GUIDELINES FOR REFERRAL TO THE SPECIALIST

HOSPITAL AND SPECIALIST PRIMARY DENTAL CARE

SERVICES IN EAST DORSET

May 2006

GUIDELINES FOR REFERRAL TO THE SPECIALIST HOSPITAL AND

SPECIALIST PRIMARY DENTAL CARE SERVICES IN EAST DORSET

Page No

SECTION 1 Foreword 1

National Health Service (NHS) Referral Centres

SECTION 2 Poole Hospital NHS Trust/ The Royal Bournemouth Hospital NHS Trust

• Maxillofacial Surgery2/3

SECTION 3 Dorset Healthcare NHS Trust

Primary Care Dental Services including

• Community Dental Service

• Intermediate Dental Service

• Restorative Dentistry

4/5/6

7

8

SECTION 4 The Royal Bournemouth Hospital NHS Trust

• Orthodontics 9/10/11

SECTION 5 Independent Orthodontic Referral Guidelines

• Only Orthodontics

• CHRISTCHURCH ORTHODONTICS

12/13

14

APPENDICES15

Appendix A The Royal Bournemouth Hospital NHS Trust

Orthodontic Referral Form 16

Appendix B Dorset Healthcare NHS Trust

Community Dental Service Referral FormPoole Community Health Clinic 17

Appendix CCommunity Dental Service Referral Form

Page No

Parkstone Health Centre 18

Appendix DCommunity Dental Service Special Needs Referral Form

19

Appendix ECommunity Dental Service Domiciliary Referral Form 20

If you require further copies of this document please contact:

The Primary Care Contracts TeamFamily Health Services AuthorityVictoria HousePrinces RoadFerndownDorset BH22 9JR(01202) 893000

SECTION 1

GUIDELINES FOR REFERRAL TO THE SPECIALIST HOSPITAL AND SPECIALIST PRIMARY DENTAL CARE SERVICES IN EAST DORSET

Foreword

This guide is to be sent to all dentists in East Dorset to assist with the appropriate referral of patients to the comprehensive secondary care specialist services that are available.

The guide details current NHS specialist centres and every effort has been made to ensure that the information given is correct.

Documents such as this become rapidly outdated and it is intended that revisions are published from time to time. Your comments and suggestions for future guidelines would be welcome.

SECTION 2

NATIONAL HEALTH SERVICE (NHS) REFERRAL CENTRES

Maxillofacial Surgery

Poole Hospital NHS TrustLongfleet Road Poole Dorset BH15 2JBTelephone (01202) 442145Fax (01202) 442230

Consultants Mr W J PetersMr A F MarkusMr V IlankovanMr P L Ramchandani

Services also provided at Consultants

Royal Bournemouth Hospital WP, AFM, PRDorset County Hospital VIWimborne Hospital AFMBlandford Hospital AFM

Scope of the speciality

Oral and maxillofacial surgery is the surgical specialty concerned with the diagnosis and treatment of diseases affecting the mouth, jaws, face and neck. Consultant specialists working in this area are variously termed oral surgeons, maxillofacial surgeons or oral and maxillofacial surgeons. The specialty is unique in requiring a dual qualification in medicine and dentistry and is a recognised surgical specialty within Europe, as defined under the medical directives. The scope of the specialty is extensive and includes facial injuries, head and neck cancers, salivary gland diseases, facial disproportion, facial pain, temporomandibular joint (TMJ) disorders, impacted teeth, cysts and tumours of the jaws as well as numerous problems affecting the oral mucosa such as mouth ulcers and infections. BAOMS (www.baoms.org.uk) has produced specialty specific standards, criteria and evidence for the practice of oral and maxillofacial surgery in the UK

Referrals accepted for:

• Temporomandibular joint (TMJ) disorders.

• Salivary gland disorders.

• Maxillofacial/head and neck.

• Lumps and bumps: Dermoids, sebaceous cysts, heamangiomata, vascular lesions, branchial cysts, etc.

• Skin and lips Benign: solar keratosis, kerato-acanthomaMalignant: BCC, SCC.

• Mouth/tongue Benign: mucosal conditions including lichen planus, pemphigus, pemphigoid, etc.

Malignant: SCC, adenocarcinoma.

• Facial deformity, facial pain, Maxillofacial trauma

• Maxillofacial emergencies: Acute neck swellings Refer to A & E

• Dento alveolar Impacted teeth NICE guidelinesWarfarinised patients BAOMS guidelinesApical pathology BAOMS guidelines

These guidelines are intended to help PCT's and primary care practitioners make an informed decision when contemplating referring patients to a consultant oral and maxillofacial surgeon for advice or treatment.

Referrals must be within the abovementioned categories and meet guidelines where they exist. The BAOMS website is a useful guide and it is strongly recommended that you visit it.

Referrals must be accompanied by a letter containing full details of the patient, their complaint, medical history and clinical symptoms, and the reason for requesting an opinion/further management. Failure to provide this information will be met with a request for it be given before an appointment will be sent. Referrals are NOT accepted for:

• We do not provide a routine dental service.

• We do not accept patients for economic reasons.

• We do not make any form of appliance, except diagnostic splints.

• We do not accept referrals for routine extractions unless the patient has a medical condition that means their care cannot be reasonably managed within the dental surgery.

