a referral contact the referral centre for advice
When printing your referral forms please print on both sides of a single sheet of A4 paper to minimise paper volumes in hospital files.
The only exceptions are a) Oral and Maxillofacial Surgery – up to 3 sides b) Children’s Anxiety Management (including GA) - 1 single side.
NB Patient information can be typed in Word on the downloaded forms before printing.
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Quick Reference Guide Chart (Page 1 of 2) Primary Care Dental Referrals Version 1 April 2011 (*Patients treated under NHS terms of service and are liable to patients charges*) Minimal details for referral include Name; Date of birth; Address; Tel; Informed consent from parent (if under 16 years); Main problem; Urgency;
Patient Group Service Contact Details Who can/should refer CHILDREN Health Visitors Children at high risk of dental Childsmile practices Medical practitioners disease 0 - 5 yrs with no dentist (NHS Registration) Dental Advice and Referral Centre The DARC Administrator Refer using nhs.net (preferred method) Children with untreated dental Woodend Education /Social Services disease / pain NHS Grampian Telephone 0845 45 65 990 Phone Referral Centre Children requiring s pecial care or Public Dental Service Fax 01224 556587
complex care including extractions Email [email protected] Dentists Or under general anaesthesia SCI Gateway: Dental - Referral Centre (link under development March 11) Routine care – Independent dental
Children of all ages practice Parents /Carers
ADULTS: Priority Groups, Special Care, High Need, Dental Primary Care Intermediate Referral Service (DP CIRS ) Priority groups inc people with medical problems requiring Consultant led services General medical practitioners urgent routine dental care Dental Advice and Referral Centre Senior nursing staff e.g. bisphosphonate/cardiac. Referred to local The DARC Administrator Adult Special Ca re Woodend dental practitioner Dentists, social care /carers People with disabilities, learning Tel 0845 45 65 990
difficulties, mental illness. or Fax 01224 556587 Dental extractions and surgical Email [email protected] Medical and Nursing services extractions / treatments 7-7 NHS Grampian SCI Gateway: Dental – Referral Centre Care of the Elderly 75+ Public Dental Service (link under development March 11) Domiciliary care , Care homes Homeless. Pregnant & nursing mothers EMERGENCY, URGENT, UNSCHEDULED CARE Tel: - 0845 45 65 990 Unplanned and urgent care; NHS G Unscheduled Patients /carers medical nursing and dental Or out of hours care service professionals Advise patients /carers to contact NHS 24 08454 24 24 24
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Quick Reference Guide Chart (Page 2 of 2) - Secondary / Intermediate care referrals Full details required for referrals including Name; Date of birth; Address; Tel; Informed consent from parent (if under 16 years); Main problem; Urgency; Associated medical history
Department Service Contact Details Who can/should refer ACUTE SURGICAL SPECIALTY Consultant led services for Oral & Maxillo-Facial Surgery General medical and general dental oral lesions, oral surgery, Aberdeen Royal Infirmary practitioners Oral & Maxillo-Facial facial fractures, head & neck Tel 01224 550673 Consultant led acute services Surgery cancer . SCI gateway
Need to speak to an on-call clinician? The Maxillofacial Department is on call 24/7. In an emergency, telephone advice is always available on 0845 4566000 (ARI hospital switchboard) and ask for SHO/FY2 on call – bleep 2340. The consultant on call can also be contacted via the SHO on call or via the departmental secretaries. ABERDEEN DENTAL SCHOOL & HOSPITAL Correction of dental Orthodontic malocclusions Aberdeen Dental School and Hospital Dentist Oral and dental rehabilitation Cornhill Road Restorative Dentistry and restoration Aberdeen AB25 2ZR Child oral and Tel 01224 551901 Dentist dental rehabilitation and Consultant led acute services Paediatric Dentistry restoration Orthodontic Referral direct to independent practice see Dentists Independent practices detailed guidance. DENTAL PRIMARY CAR E INTERMEDIATE REFERRAL SERVICE (DP CIRS) Dental Advice & Referral Centre Special care Special care The DARC Administrator Surgical dentistry Woodend Surgical dentistry Tel 0845 45 65 990 Dental and Orofacial consultant services Fax 01224 556587 Dental practitioners Email [email protected] SCI Gateway: Dental – Referral Centre (link under development March 11)
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1. Emergency & Out of Hours Dental Care (Part of the Unscheduled Dental Care Service)
Administration contact details NHS Grampian Westholme Queen's Road Aberdeen, AB15 6LS Phone 01224 556661 Fax 01224 556587
Lead Clinician for Unscheduled Care Service Alexandra Lowe [email protected]
Services available During the day and out of hours, all patients who are registered with a dentist should contact their practice for urgent or emergency advice and treatment. NHS Grampian operates a service for patients who are not registered or who are visitors to the Grampian area.
Daytime service Monday to Friday between the hours of 8.05am and 5.45pm The Dental Information and Advice Line DIAL is available on 0845 45 65 990.
DIAL provides a dental triage and appointment booking system for dental urgent and emergency conditions. The staff are also able to provide self-help advice for minor problems and can advise on dental waiting lists and registration.
This service is supported by the Salaried Dental Service SDS which provides appointments on a daily basis across the Grampian region for those patients who are not registered with a dentist. Patients at SDS clinics are provided with NHS care and treatment appropriate to their condition and there is the opportunity to provide follow-up urgent care should this be required. For routine care patients are directed to the NHS Grampian dental waiting list.
Out-of-hours service The out of hours service is integrated with NHS 24 and the national Scottish Emergency Dental Service SEDS, to provide an additional dental triage between 6.00pm – 8.00am and throughout the weekend.
Treatment for urgent and emergency conditions is arranged through the Grampian Emergency Dental Clinic GDENS (via NHS 24).
Clinics operate 6.15pm – 9.15pm weekday evenings and 9.00am – 12.30 pm Saturday & Sunday. Patients can contact NHS 24 on 08454 24 24 24
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GDENS provides care for • unregistered patients, • patients of participating General Dental Practitioners • patients receiving care and treatment within Aberdeen Dental School and Hospital, including the Restorative Dentistry and Orthodontic departments. • in exceptional circumstances, for patients who are not able to contact their own registered dental practitioner.
Care and treatment is provided under National Health Service General Dental Services terms and conditions for occasional patients. The usual NHS fee charging system applies.
The offer of an appointment will be made on the basis of triaged need (SDCEP guidelines) and whilst every effort is made to see patients as soon as possible and at a convenient location, it may not be possible to see patients on the same day except in cases of severe emergency.
The following sheet on how to access unscheduled care can be photocopied for wider distribution
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How to Access Emergency & Out of Hours Dental Care Services
During the day and out of hours, all patients who are registered with a dentist should contact their practice for urgent or emergency advice and treatment. NHS Grampian operates a service for patients who are not registered or who are visitors to the Grampian area.
Unregistered patients requiring urgent or emergency dental care should make direct contact, in person, with the appropriate daytime or Out of Hours emergency service below.
NHS Grampian Dental Information and Advice Line (DIAL) DIAL 0845 45 65 990 8.05 am – 5.45 pm Monday to Friday
NHS24 0845 4 242424 (6.00 pm – 8.00 am and weekends)
Patient Charges Patients should be informed that normal NHS Dental treatment charges apply.
Follow up care and waiting lists Patients do not have direct access to routine dental care or registration via this service. Information on waiting lists for NHS dental treatment can be obtained by contacting DIAL.
Patients with no dentist who require urgent dental care Patients who do not have direct access to routine dental care and who have considerable need may be referred by other health professionals to DIAL for assessment.
Urgent referral from medical, dental and nursing professionals for assessment & treatment planning.
Patients in acute services or under care with general medical practitioners who require assessment prior to medical or surgical care/treatment plans will be assessed and treatment planned to facilitate prompt completion of the medical treatment plan; e.g. those about to have heart surgery or about to start a course of bisphosphonate medication.
Patients already registered with a dentist should request an urgent review with their own dentist, as this service is primarily for unregistered patients.
These services are part of the NHS Grampian Unscheduled Dental Care Service
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Please photocopy and circulate the notice on the previous page for use wherever required e.g. Community or Health Care Centre noticeboards, pharmacies. etc
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2. Oral and Maxillofacial Surgery & Oral Medicine
Contact details Maxillofacial Unit Aberdeen Royal Infirmary Foresterhill Aberdeen AB25 2ZN
Main Reception 01224 550673/552655 Fax 01224 554865 Email: [email protected]
Secretaries Haleigh Scott 01224 553280 Louise McKimmie 01224 553052 Julie Elrick 01224 558859 Annemarie Thom 01224 554591 Jeanette Smith 01224 552654
Receptionists 01224 552655 / 01224 550673 Angela Reid Dorothy South Anne Ross Catherine McCarthy
Maxillofacial Laboratory 01224 552656
Department Staff:
Consultants Subspecialty interest Mr Terry Lowe Head and Neck oncology/reconstruction Mr Rory Morrison Orthognathic surgery/facial deformity Mr Nick Renny Head and Neck oncology/reconstruction. Mr Martin Ryan Orthognathic surgery/facial deformity
Staff Grades Janice Boggon Mark Burrell Binnie Ahamat 1 Specialist Registrar On rotation from Glasgow 3 SHOs 2 FY2s 1 DF2 Nursing staff: General and dental nurses. Maxillofacial technologists Mike Duncan , Karen Boyd-Glen
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Dept of Oral and Maxillofacial Surgery - Overview
We provide the full range of oral and maxillofacial surgery through • new patient diagnostic clinics, • operative sessions for minor surgery along with • day case and inpatient elective surgery
We also provide an emergency service for management of patients with all forms of • craniofacial trauma, • haemorrhage and • acute infections of the head and neck.
We offer comprehensive treatment for the vast range of conditions presenting in the anatomical region of the head and neck. This includes but is not limited to: • Maxillofacial / craniofacial injury. • Orofacial cancer and reconstruction including free tissue transfer. • Orthognathic / facial deformity surgery. • Facial aesthetic surgery. • Salivary gland disease. • Minimally invasive surgery. • Distraction osteogenesis. • Preprosthetic surgery / bone grafting techniques and dental/facial implants. • Temporomandibular joint surgery including joint replacement. • Dentoalveolar / oral surgery. • Oral Medicine and treatment of oral mucosal disease. • Management of facial pain. • Maxillofacial prosthetics and technology.
Clinics • Out-patient clinics are run every day for the diagnosis and investigation of new patients. • A one stop biopsy/cytology service is available when required.
• All new patients are initially assessed at a consultant or staff grade clinic. All general referrals are pooled unless named for a specific reason.
Combined Clinics We also conduct combined clinics with other specialty services: • Orthognathic clinics with colleagues in orthodontics and restorative dentistry. (every Thursday morning) • Combined implant clinic with colleagues in restorative dentistry • Head and Neck Oncology clinics with colleagues in ENT, Oncology, Speech and language therapy, Dietetics, Pathology, cytology and MacMillan nursing support. (every Wednesday morning) • Combined clinics with ophthalmology colleagues. • Hyperbaric oxygen therapy clinics including a national tertiary referral service for this facility.
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Referrals to the department
Referrals can be made in writing or via the electronic portal if this is available to you. • Forms and updates to the information will also be available at www.hi-netgrampian.org/referralformsbyspeciality
• Urgent referrals can be faxed on 01224 554865 or emailed to the department on [email protected] if the referrer has an nhs.net email account.
