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Referral Forms

For dentistry and healthcare professionals referring their existing patients OR for domiciliary ‘home’ care requests.

Criteria for referral into the Gloucestershire Community Dental Service

The role of the Community Dental Service (CDS) has developed over the last few years and we are commissioned to provide special care dentistry for adults and children in Gloucestershire. We have a central referral system and all referrals are triaged by a senior clinician prior to being accepted onto the waiting list, Patients are then offered an appointment at a clinic that has appropriate facilities for their particular needs.

Many patients referred to special care dental services only require the skills of that service for some procedures, whilst routine examination, oral health assessment and preventative care can be managed quite satisfactorily in the general practice. Unless patients meet the strict criteria for ongoing care within the service, they will be discharged back to the referring dentist at the end of a course of treatment. The Community Dental Service intends to operate a policy of shared care with dental practitioner colleagues and patients may be referred back to the CDS if they have further similar treatment requirements at a later date.

Special care dentistry

Special care dentistry definition:   The speciality of special care dentistry is concerned with the improvement of the oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or more often, a combination of these factors.

Patients suitable for management within routine primary care should be treated safely and effectively and not disadvantaged through inappropriate and unnecessary referral.  Unless patients fulfill strict referral criteria for ongoing care, they will be discharged back into the care  of the referring dentist at the end of the course of treatment.

Referrals will be accepted for people with:

  • Learning Disability
  • Physical Disability
  • Complex Medical Condition
  • Severe Mental Health Condition
  • Socially Excluded
  • Domiciliary Care 

Excluded from this service are:

  • People who do not have either a GL postcode themselves or a GP with a GL postcode
  • Patients who should receive treatment in Primary Care
  • Patients requiring complex restorative care, orthodontics or oral surgery
Adult special care referral criteria

ADULT SPECIAL CARE

Table 1:  Acceptance and exclusion criteria for adult special care dentistry

Special Care GroupAcceptance CriteriaExclusion Criteria
Learning Disability

Limited verbal communication due to cognitive or sensory impairment.

Learning difficulty severely impacts on the patient’s ability to accept dental care.

Capacity to consent is impaired; clinician may be required to make best interest decision.

Requires assistance to carry out and maintain oral hygiene.

 

Mild learning disability where patient requires only reasonable adjustment in terms of time, equipment or facilities to accept care.
Physical Disability

Unable to weight bear or transfer to dental chair.

Requires risk assessment and/or specialist equipment e.g. wheelchair tipper.

Has communication, sensory, or cognitive impairment impacting on capacity to consent.

Requires assistance to carry out and maintain oral hygiene.

 

Wheelchair users who can transfer into dental chair, people who have difficulty with stairs – alternative ground floor accessible NHS practices are available.
Medical Disability

Complex medical history which impacts either directly on oral health or ability to receive care.

Medical conditions which are not stable or well controlled, which requiretreatment with medical specialist advice.

Progressive, degenerative medical or disabling condition e.g. motor neurone disease, dementia.

Has communication, sensory or cognitive impairment.

Blood borne virus:  Hep B, C.

Anticoagulant therapy with a stable INR below 4.0.

For further guidance please consult the Scottish Dental Clinical Effectiveness Programme – Management of Patients taking Anticoagulents and Anti-platelet Drugs August 2015.

Medical conditions which are stable and controlled by medication e.g. epilepsy, hypertension, diabetes, asthma, HIV.

Patients for whom Medical Specialists have advised there are no additional concerns for safety in relation to the provision of dental care in practice.

 

Mental Health

Complex psychiatric condition requiring support from mental health team.

Extreme mood or cooperation problems.

Hascommunication or cognitive impairment impacting on capacity to consent.

Requires assistance to carry out and maintain oral hygiene

 

Mental health condition managed with GP prescribed medication e.g. depression.
Socially Excluded

Homeless/Drug dependent.

Requiring an outreach service to facilitate access.