All referrals should contain the following essential details:
Patient details Include current telephone number so that patient can be contacted to attend a clinic at short notice Include details of patient’s General Medical Practitioner Referring clinicians details
Short medical history Including medication and known allergies.
Relevant social history Including smoking and drinking status
Detailed history of the lesion or of the presenting complaint including • Nature / duration of symptoms • Site and size of the lesion • description of the lesion
Clinical diagnosis (or diagnoses) in order to categorise the urgency of the referral
If you have any doubts about the urgency of a particular lesion you can phone the local maxillofacial surgery unit to discuss the case with one of the consultants.
Need to speak to an on-call clinician?
The Maxillofacial Department is on call 24/7. In an emergency urgent advice is always available by telephone.
Tel 0845 4566000 (ARI hospital switchboard) and ask for SHO / FY2 on call – bleep 2340.
The consultant on call can also be contacted if necessary via the SHO on call or via the departmental secretaries.
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Oral and Maxillofacial Imaging
1. Plain dental radiography is provided by the ARI Outpatient X-ray department and can be arranged by telephone 01224 552268 or written referral to the Department of Radiology. Please remember that justification for the radiograph must be included.
2. OPTs can be requested directly if required.
3. CT and MRI imaging can be requested via the Maxillofacial unit where there is a specific indication.
Contact the superintendent radiographer, Maureen Tough with any queries.
Oral / Head and Neck Pathology
Oral / Head and Neck pathology services are available either through the OMFS unit or directly through the Pathology Dept. Information on sending biopsies and utilising pathology services can be found on the NHSG Intranet as follows:
Go to NHSG Intranet Homepage , click on: Departments and Services , Then Laboratories , Then Pathology , Then Surgical pathology specimens and biopsies.
The website address for this is: http://intranet.grampian.scot.nhs.uk/ccc_nhsg/6221.html?pMenuID=460&#surgical%20pathology% 20specimens%20and%20biopsieS
Teaching / training We are all actively involved in undergraduate training of medical and dental students and postgraduate training of doctors and dentists. We have close links with the University of Minnesota, Minneapolis and their maxillofacial trainees who attend Aberdeen biannually for elective training within the unit.
We are also keen to continue forging strong links with primary care by providing teaching and training for practitioners who wish to improve their diagnostic and operative skills in oral surgery. This includes provision of approved CPD courses for dentists and Dental Care Professionals. Details available through the NES Dentistry Portal. http://www.dentistryportal.scot.nhs.uk/login.asp
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Referral Form for Oral & Maxillofacial Surgery
Send to: Maxillofacial Unit, Aberdeen Royal Infirmary, Foresterhill Aberdeen, AB25 2ZN
Need to speak to an on-call clinician? The Maxillofacial Department is on call 24/7. In an emergency, telephone advice is always available on; 0845 4566000 (ARI hospital switchboard) and ask for SHO/FY2 on call – bleep 2340. The consultant on call can also be contacted via the SHO on call or via the departmental secretaries.
The fastest method of referral is via the electronic SCI Gateway: click on Head and Neck Cancer If you do not have access to this, fax a copy of this form to: 01224 554865 DO NOT SEND FORMS BY EMAIL.
A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Referral Surname
Gender Male Female Forename CHI Number Date of Birth
Address
Town Postcode Daytime Phone Mobile
Home Phone e-mail
If your patient needs to communicate in a language or mode other than English please specify: If yes, please specify and state whether an accompanying person can translate or if an interpreter will be needed.
URGENT: YES NO If URGENT, please ma rk one or more of the following: Malignancy suspected Pain for 48 hours Swelling Trauma
Other (please specify)
To aid compliance with the Disability Discrimin ation Act, please indicate if patient has any special mobility requirements : Mobility Assistance
Impairment
Is the patient registered at your practice? Yes No Please c heck box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services
Print Name of Referring Clinician Signed (Clinician) Date
REFERRING PRACTITIONER GDP STAMP/DETAILS GMP STAMP/DETAILS
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PLEASE PRINT Page 1 & 2 on BOTH SIDES OF ONE SHEET. If this is not possible then please re-enter
Patient’s name & Date o f Birth Patient’s presenting complaint
Clinician’s concerns Why are you referring the patient?
What outcome do you seek?
Medical history, including all drugs being taken and any allergies. Note if NO relevant history
Dental history What treatment has been attempted for this problem before the referral was made?
Smoking status Alcohol consumption
Enclosures : Radiographs Study models Photographs Details:
Would you like these returned? Yes No
Is there any other information we need to know?
Administrative Information for the Referral Service (Do not write in the box below)
Form reviewed March 2011
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Complete this additional section for Fast Track Referral for Facial and /or Oral Symptoms The fastest method of referral is via the electronic SCI Gateway: click on Head and Neck Cancer If you do not have access to this, fax a copy of all 3 pages of the form to: 01224 554865
Please re -enter patient’s name & Date of Birth
Cancer area su spected: (please tick boxes below): Neck Oral cavity Salivary gland Skin of face
Appearance : Discrete swelling Ulceration Red patch (erythropl akia)
Mixed/red/white patch Faci al mass Cranial neuropathy
Unresolved neck mass Unexplained tooth mobility
Associated with : Neck node(s) Pain Bleeding Tongue fixation Record manually the extent of any pathology on the mouth and describe it below:
Further Description & Notes, including duration
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3. Restorative Dentistry
Contact details
Restorative Dentistry The University of Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZR
Reception : 01224 552707 (Restorative/Orthodontic Reception) 01224 551901 or 551084 (Dental School Main Reception)
Department Secretary : Miss Sarah Raffan Tel: 01224 559382 Fax: 01224 550137 E-mail: [email protected]
Clinical Staff
Consultants : Mr Martin Donachie Dr Dean Barker Staff Grade: Mr Shahab Rahman Specialist Registrars Senior House Officers Dental Hygienists Dental Nurses Dental Technicians
Aberdeen Dental School staff will contribute to NHS clinical services in due course.
Restorative Dentistry - Overview
The work of the Department consists of new patient diagnostic clinics, multidisciplinary clinics with colleagues in Orthodontics and Oral & Maxillofacial Surgery and specialist treatment. Treatment includes:
• Fixed & Removable Prosthodontics • Prosthetic rehabilitation of cancer/trauma • Implant dentistry (placement and restoration) • Endodontics, including peri-radicular surgery • Periodontics, including periodontal surgery • Management of tooth wear cases • Treatment of congenital conditions including hypodontia
Patients accepted for treatment in the Department are prioritised in terms of need.
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Clinics
Consultant clinics are held for the assessment and treatment planning of new patients. Maximum waiting time for assessment is 12 weeks from referral.
Multidisciplinary clinics held weekly with colleagues in Orthodontics and Oral & Maxillofacial enable planning of cases requiring combined care e.g. • Hypodontia • cleft lip and palate and • facial deformity. Patients who require to be seen on this clinic should first be referred to the most appropriate Department where they will initially be seen within 12 weeks. The waiting time for the combined clinic is currently 12 months.
A monthly implant clinic runs with Oral & Maxillofacial Surgery. Refer patients for a new patient consultation initially to assess suitability / eligibility for implant treatment. Each case is assessed on an individual basis but the Department follows the NHS Guidance on Implant Placement within the NHS, which can be broadly divided into rehabilitation of the following groups: • Trauma • Cancer • Hypodontia • Severe denture intolerance • Those patients who simply can not be reasonably treated by an alternative approach
Head and Neck Cancer Restorative Dentistry also forms part of the hospital’s multidisciplinary team for the treatment and rehabilitation of patients with Head and Neck Cancer.
Teaching The Restorative Dentistry department is actively involved in teaching and training of undergraduates and postgraduate trainees.
Referrals
Referrals should be made in writing. Please note that named referrals tend to be pooled and could be seen by either consultant. If a referral is urgent a letter can be faxed or preceded by phone or e-mail contact.
The following information should be included in a referral letter: • Contact details of the referring practitioner • Patient name, address, date of birth and contact details • Reason for referral, including whether advice or treatment is sought • Relevant history and clinical findings • Relevant medical and social history
For Restorative Referrals please read the guidance in Section 9.
Restorative referral forms are available at www.hi-netgrampian.org/referralformsbyspeciality
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ADULT Referral Form for Restorative Dentistry Send to: Restorative Dentistry, The University of Aberdeen Dental School & Hospital, Cornhill Road, Aberdeen, AB25 2ZR.
A. Patient’s Personal Details Ple ase insert dates in dd/mm/yyyy format Date of Referral Surname
Gender Male Female Forename CHI Number Date of Birth
Address
Town Postcode
Daytime Phone Mobile
Home Phone e-mail
If your patient needs to communicate in a language or mode other than English please specify: If Yes, please state whether an accompanying person can translate or if an interpreter will be needed.
B. Which discipl ine should see the patient? FOR Select ONE option Select ONE option Opinion Only Conservative Dentistry Periodontology Care Plan Endodontics Prosthetics Specific Treatment Multidisciplinary Special Care Emergency Treatment Total Care Only
If URGENT, please give details:
To aid compliance with the Disability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance
Impairment
Is the patient registered at your practice? Yes No Please tick box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services Print Name of Referring Clinician Signed (Clinician) Date
REFERRING PRACTITIONER GDP STAMP/DETAILS GMP STAMP/DETAILS
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Adult Restorative Referral: Clinical Details
Please re -enter patient’s name & Date of Birt h Clinician’s concerns Tick box if this is a TRAUMA case
Why are you referring the patient?
Dental history What treatment has been attempted for this problem before the referral was ma de? If there are repeated failures, details must be given of deterioration. For tooth wear, is it localised or generalised? Is there an occlusal problem?
What treatment are you planning to provide for the patient in their current care plan?
Caries status:
BPE Scores Oral Hygiene
Medical History Please include all current medications and allergies. Note if no relevant history
Enclosures : Radiographs Study models Photographs Details:
Would you like these returned? Yes No
Is there any other information we need to know?
Form reviewed August 2010 Administrative Information for the Referral Service (Do not write in the area below)
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4. Orthodontics Orthodontic Referrals may be made to a Specialist Orthodontic Practice or to the Orthodontic Department at Aberdeen Dental School (see ‘Quick’ referral guide).