Able to access care within General Dental Service.

People whose first language is not English and who require a translator – translation services are available for NHS patients to facilitate care within the dental practice setting.

 

Domiciliary Care

People confined to bed 24 hours per day.

Hospital In-Patient.

People with a medical, physical or mental health condition which requires assessment to take place in non-clinical setting.

 

People who are able to attend G.P. and hospital appointments, or social outings.

People who are able to travel with assistance e.g. wheelchair friendly transport.

 

 

Discharge

Patients with a learning disability, physical disability and mental health problems are by definition, vulnerable adult groups.  Following an initial course of treatment, patients may be offered regular ongoing care within the CDS if, due to their special needs, they are not able to access care from a General Dental Practitioner.

 

If, however, management of routine regular care e.g. dental examinations, preventive advice and simple treatments is possible with carer support; these patients may be referred back into the GDS.

A shared care arrangement with a specific GDP may be appropriate for some patients.

 

 

 

 

ADULTS WITH SEVERE DENTAL ANXIETY OR DENTAL PHOBIA

Many adults express feelings of anxiety associated with dental treatment, but most can be managed within general dental practice with extra time allowed and a sympathetic approach.

 

GCS CDS are able to offer a referral service for adult patients for whom provision of routine care has been attempted within general practice but has not been successful.  This would be for one course of treatment only and patients will only be accepted for care providing ALL of the referral criteria have been met.

 

Acceptance Criteria for Phobic Patients

  1. The patient has expressed severe anxiety or phobia about dental treatment.
  2. The patient’s anxiety/phobia has prevented them from accepting dental care within general

dental practice.

  1. The referring dentist has attempted to provide dental treatment on more than one occasion.
  2. The referring dentist can describe procedures that have already been attempted without

success.

  1. The patient is ready to have their anxiety/phobia addressed.
  2. The patient understands that they may be managed by a variety of techniques including

behavioural therapy or inhalation sedation.

  1. The patient is willing to complete a dental anxiety questionnaire prior to being accepted for

dental services – this will be sent by post to the patient’s home address or by email.

  1. The referring dentist will consider accepting the patient for routine ongoing care and preventive advice following care within this service.

 

The Community Dental Service may be able to provide clinical services which include examination, scaling, routine restorations and extractions providing patients meet the required criteria.

Inhalation Sedation may be provided for patients who are assessed as ASA1 or ASA2.

Children special care referral criteria

PAEDIATRIC SPECIAL CARE

Table 2: Acceptance and exclusion criteria for paediatric special care dentistry

Special Care Paediatric GroupsAcceptance CriteriaExclusion Criteria

Medically Compromised

 

 

Complex medical history which impacts either directly on oral health or ability to receive care.

Medical conditions which are not stable or well controlled,which requirestreatment with medical specialist advice.

Progressive, degenerative medical or disabling condition

 

Conditions requiring PEG feeding.

May also have communication, sensory or cognitive impairment.

 

Medical conditions which are stable and controlled by medication e.g. epilepsy, diabetes, asthma.

 

Physical DisabilityPhysical disability preventing access to dental practice or requiring specialist equipment.

Wheelchair users who can transfer into dental chair, people who have difficulty with stairs – alternative ground floor accessible NHS practices are available.

 

Learning Disability

Moderate to severe LD.

Limited verbal communication due to cognitive or sensory impairment.

Unable to cooperate with dental examination in the dental chair.

 

Mild learning disability where patient requires only reasonable adjustment in terms of time, equipment or facilities to accept care.

 

Table 3: Acceptance and Exclusion Criteria for Routine Paediatric Patients

 

Some children have particular difficulty in accepting dental care or are especially vulnerable due to certain social circumstances.  The Community Dental Service can accept routine paediatric patients for care who fulfil the following criteria.

 

Routine Paediatric CareAcceptance CriteriaExclusion Criteria
Vulnerable Children

Child In Need or Child subject to Child Protection Plan.