Orthodontic Practices: Contact Details
Aberdeen Orthodontics Orthoworld The Orthodontic Clinic 230 George Street 1st Floor Lower Ground Floor Aberdeen Thistle House 9 Golden Square AB25 1HN 24-26 Thistle Street Aberdeen Aberdeen AB10 1RB AB10 1XD Practice Orthodontists Practice Orthodontist Practice Orthodontists Richard Buckle Graham Templeton Lisa Currie Johann Bell Dipali Patel Practice Dentists Mhari Walker Lidia DeSousa Gillian Robertson Orthodontic therapist Catriona Burrell Orthodontic therapist Margaret Davie Sheila McConville Michelle Stalker Tel: 01224 641 928 Tel: 01224 638 404 Tel: 01224 611 633 Fax: 01224 656 329 Fax: 01224 638 064 Fax: 01224 611 614 www.aberdeenortho.co.uk www.orthoworld -aberdeen.co.uk www.theorthodonticclinic.co.uk [email protected] [email protected] info@ theorthodonticclinic .co.uk
Practice Manager: Practice Manager: Practice Manager: Sara McQuillan Nicola Rattray Alison Daly Tel: 01224 656 324 [email protected] [email protected] 07921 769 928
The Hospital Orthodontic Service Contact details Orthodontic Department Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZG Reception: Tel: 01224 552707 (main reception)
Department Secretary: Mrs Fiona Birnie Tel: 01224 554911 Fax: 01224 550137 E-mail: [email protected]
Staff Consultants: Mr Colin Larmour Dr Liz Turbill Ms Mhairi Walker Dr Khaled Khalaf (Senior Lecturer/Hon. Consultant)
Staff Grade: Mrs Helen Shaw
Clinical Assistants: Mrs Ann Ovall
Orthodontic Therapist: Mrs Catriona Burrell Last updated 30/07/2014 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality 25
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‘Quick’ Orthodontic Referral Guide
This is a guide only. Please identify the main presenting problem on the left and then select the specific problem. The corresponding white box will indicate the most appropriate referral pathway. NHS Grampian January 2009
Referral Refer Refer Presenting Specific presenting problem. probably to to Problem not Specialist indicated practice Hospital
Increased Overjet 6mm or under at any age
Overjet Overjet over 6mm
10+ years Overjet over 9mm 10+ years or with significant skeletal discrepancies Crossbite Anterior crossbite with no/or mild skeletal discrepancies
Posterior crossbite
Overbite Overbite traumatic to tissues, or open bite >3mm
Crowding Crowding in mixed dentition
Crowding in Moderate or severe crowding
permanent dentition Mild crowding, significant aesthetic detriment
Mild crowding, little significant ae sthetic detriment
Not palpable buccally
Canines 10+ years Palatally placed on radiographs
Cs retained, not mobile
11+ years Hypodo ntia More than 1 tooth missing per quadrant
(ignore 8’s) One buccal tooth missing per quadrant
Cleft lip and palate and syndromes
Medical history or management issues complicating treatment
Problems likely to need specialist surg ical or restorative care
Severe Skeletal Discrepancy / Facial Disharmony
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Who is Likely to Benefit from Orthodontic Treatment? Guidance on who is likely to benefit from orthodontic treatment is discussed in Section 9 (page 67).
The Hospital Orthodontic Service Overview The Orthodontic Department provides a referral and advice service for all of the Grampian region and Northern Isles. The main base is Aberdeen Dental School with weekly peripheral clinics to Dr Gray’s Hospital, Elgin and quarterly visits to clinics in the Northern Isles. Patients requiring treatment are prioritised according to individual clinical need. Historically the hospital orthodontic service was ‘overloaded’ with routine orthodontic cases which reduced the capacity for the management of complex malocclusions including multidisciplinary cases. At present, the hospital service only offers treatment of more complex cases especially those likely to require multidisciplinary treatment.
Orthodontic Department Clinics
New Patient All referrals to the Department are triaged by a Consultant Orthodontist according to the clinical information provided in the referral letter and accompanying radiographs. There are four consultants and a pooled waiting list is in operation. New Patients are assessed and treatment planned at a Consultant clinic.
If a referring practitioner requires more urgent advice about a patient then this can be provided by telephoning/fax or emailing the department directly to discuss with a Consultant.
Multidisciplinary clinics are held weekly with colleagues in Restorative Dentistry and Oral & Maxillofacial Surgery for cases requiring combined care e.g. hypodontia and facial deformity. Patients should be referred to the most appropriate department initially for preliminary assessment.
Cleft Clinic The Regional Cleft Clinic is held on a monthly basis at Royal Aberdeen Children’s Hospital. The cleft team is a multidisciplinary team including orthodontics and provides a comprehensive assessment and treatment service for patients with cleft lip and/or palate and any associated anomalies or medical problems. It functions within a managed clinical network (CleftSiS) which manages cleft care for all patients throughout Scotland.
Teaching Clinics The orthodontic department is actively involved in both undergraduate and postgraduate training. Dental students may attend Consultant new patient and treatment clinics as part of their course to observe and assist. Postgraduate trainees at both basic speciality stage and advanced pre- consultant stage also work in the department in shared posts with Dundee Dental Hospital.
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Making referrals
For direct referrals to Specialist Orthodontic Practices, please contact the relevant practice directly.
Hospital referrals should be made in writing or via the e-Referral system if available. Referrals tend to be pooled and could be seen by any consultant. If a referral is urgent a letter or referral form can be faxed or preceded by phone or e-mail contact.
The following information should be included in the referral document • Contact details of the referring practitioner • Contact details of General Dental Practitioner (if different from Referrer) • Patient name, address, date of birth and contact details • Reason for referral, including whether advice or treatment is sought • Relevant clinical findings (salient features of malocclusion) • Relevant medical and social history • History of previous orthodontic treatment or referrals • Study models if requesting a treatment plan or second opinion • Recent relevant radiographs if available • Stability of oral health: Caries free for 12 months (exception for opinion e.g. compromised 6s) No active Periodontal Disease, Excellent oral hygiene*
*NB: If your patient has severe disease in permanent teeth, you may request an orthodontic opinion to help with planning extractions as part of your patient’s treatment.
Please note
All patients referred for orthodontic treatment should be:
• Appropriately motivated to maintain good oral health • In a stable healthy oral state • Understanding of the complexity and length of orthodontic care and treatment • Clearly aware of their relationship with dental and orthodontic services i.e. NHS or private • Referred to one orthodontic provider only. • Advised that the initial appointment will be for orthodontic assessment only and does not guarantee that treatment will be offered.
• Aware that they may be referred on to another provider within the local network depending on the complexity of their problem.
Referral Forms An example of the Referral Form for the Orthodontic Department is on the following page. Further copies of referral forms are available at www.hi-netgrampian.org/referralformsbyspeciality
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Orthodontic Referral Form for Aberdeen Dental School & Hospital Send to: Orthodontic Department, The University of Aberdeen Dental School & Hospital, Cornhill Road, Aberdeen, AB25 2ZR.
A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Referral Surname
Gender Male Female Forename CHI Number Date of Birth
Address
Town Postcode
Daytime Phone Mobile
Home Phone e-mail
If your patient needs to communicate in a language or mode other than English please specify: State whether an accompanying person can translate or if an interpreter will be needed
B. Service requested Advice only Treatment Plan Treatment request Medical or Special need
For remote areas : preliminary advice from a dentist with orthodontic experience Multidisciplinary clinic
URGENT: YES NO Please specify reasons for urgency
To aid compliance with the Dis ability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance
Impairment
Is the patient registered at your practice? Yes No Please tick box to confirm I confirm the patient is dentally fit with excellent oral hygiene and I shall remain responsible for their general dental care (except requests for advice on teeth of poor prognosis). Print Name of Referring Clinician Signed (Clinician) Date
REFERRING PRACTITIONER GDP STAMP/DETAILS GMP STAMP/DETAILS
Continued overleaf
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Orthodontic Referral: Clinical Details
Please re -enter patient’s name & Date of Birth
Medical history: Please list all current medications taken, allergies and any specialist medical clinics attended. Note if no relevant history
Clinician’s concerns Mark box if this is a TRAUMA case
Please refer the document “Who is likely to benefit from Orthodontics?” and state which of the conditions specified in the “ Likely to benefit” list applies to your patient :
PLEASE CONFIRM: S/he is interested in having orthodontic treatment. S/he is maintaining excellent Oral Hygiene. S/he has had no new carious lesions detected during the last 12 months. All his/her first premolars have erupted All second premolars (unless congenitally absent) are erupting OR: I would like advice on a mixed dentition problem or extractions only
Additional information/concerns
Treatment you would wish to provide in this case Please mark types of orthodontic treatment you could provide in this case:
Removable Functional Fixed
Enclosures (e.g. radiographs, study models, photographs)
Would you like these returned? Yes No
Administration. Please do not write below . Form reviewed August 2010
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5. NHSG Children’s Dental Services
All referrals should be made through Dental Advice and Referral Centre to Children’s Dental Primary Care Service NHSG Dental Advice and Referral Centre Westholme, Queen's Road Aberdeen, AB15 6LS Phone 01224 556301 Email [email protected]
All referrals should be made in writing. Further copies of the customisable referral forms for Children’s Dentistry are available on NHSG Hi-Net.
It is important that all referrals include a full medical history and clear reasons for referral. Referrals with insufficient information may be rejected. The referral will be acknowledged by letter to the referrer giving details of the allocated clinic and / or clinician.
Clinical Staff NHSG Lead clinician: Malcolm Stewart Contact through Dental Advice and Referral Centre Consultant/Senior Lecturer: Dr Jennifer Foley University of Aberdeen Dental School & Hospital See Section 7.2 for contact details
Children’s Dental Services Overview The salaried primary care dental service accepts child patients for • routine care by self referral (see below) • where a child has a special need or medical issue which makes it inappropriate to have care provided in a general practice setting, please use the Children’s Dentistry referral form . • care requiring anxiety management including anxiety management, inhalation sedation and general anaesthetic, please use the Anxiety Management referral form.
Self Referral Patients requiring an Urgent Appointment 1. Patients should contact their registered dentists in the first instance or
2. DIAL on 0845 45 65 990 Monday – Friday 8.05- 5.45 or
3. NHS24 on 0845 4 24 24 24 outwith these times.
Non Urgent Referrals Currently routine children’s care should be arranged by contacting 1. The salaried primary care dental services via DIAL on 0845 45 65 990 Monday – Friday 8.05- 5.45 or
2. NHS24 on 0845 4 24 24 24 outwith these times.
Waiting times All patients should receive an initial appointment within 12 weeks.
Management of Dental & Dento-Alveolar Trauma For a brief overview of the initial management of dental trauma to both the primary and permanent dentitions see Guidance Notes in Section 9 of the Guide.
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Anxiety Management Referrals (including inhalation sedation & general anaesthetic)
These should only be made as a last resort when other methods of anxiety management or sedation have been attempted.
Please read Guidelines for Referring Child Patients for Dental Extractions under General Anaesthetic in Section 9 of this guide.
Pre Assessment For Children’s Dental Anxiety Management including General Anaesthetics
In order to reduce the risk involved in children’s extractions under general anaesthetic NHS Grampian provides a pre-assessment service for all children referred for General Anaesthetic.
All referrals should be sent to Children’s Dental Primary Care Service NHSG Dental Advice and Referral Centre Westholme Queen's Road Aberdeen, AB15 6LS Phone 01224 556301
Patients will then be offered a pre-assessment appointment in or near their locality in • Aberdeen • Peterhead • Banff • Inverurie • Stonehaven • Elgin
Please tell your patients that the first appointment is for assessment and consultation only.
At this appointment, they will be seen by a suitably trained dentist, who will assess them for GA according to GDC guidelines. Treatment plans may be changed at this stage, and you will be informed of any changes in writing prior to the GA session.
Patients will then be referred on for treatment under LA, RA or GA.
If you need your patient to be seen urgently please contact the clinic directly at RACH for urgent arrangements. Dental Anaesthetic Clinic, First Floor, Royal Aberdeen Children’s Hospital, Foresterhill Westburn Road, Aberdeen AB25 2ZG Tel 01224 550426
Please follow the GA Guidance for Child Patients in Section 9 and ensure that all urgent and emergency patients have been carefully assessed by their referring dentist before contacting the clinic. Dental pain should be alleviated, if at all possible, before a referral is made.