Child under care of temporary foster parents.

Looked after children.

 

Children in stable social circumstances where there are no issues with parental responsibility.
Behaviour Problems

Associated with diagnosed ADHD or Autism.

Delayed Emotional Development.

 

Children who may be managed with reasonable adjustment in terms of time for appointment.
Dental Anxiety

Very young children requiring extractions under General Anaesthetic.

Children with extreme dental anxiety who have proven inability to cooperate with routine dental treatment.

Children for whom no routine preventive measures or treatment have been attempted.

Routine or emergency dental care for healthy, cooperative children.

Children simply presenting with a high level of treatment need.

Root canal treatment in permanent molars.

Orthodontic extractions under General Anaesthetic.

 

Developmental Dental Conditions e.g. amelogenesis and dentinogenesis imperfecta, Cleft lip or palateOnly accepted where additional Special Care Need exists e.g.  Learning Disability, complex medical condition.Where Specialist advice is required a referral to Specialist Paediatric Dental Service would be appropriate e.g. Dental Hospital.

 

Orthodontic Assessment

We do not provide any orthodontic services and so are unable to accept referrals for orthodontic assessment or treatment.  Children likely to require extraction of permanent teeth e.g. decayed first permanent molars, will ideally require an orthodontic specialist opinion to ensure that the best possible long term result is achieved for the developing dentition.  This is especially important where a general anaesthetic is required.  It is the responsibility of the referring dentist to ensure that this is undertaken prior to referral, so that the need for any additional balancing or compensating extractions is considered.

 

Discharge

Where possible we aim to provide acclimatisation and one course of treatment, after which routine paediatric patients will be referred back to the referring dentist for ongoing care.

 

Children requiring special care dentistry who meet the referral criteria due to the nature of their disability or impairment may be offered ongoing care within the CDS.

 

Children who may be considered a safeguarding risk may also be offered ongoing care until a referral into the GDS becomes achievable and appropriate.

INHALATION SEDATION AND GA SERVICES FOR CHILDREN

Inhalation sedation can be a useful adjunct when providing care for the nervous and anxious child, however, to be successful this still requires a certain level of understanding and cooperation from the patient.  For this reason very young children are not routinely offered sedation and other behaviour management options are explored in the first instance.  The suitability of a patient for inhalation sedation is based on the assessment of the individual patients’ needs and not on the demands of the parents.  It would be appreciated if referring clinicians can explain this to parents to reduce the expectation that an extensive course of restorative care is possible under inhalation sedation in this age group.

The paediatric general anaesthetic service can only provide exodontia for routine, healthy children; there is no facility for restorative work to be completed at the same time.  All restorative work possible should be completed ideally prior to a referral for general anaesthetic.

Assessment and treatment planning for a general anaesthetic appointment will be carried out to ensure that all unrestored, decayed teeth and teeth of poor prognosis are removed, reducing the likelihood of the need for a repeat general anaesthetic in the future.

Please note that general anaesthetic is not available for orthodontic extractions prior to active treatment, unless there is a Special Care requirement.

 

 

 

Please note:

No posterior RCT or Crown/Bridge work will be provided unless medical history precludes extraction as treatment of choice e.g. history of radiotherapy in region of head and/or neck, bisphosphonate therapy, patients whose blood clotting cannot be easily controlled.

The Community Dental Service does NOT provide intra venous (IV) sedation services or general anaesthetic (GA) for the anxious patient with no requirement for special care dentistry.

Emersons Green NHS Treatment Centre is able to offer dental extractions with IV sedation and may be an alternative option for patients willing to travel.

Website:  www.emersonsgreentreatmentcentre.nhs.uk

Referral forms

Community Dental Services are ONLY available to current patients and those who are referred by their dentist, or healthcare worker

 

To access our specialist services please be sure to contact your current dentist, or healthcare professional.

 

 

 

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