Emergency Referrals for Child GAs. If an emergency referral for a child GA is required, please contact the Maxillofacial Service. This would only be used in case of trauma, haemorrhage or swelling affecting the airway.
Referral forms • Children’s Anxiety Management referral form and • Children’s dentistry referral form are available at www.hi-netgrampian.org/referralformsbyspeciality or email the Referral Hub for further copies at [email protected] .
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Children’s Dentistry Referral Form - excluding Orthodontics Send to: Children’s Dental Primary Care Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS.
A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Referral Surname
Gender Male Female Forename CHI Number Date of Birth
Address Town Postcode
Daytime Phone Mobile Phone
Home Phone e-mail
Medical History Mark the box and comment where appropriate Treatment Required Any Heart complaint/disease Epilepsy Bronchitis/Asthma Hepatitis Excessive bleeding Any serious illness Allergies Regular medication History of present complaint Steroids in the last 3 months Any history of behavioural problems Family history of problems with GA Any other comments
Preferred destination (please choose one) Reason for referral Aberdeen Dental School and Hospital 1.Anxiety/phobia Children’s Primary Care Dental Service (Local 2.Special Needs service in various locations across Grampian) 3.Complex treatment 4.Specialist opinion Enclosures 5.Trauma e.g. radiographs Details Additional Information
Name of Parent/ Legal Guardian/ Carer Registered patient Occasional patient
Keep a copy of this form for your records. REFERRING PRACTITIONER GDP STAMP/DETAILS Name, address and telephone of patient’s GP Name: Dr Address:
: Form reviewed February 2012
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Referral Form for Child Extractions with Anxiety Management incl General Anaesthesia Send to: Children’s Dental Primary Care Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS.
A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Referral Surname
Gender Male Female Forename CHI Number Date of Birth
Address Town Postcode
Daytime Phone Mobile Phone
Home Phone e-mail
Medical History Mark the box and comment where appropriate Teeth to be extracted or requiring treatment Any Heart complaint/disease Epilepsy Bronchitis/Asthma Hepatitis Excessive bleeding Any serious illness Allergies Alternatives offered Regular medication Which alternative treatment methods have been offered Steroids in the last 3 months Any history of behavioural problems Family history of problems with GA Any other comments
Enclosures: Reason for referral Radiographs 1. Anxiety/phobia Must be sent when treatment plan involves pe rmanent extractions 2. Age/lack of understanding Appliances 3. Multiple extractions 4. Sepsis Instructions: 5. Other • Hospital will send details Justification Expected difficulties
THE PATIENT/PARENT HAS BEEN FULLY INFORMED OF ALL DETAILS AND HAS CONSENTED TO THE ABOVE TREATMENT – WHICH MAY BE SUBJECT TO CHANGE BY THE OPERATING DENTIST. THE PATIENT/PARENT ALSO UNDERSTANDS THAT AFTERCARE CAN ONLY BE PROVIDED BY YOUR PRACTICE. Signed Parent Date Signed (Clinician) Date Keep a copy of this form for your records. REFERRING PRACTITIONER Form reviewed September 2010 GDP STAMP/DETAILS Name, address and telephone of patient’s GP Name: Dr Address:
:
Clinician’s Checklist Office use: Consent obtained Form rec’d Appt sent Instructions given Comments Relevant risks Date of appointment
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Child Protection
All practices should have a Yellow Box containing information on Child Protection Services in Northeast Scotland. A one page summary of important contact information follows on the next page. Further copies of Child Protection documents are downloadable from NHSG Intranet.
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NHS Grampian Child Protection – Important Contact Information
Protecting Children Everyone’s job Matters for Concern What to do A Commitment from Children can come into contact with a range of Children can be at risk through Specific guidance is contained in the NESCPC health service staff, not only those working in Guidelines. As a minimum, all staff should children’s services, e.g. • Physical abuse • Emotional abuse • Listen to what is said • Children visiting relatives • Sexual abuse • Observe what is happening • Children of women receiving treatment for • Neglect • Write down exactly what you see and domestic violence hear • Children of carers receiving treatment or You may see or hear things which make • Refer to your nearest social work support for mental health, alcohol or drug you worry about a child’s care, welfare or office, Child Protection Unit or Police Keep this card with you for future abuse problems safety. • If child requires urgent medical reference attention call 999 or on-call So every member of staff, and the public, has a If you have any such concerns, you must do paediatrician at Royal Aberdeen role to play in protecting children; it’s not just something about them Children’s Hospital doctors, nurses, social workers, teachers and the Revised August 2010 police Further advice and support can be obtained from one of the contacts shown on the back of this leaflet.
Aberdeen City Aberdeenshire Moray NHS Grampian: Social Work Social Work Social Work Designated Doctor Child Protection and Nurse Consultant Child Protection Joint Child Protection Unit Aboyne 01339 887096 can be contacted on 01224 306879 Banchory 01330 824991 Buckie 01542 837200 01224 551706 during office hours Area teams Banff 01261 812001 Elgin 01343 557222 Kincorth 01224 874278 Ellon 01358 720033 Forres 01309 694000 In an emergency dial 999 Tullos 01224 241050 Fraserburgh 01346 513281 Keith 01542 886174 K’gate House 01224 264200 Huntly 01466 799600 Lossiemouth 01343 557222 For Out of Hour urgent medical referral contact Quarry Centre 01224 694554 Inverurie 01467 625555 Royal Aberdeen Children’s Hospital receiving Consultant Paediatrician Mastrick 01224 690404 Kemnay 01467 641297 Emergency Out of Hours 0845 7 565656 Via Medical Registrar on Royal Abdn Children’s Hosp 01 224 552994 Peterhead 01779 477333 Children’s Reporter 01343 550015 Tel: 0845 456 6000 Aberdeen Maternity Hospital 01224 552613 Portlethen 01224 783880
Stonehaven 01569 763800 To Contact Grampian Police as part of the IAF
Emergency Out of Hours 01224 693936 process, or to invite them to attend a multi- Strichen 01771 638200 Children’s Reporter 0300 2002166 agency meeting: Turriff 01888 569260 Moray : Social Work Reception 01224 264198 [email protected] Contact ‘Named Doctor’ Consultant Paediatrician, Team Emergency Out of Hours 0845 840 0070 at Dr Gray’s Hospital Elgin Children’s Reporter 0300 2002166 . Tel: 0845 456 6000 To Contact Grampian Police as part of the IAF process, or to invite them to attend a multi- To Contact Grampian Police as part of the IAF Out of hours or urgent medical referral agency meeting: process, or to invite them to attend a multi- Tel: 0845 456 6000 – ask for [email protected] agency meeting: Duty Consultant Paediatrician Dr Gray’s [email protected]
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6. Dental Primary Care Intermediate Referral Service (DPCIRS)
Referrals to primary care staff with a special interest / specialist. All these patients are treated under General Dental Services and are liable to normal NHS charges as per the Statement of Dental Remuneration.
Services include • Adult Special Care • Surgical dentistry • Restorative/special care dentistry (under development)
6.1 Special Care Dentistry
Contact Details All referrals should be made through NHSG Dental Advice & Referral Centre indicating which service you wish to access:
Special Care Dental Services NHSG Dental Advice and Referral Centre Westholme Queen's Road Aberdeen AB15 6LS
Referral Hub Phone 01224 556301 Referral Hub Fax 01224 556587
Clinical Staff (in alphabetical order) Senior Dentist Iain Bovaird [email protected] Senior Dentist Francis Collier [email protected] Senior Dentist Clare Donachie [email protected] Senior Dentist Lois Gall [email protected]
Special Care Services Overview All referrals for Special Care are triaged by senior clinical staff according to the description of the case and urgency with which the patient needs to be seen. The referral will be acknowledged by letter to the referrer giving details of the allocated clinic and or clinician.
Treatment Services / Advice Available
• Wheelchair platform and recliner availability • Domiciliary services • Conscious sedation – inhalation sedation, intravenous sedation • Full clinical care under general anaesthesia • Information and care support packs • Prevention and rehabilitation service (normally dental nurse led)
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Referrals to Special Care Dental Services
Please advise your patients that the first appointment for Special Care Dentistry Services is for assessment and consultation only .
Referrals can be made in writing either by form or letter to the Woodend Dental Advice and Referral Centre or via the electronic portal if this is available to you.
If your patient needs to be seen urgently you may obtain advice from the Special Care Dental Team directly at Aberdeen Dental School Reception Tel 01224 551901
All referrals should contain the following essential details; • Contact details of referring practitioner • Patient name, address, date of birth and telephone numbers • Relevant clinical findings • Reason for referral • Relevant medical and social history
Dental Anxiety Management Services for Adults
This service is able to provide support for the small minority of patients who are unable to accept dental treatment due to a high level of dental anxiety or dental phobia which cannot be managed in regular primary care dental practice.
Prior to referral, the practitioner should attempt to provide regular dental treatment on at least two separate occasions, and details of outcome should be included in the referral. All available methods of pain and anxiety management should be discussed fully with the patient prior to referral. Patients should be fully informed regarding procedures and risks of treatment under sedation, including the requirement for cannulation and administration of local anaesthetic.
Patients should be made fully aware that a number of visits will be required for treatment. All care will be provided in a Primary Care practice environment and usual NHS General Dental Services charges will apply.
Practitioners should satisfy themselves that patient expectations of this service are realistic and patients should not expect multiple procedures at a single visit, hospital-based treatment or access to treatment without charge.
Please note, at the present time, we are not able to offer surgical treatment under sedation in Primary Care, and patients requiring this service should be referred directly to the Oral and Maxillofacial Surgery Department at Aberdeen Royal Infirmary.
Provision of emergency and urgent unscheduled care for registered patients will remain the responsibility of the referring practitioner. On completion of the agreed treatment, patients will be discharged back to the care of the referring practitioner.
All referrals should be made through NHSG Dental Advice & Referral Centre Using the Adult Anxiety Management referral forms
Please send to:-
NHSG Dental Advice and Referral Centre Westholme Queen's Road Aberdeen AB15 6LS
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The referral forms include information about the dental treatment required and also information about any treatment that has been tried.
In particular, please ensure you fill in as much information about
1. What treatment has been tried and the outcomes from these attempts? 2. What ongoing care you will continue to provide? 3. Any medical history details 4. The full details and enclosures about treatment that is to be done 5. The completed Modified Dental Anxiety Score (MDAS) sheet – to be completed by the patient and returned with the referral
All this information will help assess what can be done to provide dental care appropriate to the level of dental anxiety.
Ideally, the patient will enter a pathway of care in the referral process.
1. Referral 2. Assessment by a local salaried or community dentist for discussion of the options of treatment with supportive behaviour management, oral pre-medication or inhalation sedation. 3. If required, onward referral to IV sedation services, which is provided at key locations across Grampian 4. If required, but on rare occasions, onward referral for GA services in hospital. 5. Re-assessment of the level of dental anxiety with a reduced need for sedation, if appropriate 6. Return to routine care with own GDP
Patients will be able to access the appropriate level of the care pathway, ensuring the lowest required level of sedation is prescribed at all times, and whilst working towards provision of routine dental care within a primary care practice environment without the need for specialised support.
Referral forms Referral forms are downloadable at www.hi-netgrampian.org/referralformsbyspeciality
Waiting Times All referrals for adult Special Care Dentistry are triaged by senior clinical staff according to the description of the case and the urgency with which patients need to be seen.
Radiographs Up to date, relevant radiographs, if appropriate, should be provided.
Patients/Carers requiring an Urgent Appointment
1. Patients should contact their registered dentist in the first instance or
2. DIAL on 0845 45 65 990 Monday – Friday 8.05 - 5.45 or
3. NHS24 on 0845 4 24 24 24 outwith these times.
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NHS Grampian Dental Treatment of Bariatric Patients
Introduction
The following guidance has been developed to provide information to staff regarding the safe treatment of patients within certain weight ranges.
Please use Special Care Referral form and CLEARLY mark on the form you require the Bariatric Service. Referrals should be forwarded to the Dental Advice and Referral Centre.
NHS Grampian protocol offers the following definition:
All individuals assessed as being in excess of 20st (125kg) will be considered as ‘heavy’ and will therefore be regarded as unsafe or unsuitable for certain items of routine NHS equipment. All individuals assessed as being in excess of 25st (160kg) are classed as bariatric and therefore are unsafe or unsuitable for the majority of routine NHS equipment.
Local Arrangements
• Should your patient not know their weight, we have scales at the Health Village which can weigh a patient up to 39 stone (247kgs). • Patients weighing under 21 stone (133kgs) may be safely treated in any standard dental chair. • Patients weighing over 21 stone (133kgs) but under 35 stone (222kgs) may be treated safely at the bariatric chair in the Health Village. • Clinicians should document in a patient’s clinical notes if their weight is a concern and should include this information in any referral to ensure that the patient is treated in the safest place possible. • The NHS Grampian Dental Bariatric Service is available to all dental patients residing in the Grampian area on referral from their GDP.
Additional Benefits
The promotion and use of this service will:
• Reduce mechanical breakdown and wear and tear of standard dental chairs. • Provide patients with safe transfer to and from chair using moving and handling procedures and techniques with or without hoist and zimmer equipment. • Ensure greater comfort for bariatric dental patients thus encouraging improved appointment attendance and therefore the promotion of excellent oral health.
Continuing care and ongoing preventive support
Patients will initially be accepted for treatment on a referral basis and may subsequently be offered long term dental care if appropriate. Until such agreement has been reached, and while waiting to be seen within the bariatric dental suite, all patients who remain registered with a dental practice should continue to receive preventive advice and instruction from that practice in order to reduce dental disease risk. The decision to provide this advice and support within the practice or on a domiciliary basis will be by agreement between the patient and the registered dentist.
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Management of Patient Referrals
• Patients who are greater than 35 stone (222kgs) may still not be suitable for treatment in a surgery e.g. medical consideration or physically unable to access the surgery. Domiciliary assessment may be required in some cases. • Bariatric Scales available at Health Village Dental Department should patient be unaware of weight. • Referrals to the Bariatric Dental Service are included in the NHS Grampian “Dental Services – Dental Referral Guide” on Hi Net and should be submitted via the Special Care forms to the Dental Advice and Referral Centre, 1st floor Westholme, Woodend Hospital, Aberdeen AB15 6LS.
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Primary Care Dental S ervices Referral Form – Special Care Dentistry Send to: Special Care Dental Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road , Aberdeen, AB15 6LS.
Normal NHS Patient Charges Apply A. Patient’s Personal Details Referral date Surname
Gender Male Female Forename
CHI number Date of birth
Address
Town Postcode
Daytime Phone Mobile Phone
Home Phone e-mail
If your patient needs to communicate in a mode or language other than English please specify: Please state whether an accompanying person can translate or if an interpreter will be needed:
Name of contact person : Relationship / status e.g. relative / key worker / social worker etc: Address
Tel: Reason for Referral Clinical Reason for Referral
Summary of Special Care Need
Medical history Please list all current medications taken and any specialist medical clinics attended:
Summary of oral health status (e.g. caries and oral hygiene)
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Special Care Dentistry Referral Form Page 2 If unable to print form double sided, then please re-enter Please re -enter patient’s name & DoB
Further Information Please tick Access Medical complications Anxiety / phobia
Learning disability Mental Illness
Does the person go out at all? Yes No
Living arrangements: Alone With family In care
Mobility: Walks unaided Needs walking aid Wheelchair user Bedbound Does patient have capacity for consent Yes No If no please enter details of Welfare Guardian
Name Contact Number
Help that you can provide Please include details of dental care that you are able to provide e.g. prevention, as well as your referral request
Enclosures (e.g. radiographs, study models, photographs)
Would you like these returned? Yes No
Is the patient registered at your practice? Yes No Please mark box to confirm I confirm this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services
Print Name of Referring
Signed (Clinician) Date
REFERRING PRACTITIONER GDP STAMP/DETAILS GMP STAMP/DETAILS
Administrative Information for the Referral Service (Do not write in the box below)
Form reviewed February 2012
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Primary Care Dental Services Referral Form - Domiciliary Request Send to: Special Dentistry Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS. A. Patient’s Personal Details Referral date Surname
Gender Male Female Forename
CHI number Date of birth
Address
Town Postcode
Daytime Phone Mobile Phone
Home Phone e-mail
If your patient needs to communicate in a mode or language other than English please specify: Please state whether an accompanying person can translate or if an interpreter will be needed:
Name of contact person : Relationship / status e.g. relative / key worker / social worker etc: Address
Tel:
Is the patient registered at your practice? Yes No Please mark box to confirm I confirm this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services
Print Name of Referring Clinician Signed (Clinician) Date
REFERRING PRACTITIONER GMP or GDP STAMP/DETAILS inc Phone OR Other Referrer’s DETAILS inc Phone
Form reviewed February 2012 Administration for the Referral Service (Do not write in the area below)
Continued overleaf
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Primary Care Dental Services Referral Form Domiciliary Request Page 2 If unable to print form double sided, then please re-enter Please re -enter patient’s name & DoB Reason for referral: Access Medical complications Anxiety / phobia Learning disability
Does the person go out Yes No at all?
When did they last get out?
How do they attend hospital appointments?
Living arrangements: Alone With family In care
Mobility: Walks unaided Needs walking aid Wheelchair user Bedbound
What transport arrangements would be required to allow them to attend a dental surgery adapted to cater for special care patients:
Medical history Please list all current medications taken and any specialist medical clinics attended:
Physical Disability:
Mental Disability:
Sensory Disability:
Communication Difficulties:
Any other relevant information:
Summary of oral health status (e.g. caries and oral hygiene)
Help that you can provide Please include details of dental care that you are able to provide e.g. prevention, as well as your referral request
Enclosures (e.g. radiographs, study models, photographs)
Would you like these returned? Yes No
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Referral Form for Adult Anxiety Management for Dental Treatment Send to: NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS.
A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Referral Surname
Gender Male Female Forename CHI Number Date of Birth
Address Town Postcode
Daytime Phone Mobile Phone
Home Phone e-mail
Please detail what treatment has been tried and the outcomes from that treatment
Enclosures: Ongoing dental care Radiographs What treatment are you continuing to provide? Please enclose all recent, relevant radiographs Appliances
Instructions re enclosures - do you wish these to be returned?
Medical History Mark the box and comment where appropriate Provisional treatment plan Any Heart complaint/disease Epilepsy Bronchitis/Asthma Liver disease Excessive bleeding Any serious illness Allergies Other details regarding current treatment plan Regular medication Steroids in the last 3 months Any history of behavioural problems Smoking/alcohol
Family history of problems with GA Any other comments re medical history
The patient/parent has been fully informed of all details and has consented to the above treatment – which may be subject to change by the operating dentist. The patient/parent also understands that ongoing regular care can only be provided by your practice. Signed Patient Date Signed (Clinician) Date
Continued overleaf
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Adult Anxiety Management Referral Form
Please re -enter patient’s name Date of Birth
Please keep a copy of this form for your records. REFERRING PRACTITIONER GDP STAMP/DETAILS Name, address and telephone of patient’s GP Name: Dr Address:
: Clinician’s Checklist Office use: Consent obtained Form rec’d Appt sent Instructions given Comments Relevant risks Date of appointment
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Please re -enter the patient’s details Name: Date of Birth:
Patient Information Sheet
Adult Anxiety Management Referrals
Due to a level of anxiety you have about having dental treatment, your dentist has referred you to consider some alternative approaches for your care.
There are a number of measures that can be considered in our service. So that you can be directed for the most suitable care, please fill in the questionnaire as accurately as you can. This information will form part of your clinical records and assessments.
By completing this form, it will allow us to help you access the appropriate treatment, as quickly as we can.
How long you need to wait for treatment will be dependent on the availability of the particular kind of anxiety management you require, so please fill in the form as openly as you can.
You will remain registered with your own dentist, who will continue to provide ongoing preventive advice and care.
Thank you.
DARC – Dental Advice and Referral Centre Westholme, Queens Road, Aberdeen, AB15 6LS
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Please re -enter the patient’s details Name: Date of Birth:
CAN YOU TELL US HOW ANXIOUS YOU GET, IF AT ALL,
WITH YOUR DENTAL VISITS?
PLEASE INDICATE BY INSERTING ‘X’ IN THE APPROPRIATE BOX – as accurately as you can
1. If you went to your dentist for treatment TOMORROW, how would you feel?
Not Slightly Fairly Very Extremely Anxious Anxious Anxious Anxious Anxious
2. If you were sitting in the WAITING ROOM (waiting for treatment), how would you feel? Not Slightly Fairly Very Extremely Anxious Anxious Anxious Anxious Anxious
3. If you were about to have a TOOTH DRILLED, how would you feel?
Not Slightly Fairly Very Extremely Anxious Anxious Anxious Anxious Anxious
4. If you were about to have your TEETH SCALED AND POLISHED, how would you feel?
Not Slightly Fairly Very Extremely Anxious Anxious Anxious Anxious Anxious
5. If you were about to have a LOCAL ANAESTHETIC INJECTION in your gum, how would you feel? Not Slightly Fairly Very Extremely Anxious Anxious Anxious Anxious Anxious Can you describe in your own words, any dental treatment you have had recently and how you felt during the treatment?
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6.2 Surgical dentistry services
Contact Details All referrals should be made through Dental Advice and Referral Centre indicating which service you wish to access:
Surgical Dentistry Services NHSG Dental Advice and Referral Centre Westholme Queen's Road Aberdeen AB15 6LS
Referral Centre Phone 01224 556301 Referral Centre Fax 01224 556587
Clinical Educational Lead/ Senior Dentist: Andrew McIntosh Senior Dentist: Bernice McLaughlin Salaried Dentist: Archana Kavi Dental Nurse Team Leader Jill Greig
• Please ensure referrals are made on the appropriate form and accompanied with radiographs where indicated otherwise the referral may be declined. • DO NOT EMAIL FORMS to the service. (E-Referrals under development) • Patients will be treated under the GDS contract and therefore a fee will be incurred for patients eligible for payment
Services available
The Surgical Dentistry Service will accept NHS or unregistered patients, aged 16 years and over, from the following categories for treatment under local anaesthesia only.
• Failed dental extractions • Surgical removal of fractured/buried roots • Impacted third molars with soft tissue/moderate bone impaction • Apicectomies of upper and lower single rooted anteriour teeth which have been root treated (upper and lower 3-3) and the root treatment cannot be improved by repeat RCT • Mild/moderate medically compromised patients; ASA I and II, e.g.: patients on warfarin, cardiac, respiratory & other medications, fit for treatment under local anaesthesia.
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Referral Form for Surgical Dentistry Send to: Surgical Dentistry Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS.
A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Surname Referral
Gender Male Female Forename CHI Number Date of Birth
Address
Town Postcode Daytime Phone Mobile
Home Phone e-mail
If your patient needs to communicate in a language or mode other than English please specify: If yes, please specify and state whether an accompanying person can translate or if an interpreter will be needed.
To aid compliance with the Disability Discrimination Act, please indicate if p atient has any special mobility requirements : Mobility Assistance
Impairment
Is the patient registered at your practice? Yes No Please check box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services
Print Name of Referring Clinician Signed (Clinician) Date
REFERRING PRACTITIONER GDP STAMP/DETAILS GMP STAMP/DETAILS
Patient’s presenting complaint
Clinician’s concerns Why are you referring the patient?
What outcome do you seek?
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PLEASE PRINT FORMS on BOTH SIDES OF ONE SHEET. If this is not possible then please re- enter please re -enter patient’s & Date of Birth name Medical history, including all drugs being taken and any allergies. Note if no relevant history
Dental history What treatment has been attempted for this problem before the referral was made?
What treatment are you planning to provide for the patient in their current care plan?
Summary of oral health status (e.g. caries and oral hygiene)
Smoking status Alcohol consumption
Enclosures : Radiographs Study Photographs models Details:
Would you like these returned? Yes No
Is there any other information we need to know?
Form reviewed February 2012 Administrative Information for the Referral Service (Do not write in the box below)
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7. University of Aberdeen Dental School & Hospital
Contact details Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZR Reception: Tel: 01224 551901
Staff Director & Head of Aberdeen Dental School: Professor James Newton Clinical Director Mr Martin Donachie
The University of Aberdeen Dental School and Hospital opened in November 2009. It comprises the University of Aberdeen Dental School, Secondary Care consultant dental services including Restorative Dentistry, Children, Orthodontics and Oral Surgery. The building has its own laboratories, LDU and radiology facilities. In addition primary care services for patients with special needs, emergency dental care and other sub consultant support staff are co-located on the same site in a purpose-built, state-of- the-art institution.
At full student complement, the centre will have 80 Dental Students, 8 trainee Dental Nurses and 2 trainee Dental technicians.
7.1 Student Clinics The Dental School requires patients for the training of dental students. This treatment is provided free of charge. All patients recommended for treatment by dental students will be assessed by a clinical member of staff. If they are not suitable, for any reason, then the treatment will not be offered and the patient discharged. It is important to note that the patient will not be assessed by a consultant and a treatment plan will not be provided.
If you think that the patient requires a consultant opinion then please make a referral in the usual way using the proforma.
If you are recommending a patient for assessment you must tell the patient that they will be treated by students who are obviously relatively inexperienced and take longer than an experienced dentist. The patient must be able to attend regularly during the working week.
The patient must be told that: • they must attend for an assessment visit to assess their suitability for treatment • they are being recommended for free treatment by dental students • requests for treatment are not always accepted • they must be able to be regularly available during the working week (Monday to Friday between 9am- 5pm) to attend their appointments • students take longer than experienced dentists.
If you have any queries with regard to University of Aberdeen Dental School and Hospital please contact:
Administrator Layla Smith E-mail [email protected] Tel: 01224 558845
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Dental Technician Advice at Aberdeen Dental School & Hospital
Contact details Keith Ewan University Dental Instructor Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZR Email [email protected]
Any member of the dental team who would like advice on any aspect of preparation or handling of laboratory work is welcome to contact Mr Ewan, if you are unable to obtain advice from your usual dental laboratory. He can give advice or direct you towards the appropriate route for your requirements.
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Dental School MOS Clinic Referral Guidance for Primary Care Practitioners
Patients must be willing to have their procedure carried out by a dental student under supervision. Patients should be advised that student treatment takes longer. There will be no charge. Patients must be generally fit and well and treatment will be carried out under local anaesthesia. There is no walk in service, patients must be referred on the Dental school referral letter and will be appointed. Please also enclose appropriate radiographs if available.
Treatment available:
• Surgical treatment of failed extractions • Extraction of retained roots • Routine extractions • Surgical removal of 1-7 in each quadrant • Surgical removal of third molars on assessment. If not suitable for student training the patient will be passed to the Primary Care Minor Oral Surgery service or to the Maxillofacial Surgery Dept as deemed necessary.
Referrals should be directed to:
Aberdeen Dental School Patient Coordinator Aberdeen Dental School Cornhill Road Aberdeen AB25 2ZR
Email: [email protected] Tel: 01224 559611
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ADULT Referral Form for DENTAL STUDENT TREATMENT Send to: Aberdeen Dental School and Hospital, Cornhill Road, Aberdeen, AB25 2ZR
This form should be used to recommend an adult patient for treatment by dental students. It should only be used for patients who require routine primary care.
The Dental School requires patients for the training of dental students. This treatment is provided free of charge. All patients recommended for treatment by dental students will be assessed by a clinical member of staff. If they are not suitable, for any reason, then the treatment will not be offered and the patient discharged. It is important to note that the patient will not be assessed by a consultant and a treatment plan will not be provided.
If you think that the patient requires a consultant opinion then please make a referral using their specialty form or by letter.
If you are recommending a patient for assessment you must tell the patient that they will be treated by students who are obviously relatively inexperienced and take longer than an experienced dentist. The patient must be able to attend regularly during the working week.
Please confirm that you have provided the following information (incomplete forms will be returned).
The patient has been told that: • They must attend for an assessment visit to assess their suitability for treatment
• They are being recommended for free treatment by dental students
• Requests for treatment are not always accepted • They must be able to be regularly available during the working week (Mon- Fri between 9am-5pm) to attend their appointments
• Students take longer than experienced dentists
• If accepted for treatment they will be re-registered as an NHS patient with the Dental School
A. Patient’s Personal Details Date of Referral Surname
Gender Male Female Forename CHI Number Date of Birth
Address
Town Postcode Daytime Phone Mobile
Home Phone e-mail
If your patient needs to communicate in a language or mode other than English please specify: If YES, please specify & state whether an accompanying person can translate or if an interpreter will be needed.
To aid compliance with the Disability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance
Impairment
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Adult Dental Referral to Dental Student Clinics page 2
Reasons for referral
Medical history , including all drugs being taken and any allergies. Note if no relevant history
BPE Scores Oral Hygiene
Smoking status Alcohol consumption
Treatment required
Simple periodontal care Surgical Treatment (including extractions)
Routine fillings (including composites) Routine crowns (including resin bonded and metal ceramic)
Partial Dentures Upper Lower
Complete dentures (Alveolar ridge morphology must be appropriate for undergraduates )
Endodontics (anteriors and premolars only) Tooth
Seen and agreed by patient:
Name: (please print)
Signature Date: ______
** NB REQUESTS FOR TREATMENT MAY NOT ALWAYS BE ACCEPTED **
Is the patient registered at your practice? Yes No Please tick box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services
Print Name of Referring Clinician Signed (Clinician) if manual copy Date
REFERRING PRACTITIONER GDP STAMP/DETAILS GMP STAMP/DETAILS
Form reviewed February 2012 Administrative Information for the Referral Service (Do not write in the box below)
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7.2 Paediatric Dentistry at Aberdeen Dental School
Contact Details Dr J Foley Senior Lecturer/Honorary Consultant Department of Paediatric Dentistry The University of Aberdeen Dental School and Hospital Cornhill Road Aberdeen, AB25 2ZR Tel: 01224 555155
Reception Tel: 01224 551901 or 01224 551084 Fax: 01224 551096 or 01224 550137 E-mail: [email protected]
Clinical Staff Consultant/Senior Lecturer: Dr J Foley NHSG Lead clinician : Dr M Stewart
Paediatric Dentistry Department Overview The Department was established within The University of Aberdeen Dental School and Hospital in 2010 and aims to provide an undergraduate education in Paediatric Dentistry as part of the four-year, graduate-entry BDS degree programme. In addition, the Department will accept referrals for those patients whose practitioners require advice on treatment and where indicated, specialist treatment for children within the Grampian region. The appointment of a second specialist within the region is imminent with the recruitment of a Fixed Term Training Appointment/Development Consultant in Paediatric Dentistry post which should facilitate postgraduate educational opportunities in the discipline.
Currently links are being created with the Royal Aberdeen Children’s Hospital for multi-disciplinary dental care as follows: • general anaesthetic for minor oral surgical procedures and comprehensive dental treatment of anxious- and medically compromised patients; • cleft lip and palate and dento-facial anomalies; • haematological and oncological patients, including organ transplant recipients.
Referrals The Department will accept referrals for the following types of patient: Children up to sixteen years at initial referral who have • Dental trauma; • Dental anomalies, e.g. hypodontia and hypoplastic teeth; • Advanced restorative treatment, e.g. discoloured non-vital teeth, tooth wear; • Minor oral surgery for pathology and orthodontic treatment, e.g. non-erupted incisor teeth, impacted canine units, infra-occluded primary molar teeth; • Restorative treatment of dental caries and pulpal therapy for children who are not medically- compromised; • Orthodontic extractions either with local anaesthetic or inhalation sedation; • Individuals with intellectual, medical, physical, psychological and/or emotional problems.
Referral of Patients with Dental Caries: The Department will accept as a referral those patients who meet the following criteria: • Less than four carious teeth and who are not medically-compromised; • Children with caries who are medically-compromised. Those children who have been diagnosed with multiple carious teeth, i.e. in excess of four carious teeth should be referred to the NHSG Children’s Dental Service.
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Consultant/Treatment Planning Clinics All patient referrals will be triaged by the Consultant and subsequently assessed and treatment planned within 12 weeks of the initial referral on a Consultant/Treatment Planning Clinic. Arrangements will be made to see those patients who due to the nature of their referral require a more urgent consultation. A detailed report will be forwarded on to the referring practitioner within two weeks of each patient’s initial consultation. Where advice only has been sought, a detailed plan of treatment will be included within this letter.
Joint Paediatric/Orthodontic Clinic The Department will accept patients who require a joint paediatric and orthodontic opinion for patients with the following dental problems: • Supernumerary teeth • Non-erupted teeth, e.g. central incisors • Impacted teeth, e.g. canine units • Dilacerated teeth • Infra-occluded primary molar teeth • Hypodontia
The clinic is run jointly by Drs J Foley and Dr K Khalaf, Senior Lecturer/Honorary Consultant in Orthodontics.
Dental Trauma Clinic The Department has established a monthly trauma clinic which will accept referrals for patients who have sustained oro-dental trauma which may either be for advice or treatment.
Treatment Clinics If indicated and deemed necessary, treatment will be organised as follows: • Treatment will be undertaken on the student teaching clinic under staff supervision; • Specialist treatment will occur within either the Aberdeen Dental School and Hospital or the Royal Aberdeen Children’s Hospital; • Referral of a patient to the Salaried Dental Service.
At the end of a course of treatment within the Hospital Dental Service, each patient will be returned to their referring practitioner and a letter indicating all treatment which has been undertaken will be sent within two weeks of patient discharge. Where a patient is no longer registered with their referring practitioner, arrangements will be made for a patient’s recall either within Aberdeen Dental School and Hospital or the patient will be referred to the Salaried Dental Service.
Department Referrals All patients should be referred to Dr J Foley, Department of Paediatric Dentistry, in writing (by Children’s Dentistry Referral Form or a letter) to include the following information:
• Contact details of the referring practitioner; • Patient name, address, date of birth and contact details; • Reason for the referral, including whether advice or treatment is being sought; • Relevant clinical history and findings; • Relevant medical- and social history; • Relevant and up-to-date radiographs which will be copied and the originals returned.
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8. Smoking Cessation Referrals
Stop Smoking Guidance in Scotland
If a patient is a smoker they should be advised on both the health risks of continuing and the benefits of giving up. There is evidence of links not only with oral cancers in adults but also increased incidence of decayed and filled teeth in children who live with smokers. Smokers who express a desire to quit should be informed of the value of NHS Smoking Cessation Services for specialist help with their quit attempt.
NHS Grampian Smoking Advice Service
Room G27, Summerfield House 2 Eday Road, ABERDEEN, AB15 6RE Phone 0500 600 332 e-mail [email protected] www.justfiveminutes.com/nhsgrampian
The Smoking Advice Service (SAS) is NHS Grampian’s smoking cessation service. Smoking cessation sessions are provided across Grampian at a range of healthcare and community venues. The client attends a course of six 1-hour sessions, designed to help them to plan and manage their attempt to quit smoking. The SAS can offer advice on choosing and managing medication. With a 79% success rate at 4 weeks, this is one of the most effective Stop Smoking Services in Scotland.
The Community Pharmacy Scheme is available from community pharmacies across Grampian on a “walk-in” basis. Patients attending this scheme receive 12 weeks of support and nicotine replacement therapy (NRT). With a 41% success rate at 4 weeks, this is one of the most successful pharmacy schemes in Scotland.
We also offer a range of training for health professionals . Our most popular course, “Raising the Issue of Smoking” covers knowledge around tobacco, smoking and health, communication skills and how to refer people to local stop smoking services for support.
For more information about the Smoking Advice Service , to find out how you can refer to discuss our range of training available, please contact the SAS, free of charge, on 0500 600 332 or by e-mailing [email protected] .
You can also visit www.hi-netgrampian.org/sas for more information.
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Smoking Advice Service Room G27, Summerfield House 2 Eday Road, ABERDEEN, AB15 6RE Phone 0500 600 332 e-mail [email protected] www.justfiveminutes.com/nhsgrampian
SMOKING ADVICE SERVICE:
To attend any of the classes in the Grampian Area please call free phone number 0500 600 332 for further advice. An appointment then can be made for you to attend the next available session. Sessions are available in a range of location across Grampian (see attached map).
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9. Referral Guidance Notes Department of Restorative Dentistry Referral Guidelines (Dr Dean Barker, NHS Grampian)
The role of the Restorative Dentistry Department is to provide a diagnostic, treatment planning and advice service to referring practitioners and to carry out specialist level treatment where appropriate. In the majority of cases both the patient and referring dentist should expect the treatment to be completed in the practice setting. The intention of the Consultants in Restorative Dentistry is to work in partnership with the referring practitioner. This means that the patient may be referred back to primary care for specific items of treatment or all of the recommended treatment with a detailed treatment plan.
If patients are accepted for treatment it is on the understanding that a specific course of treatment will be undertaken and the patient will then be discharged back to the referrer for continuing care.
All referrals to the Department are vetted according to the description of the case and the urgency with which the patient needs to be seen. If it is felt that the referral letter contains inadequate detail to allow this to take place, the referral may be returned to the referring practitioner for clarification, resulting in a delay in the patient being seen. The reasons for not accepting the patient will be identified.
All referrals, even those to named consultants, tend to be pooled and may be seen by any consultant.
Please note that if a patient fails to attend an appointment for a consultation without prior notice, the patient will be discharged back to the referring practitioner and a new referral will be required. The consultant involved does have discretion to provide another appointment but this will only be exercised in exceptional circumstances.
Most patients will be accepted for advice and treatment planning, however not all patients can be seen for treatment.
The following categories of patients may be accepted for some or all of their treatment:
Priority Groups
• Head and neck cancer patients requiring rehabilitation following resection, post- radiotherapy changes or due to altered anatomy. • Patients with other acquired defects due to surgery and orofacial trauma • Developmental and congenital abnormalities including cleft lip and palate, joint orthognathic and/or orthodontic cases, hypodontia and other disturbances in tooth development e.g. amelogenesis imperfecta
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Periodontics
All referrals will be expected to contain a BPE score, information relating to any acute episodes and a summary of the treatment provided, together with the patient response.
Patients who can be considered for treatment will include those with:
• Significant medical problems which may put them at increased risk of periodontal disease • Aggressive periodontitis (formerly known as early onset or juvenile periodontitis) • A requirement for periodontal surgery, including crown lengthening and mucogingival procedures • Chronic periodontitis with the following criteria: o BPE score of 4 in more than one sextant o BPE score of 4 in one sextant plus one or more of the following factors: A concurrent medical factor that directly affects the periodontal tissues Anatomical factors that adversely affect prognosis >2mm attachment loss in one year Under 35 years of age
Referrals of patients with chronic periodontitis will normally only be accepted for treatment when the following intervention has been undertaken in practice:
• Oral hygiene instruction with particular emphasis on the appropriate form of interproximal cleaning • Supragingival scaling and root surface instrumentation to all areas of pocketing >4mm. This may require to be performed over several visits to treat the whole mouth and may require the use of local anaesthetic For NHS patients this treatment would typically fall under Item 10(c) of the Statement of Dental Renumeration.
Patients who will not normally be accepted for treatment are those who:
• Are unable to maintain a satisfactory level of oral hygiene and whose motivation remains poor • Have BPE scores of 3 or less (unless they meet one of the above criteria for acceptance) • Have chronic marginal gingivitis only
Endodontics
The referral should include a radiograph of diagnostic quality, a history of recent interventions and details of the future restorative plan for the tooth. Treatment will often be limited to a ‘troubleshooting’ service which aims to overcome immediate challenges and allow treatment to be completed in primary care (e.g. identification of canals, removal of fractured instruments).
Patients who will be considered for treatment will include those requiring:
• Management of complex or narrow root canal anatomy • Treatment of iatrogenic damage including separated instruments, fractured posts and perforations • Management of open apices, resorption and trauma • Conventional re-treatment of failed root canal therapy where difficulty in carrying this out in practice has been encountered • Surgical endodontics Last updated 30/07/2014 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality 71
Patients who will not normally be accepted for treatment are those requiring:
• Uncomplicated primary root canal treatment • Treatment on teeth judged to be unrestorable or of poor prognosis • Complex treatment of teeth in poorly maintained mouths • Re-treatment of second or third molars, unless there is a compelling need for their preservation. This would include the tooth being a key abutment or to avoid extractions in patients who would present a surgical risk
Removable Prosthodontics
Attempts must have been made to alleviate problems associated with dentures that have been provided in the preceding few months.
Patients who will be considered for treatment will include those with:
• Altered or abnormal anatomy including that acquired from surgical intervention, trauma, clefts or exceptional patterns of resorption • Complex denture designs such as those with overlay components, swing-lock arms, or precision attachments
The Department is not able to provide treatment of a routine nature. If having assessed the patient’s existing prostheses it is felt that the provision of treatment is within the scope and expertise of a general dental practitioner, with appropriate advice, it is expected that the patient will return to their practitioner with a treatment plan. Where alternative options exist (eg acrylic or cobalt-chromium partial dentures) these will be identified and the practitioner and patient may elect which option to pursue.
Where it is clear that all efforts have been made by the referring practitioner to address the patient’s issues, or in the case of re-referral, where the treatment plan provided has been accurately followed, patients may be accepted for treatment within the capacity of the service.
Fixed Prosthodontics
Patients referred for the rectification of problems or replacement of fixed prosthetic work provided outwith the Hospital will not be accepted for treatment unless under exceptional circumstances. Advice on appropriate methods of removal and management of fixed restorations will be provided. Advice on the options for the management of tooth wear will also be given.
Patients requiring complex care may be accepted for treatment in those circumstances that involve a major occlusal rehabilitation such as a significant change of the vertical dimension or anterior guidance.
Dental Implants
The following categories of patients may be considered for treatment depending on the circumstances of the individual case:
• Malignancy or other pathological lesions resulting in altered oral anatomy • Congenital conditions such as clefts or hypodontia, normally involving multiple teeth • Missing teeth as a result of dentoalveolar and facial trauma • Severe intolerance to dentures that are otherwise considered to be satisfactory Last updated 30/07/2014 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality 72
Dental implants are not provided to patients that have:
• Poor oral hygiene • Active dental or periodontal disease • A smoking habit
Please also be aware that the Department is normally not able to offer treatment for the following:
• Completion of implant treatment commenced elsewhere • Rectifying prosthodontic problems in relation to implant treatment carried out elsewhere • Maintenance of implants and implant restorations provided elsewhere
An advisory service is available. Acute infection or the initial management of significant problems such as fracture of implants or components will be offered where appropriate. However, given the very large number of implant systems available, this is not always possible and patients should be made aware of this at the time of referral.
Patients who are not accepted for treatment
In addition to the above, the following categories of patients are not accepted for treatment:
• Referrals on financial grounds alone • Routine caries management • Dental phobics requiring sedation. The Department does not offer a sedation service • Patients with special needs who do not have a specialist Restorative Dentistry problem
In the case of the last two categories, referrals should be made to Special Care Dentistry.
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Who Is Likely To Benefit From Orthodontic Treatment & Who’s At Risk From It? Deciding The Risk: Benefit Balance
EA Turbill, NHS Grampian
Orthodontic treatment carries risks as well as benefits. The main risks are decalcification & caries around the appliances, gingivitis & loss of periodontal attachment , & root resorption . There is always also the risk of non-improvement or even negative improvement from the treatment; this is a particular risk if a patient’s compliance with treatment is poor. This advice sheet is to help you identify those patients most likely to benefit from an Orthodontic referral, & those it would be best to discourage from Orthodontics.
Patients likely to benefit from Orthodontic treatment (as long as their Oral Care is good) are those with: • Cleft Lip or Palate – but they’re probably already registered with the local Cleft Team, unless they have only recently come to the UK. • Teeth (other than 8s) that are ectopic or have their eruption obstructed (impactions). • Missing teeth (hypodontia) resulting in gaps. • Overjets greater than (>) 6mm. • Reverse overjets >3.5mm &/or that cause problems with speech or mastication. • Displacements on closure greater than 2mm if caused by premature contacts. • Scissors-bites with no functional occlusion in one or both buccal segments. • Crowded &/or rotated teeth with contact-point displacements greater than 4mm. • Traumatic overbites (biting the gingivae lingual or labial to the incisors). • Open-bites (anterior or posterior) in excess of 4mm. • Extra teeth or severely submerging deciduous teeth and/or: • Marked disharmony in proportions of mid- &/or lower face. • Severe cosmetic impairment due to arrangement /positions of teeth. (The above patients are also likely to score grade 4 or 5 on the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN), & / or 8, 9 or 10 on its Aesthetic Component – see attached pictures)
Patients unlikely to benefit from Orthodontic treatment & at significant risk of non- or negative- benefit are those with: • Any patient with active caries, poor plaque control or who is disinterested in treatment. • Overjets of 6mm or less if the lips are competent. • Overjets of 3.5mm or less whether or not lips are competent. • Displacements on closure of 1mm or less. • Contact point displacements & open bites of 2mm or less. • Mildly increased overbites with no palatal or gingival contact. • Open bites (anterior or posterior) of 2mm or less. and • No, or only mild, cosmetic impairment. (These patients are likely to score 1 or 2 on IOTN Dental Health Component, and 1-4 on IOTN Aesthetic Component).
Other patients - the “In-between” group, would be “Borderline Need” cases who may derive some benefit from Ortho if they are keen and compliant patients with excellent oral care, but they would also be at some risk of non- or negative- benefit.
Interpretation of Aesthetic Component of IOTN Last updated 30/07/2014 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality 74
Grade 1 = most aesthetic arrangement of the dentition Grade 10 = least aesthetic arrangement of the dentition
Grade 1 - 4 = little or no treatment required Grade 5 - 7 = moderate or borderline treatment required Grade 8 - 10 = treatment required
Interpretation of Quick Referral Guide Assess main malocclusions – identify in Column 1 Columns 3,4,5 – indicate recommended referral route (ticked box)
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Management of Dental & Dento-Alveolar Trauma
Here is a brief overview of the initial management of dental trauma to both the primary- and permanent dentitions.
1. Primary Dentition
Dental Trauma
Enamel Infraction • Review Enamel Fracture • Smooth • Composite resin, if co-operative Enamel-Dentine Fracture • Smooth • Composite resin, if co-operative Complicated Coronal Fracture • Extraction • Pulpectomy, obturation with zinc oxide eugenol and composite resin, if co-operative Coronal-Radicular Fracture • Extraction Radicular Fracture • Review if non- or minimal mobility and no displacement • Extraction of the coronal fragment if either of the following apply: o Coronal fragment is non-vital o Marked displacement and mobility
Dento-Alveolar Trauma Concussion • Review Subluxation • Review Extrusion • Extraction, if marked mobility Lateral Luxation • Review if non- or minimal mobility and no occlusal interference • Extraction if either of the following apply: o Excessive mobility and/or interference with the occlusion o Buccal displacement of the crown, i.e. palatal displacement of the root Intrusion • Review if the root is displaced buccally • Extraction if either of the following apply: o Palatal displacement of the root o Non-eruption of an intruded tooth after six months Avulsion • Do not re-implant
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2. Permanent Dentition
Dental Trauma
Enamel Infraction • Review
Enamel Fracture • Smooth • Composite resin, if co-operative
Enamel-Dentine Fracture • Temporize with either a composite- or composer dressing • Composite resin • Re-attachment of coronal fragment o If fracture line not close to the pulp, immediate re-attachment o If the fracture line is close to the pulp, dress with tooth with calcium hydroxide and a temporary composer or composite dressing. Store the tooth fragment in saline, which is changed weekly and the fragment is re-attached after one month
Complicated Coronal Fracture: Vital Pulp Therapy • Pulp capping with calcium hydroxide if < 24h exposure, • Pulpectomy with calcium hydroxide if > 24h exposure
Coronal-Radicular Fracture • Extraction of the coronal fragment(s) • Space maintain
Radicular Fracture • Review if apical third, although if mobile, splint for two weeks • Re-position coronal fragment and splint for two weeks if mid-third fracture • Re-position coronal fragment and splint for two weeks or extraction if coronal third fracture and space maintain
Dento-Alveolar Trauma
Concussion • Review
Subluxation • Review
Extrusion • Re-position and splint for two weeks
Lateral Luxation • Re-position and splint
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Intrusion • Open apex tooth: o Review if intruded < 3mm o Allow spontaneous eruption or orthodontic extrusion if intruded 3-6mm o Orthodontic extrusion or surgical repositioning and splint if intruded > 6mm • Closed apex tooth o Orthodontic extrusion if intruded < 3mm o Orthodontic extrusion if intruded 3-6mm o Surgical repositioning and splint if extruded > 6mm
Avulsion • Ideally, re-implanted at the time of injury • If not re-implanted immediately, store in milk, saliva, saline or Viaspan ® • Re-implant and splint • Endodontic treatment for the following clinical situations: o Open apex tooth with an extra-alveolar time of > 30-45 minutes o Closed apex tooth Notes • Treatment may vary depending on for example, the patient’s medical history, co- operation for treatment etc. • All patients should be advised regarding symptomatic care which includes the use of a soft diet, simple analgesia etc. • Appropriate reviews should be organised for sensibility testing • For primary tooth trauma, ensure the following: o that all treatment minimizes the risk of disturbance to the permanent dentition; o that the carer/legal guardian is aware of the risk of trauma to the permanent dentition either from the initial traumatic injury or from subsequent treatment; • For permanent tooth trauma, advise the patient/carer/legal guardian regarding the possibilities of loss of vitality and root resorption, relative to the type of trauma; • All endodontic treatment should be completed under rubber dam; • All splints used for dento-alveolar trauma are flexible, i.e. the splint includes the traumatised tooth/teeth, and also, one tooth unit either side of the traumatised unit(s); • Splints should allow for sensibility testing and if necessary, endodontic treatment.
Further Information • Guidelines for the management of traumatic injuries to the primary dentition and for fractures, luxation and avulsion injuries in the permanent dentition are available as pdf files. These may be obtained via e-mail from the Referral Centre, e-mail [email protected] • The guidelines define the various injuries, outline both immediate- and follow-up regimes and contain a number of useful photographic images.
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Guidelines for Referring Child Patients for Dental Extractions under General Anaesthetic J Foley
Currently accepted best practice for managing the child patient who requires general anaesthetic for dental extractions is to treatment plan the patient to ensure that the use of general anaesthesia is kept to the minimum. The following guidelines should ensure that this occurs:
1. Extraction of Primary Teeth All teeth which meet the following criteria should be extracted: • All carious primary teeth; • All heavily restored primary teeth; • All grossly worn primary teeth; • All mobile primary teeth; • Any primary tooth required for balancing purposes to prevent centre-line shift.
2. Extraction of Carious or Hypoplastic First Permanent Molar Teeth Where no orthodontic treatment is planned in a Class I occlusion with little or no crowding: • Extraction of the mandibular first permanent molar tooth at 8½-9½ years of age. Compensate with extraction of the opposing maxillary first permanent molar tooth. Do not balance with extraction of the contra-lateral tooth. • Extraction of the maxillary first permanent molar tooth at 8½-9½ years of age. Do not compensate with extraction of the opposing mandibular first permanent molar tooth. Do not compensate with a contra-lateral extraction. For any patient with significant crowding and for those with a Class II- or III occlusion, an orthodontic opinion should be attained prior to any extraction.
3. Dental Radiographs Ideally, radiographs should be taken at initial assessment. A set of bitewing radiographs is useful to demonstrate inter-proximal caries in both the primary- and permanent dentition. When treatment planning the carious or hypoplastic first permanent molar tooth, a DPT will demonstrate the prognosis of these teeth and also, the presence and stage of development of the other permanent teeth. If a DPT is not possible, then periapical radiographs can be useful again, to demonstrate the extent of the carious process and the presence of neighbouring teeth. If a patient is not able to tolerate dental radiographs, e.g. due to anxiety then this should be noted in the referral letter.
4. Dental Restorations All dental restorations should be completed prior to referral. Where there is doubt regarding the long-term prognosis of a restored tooth and following radiographic review, any such tooth will be extracted.
5. Orthodontic Extractions General anaesthetic will not be provided for the orthodontic extraction of non-carious teeth. In extenuating circumstances, e.g. a medically-compromised patient who is not suitable for orthodontic dental extraction with sedation and following consultation with their Medical/Paediatric Consultant and the Consultant Anaesthetist, orthodontic extractions may be organised.
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10. Useful links
• Use of Community Health Index (CHI) Numbers The SCI Gateway system uses the NHS CHI patient ID system and a dental “CHI LOOK UP Service” will be available as part of the Dental e-Referral Programme.
• Updates on Referral Guidance These will be available on the NHS Grampian Hi-Net: www.hi-netgrampian.org/referralformsbyspeciality
Check the site for availability of • Downloadable Dental Referral Forms for different specialties • Downloadable Information Sheets for Patients will be downloadable from here soon. This service is still under development (September 2010)
• Teeth TLC NHS Grampian's latest oral health campaign. www.teethtlc.com
• Scottish Dental Website http://www.scottishdental.org/ A useful starting point for any practising dentist in Scotland. Also has useful links for patients who should click on the “Public” button for easy access to topics including: • Emergency dental services • Finding a dentist • Treatment charges • Dental Topics explaining various oral conditions. These links are very informative but perhaps more user-friendly explanations for patients of oral health and disease are found at:
• NHS24 website: Health Information and Self Care Advice for Scotland The Health Library section is at: http://www.nhs24.com/content/default.asp?page=s5
• Scottish Dental Clinical Effectiveness Programme (SDCEP) http://www.sdcep.org.uk/ Downloadable evidence based guidance including: • Emergency Dental Care • Conscious Sedation • Drug Prescribing for Dentistry • Management of Dental Caries in Children • Practice Support Manual
• British National Formulary (BNF) www.bnf.org
• Knowledge Network www.knowledge.scot.nhs.uk
• Scottish Intercollegiate Guideline Network (SIGN) www.sign.ac.uk
• e-Den Dental learning free to all NHS dental staff and available 24 hours a day. Make use of this while it is still available as it is under government budgetary review (2010). www.e-lfh.org.uk/projects/dentistry/
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• Foreign languages: The British Red Cross Emergency Multilingual Phrasebook The Emergency multilingual phrasebook contains 62 common medical questions and statements in 36 languages and is used to enable basic communication between first contact carers and patients in medical emergency situations. Copies of this can be purchased for £20 from the British Red Cross but online versions are downloadable from The Department of Health Website at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4073230
The phrasebook can be downloaded in Portable Document Format. For ease of access, it has been loaded as separate chapters for each of these languages:
Albanian, Amharic, Arabic, Bengali, Bosnian-Bosanski, Chinese, Czech, English, Farsi, French, German, Greek, Gujarati, Hindi, Hungarian, Italian, Japanese, Korean, Kurdish, Lingala, Macedonian, Pashto, Polish, Portuguese, Punjabi, Romanian, Russian, Slovak, Somali, Spanish, Swahili, Tamil, Turkish, Ukrainian, Urdu, Vietnamese, Welsh.
• Foreign languages: The NHS Language Line
NHS Grampian subscribes to the following service: http://www.languageline.co.uk/page/industry_healthcare/
• Foreign languages: The NHS “Health in My Language” Resource
Information about health and health related services in Scotland which has been translated into different languages. http://www.healthinmylanguage.com/home.aspx
• Foreign languages: “How to Say in?” Language Resource
Online translation for common phrases in 24 languages: http://www.howtosayin.com/hello.html
And finally
• A Chairside Communication Guide in English, Spanish, French and Chinese courtesy of Crest Toothpaste http://www.dentalcare.com/en-US/patient/comm_guide.jspx
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