SECTION 3

DORSET HEALTHCARE NHS TRUST

Community Dental Service (CDS)

The CDS aims to provide a comprehensive treatment service for children and adults with disabilities who need special care.

Referrals

Referrals are accepted from:

General Dental PractitionersGeneral Medical PractitionersAny other Health or Social Care Professional

Referrals are not accepted for:

Routine treatment on fit/healthy patients.

Treatment for Adults

Canford Heath ClinicCulliford CrescentCanford HeathBH17 9DW

Consultants Miss Debbie Lewis, Senior Community Dentist

Referrals

We should be grateful if referrals could be made on the forms provided (Appendix D) as this will give us the information we need to care for the patient in an appropriate and timely manner.

Whenever possible, radiographs should accompany the referral.

Treatment will be provided for those patients fitting these referral criteria using a suitable modality of pain relief which may include Local Anaesthesia, Conscious Sedation or General Anaesthesia.

Referrals should be sent to Miss Debbie Lewis, Senior Community Dentist

Referrals are accepted for:

Adults with disabilities that need special care which would include;

• Severe mental health problems• Learning disabilities• Autistic Spectrum Disorders

• Severe medical problems• After head and neck radiotherapy• Significant immunocompromised or immunosuppression• Domiciliary care for housebound patients• Severe bleeding disorders• Severe physical problems• Brain injuries• Life limiting conditions

Referrals are not accepted for:

• Adult patients with dental phobias are not usually accepted for treatment and should be referred to local PDS or GDS practices willing to provide sedation.

• Adults with blood bourne viruses such as Hepatitis B and C and HIV can be treated without any special precautions and will not be accepted for treatment by the CDS

Treatment for Children

Poole Community Health ClinicShaftesbury RoadPooleBH15 2NTTelephone 01202 683363Fax 01202 667009

Consultant Miss Anne Williams, Clinical Director

Parkstone Health CentreMansfield RoadParkstonePooleBH14 0DJTelephone 01202 748133

Consultant Miss Carol John Senior Community dentist

Referrals

We should be grateful if referrals could be made on the forms provided (Appendix B, C) as this will give us the information needed to care for the patients in an appropriate and timely manner.

Relevant radiographs should be included if possible.A range of treatment modalities may be used which could include Local Anaesthesia, Conscious sedation, General Anaesthesia.

Referrals are accepted for:

Children with disabilities that need special care which would include;

• Severe medical problems• Learning Disabilities• Autistic Spectrum Disorders• Bleeding disorders• Severe physical problems• Children with repaired cleft lip/palate• Amelogenesis Imperfecta• Dentinogenesis Imperfecta• Hypodontia• Very young children with extensive decay

Referrals are not accepted for:

• routine treatment for healthy children

• orthodontic extractions under general anaesthesia (unless the child has a disability needing special care)

Intermediate Care Dental Service (ICDS)

Poole Community Health ClinicShaftesbury RoadPooleDorset BH15 2 NTTelephone 01202 683363

Dental Surgeon Mr Chris Haw

Objectives

This service provides surgical dentistry suitable for treatment with local anaesthesia and oral sedation if needed. There is no facility for general anaesthesia.

Referrals

We should be grateful if referrals could be made on the forms provided (appendix B) as this will give us the information we need to care for the patient in an appropriate and timely manner.

Radiographs should be included with all referrals.

Referrals are accepted for:

• Patients requiring the removal of symptomatic third molars that require a surgical approach.

• Apicectomy of root filled teeth.• Surgical removal of grossly decayed teeth.• Extractions for patients with medical problems that need special care that

cannot reasonably be provided in the dental practice setting.

Referrals are not accepted for:

• Routine extractions on healthy patients• TMJ problems• Snoring appliances• Extractions under general aneasthesia

Restorative Dentistry

Canford Heath ClinicCulliford CrescentPooleDorsetBH17 9 DWTelephone 01202 691520

Consultant Mr Graham Gilmour

Objectives

A comprehensive consultation and treatment planning and advice service is available to all appropriately referred patients

Referrals

Please make referrals to Mr A G Gilmour, Consultant in Restorative Dentistry.

Please include in the referral:

• The patient’s full name• Date of Birth• Address with postcode• Home and daytime telephone numbers• Clinical history• Nature of the referral.• Radiographs

The majority of patients are returned to the referring practitioner with advice on their management. Some cases are referred to other specialists or treated within the salaried dental service if they have a disability needing special care.

SECTION 4

Orthodontic Department

The Royal Bournemouth Hospital NHS Trust Castle Lane East Bournemouth Dorset BH7 7DW Telephone (01202) 704694 Fax (01202) 704645

Consultants Mr Jeremy Hodgkins (Whole time)Mrs Mary Short (Monday and Wednesday)Miss Susan Power (Tuesday, Thursday and Friday)

Department Administrator Mrs Lynda Fry

Reception Staff Mrs Dee HallMrs Philippa ManleyMrs Nicky Clarke

Objectives

To provide a comprehensive Consultant Orthodontic Service for the population of East Dorset and surrounding area:-

• By providing a consultation and advice service.• By retaining for treatment in the Orthodontic Department patients with difficult

or complex malocclusions.• By retaining for treatment in the Orthodontic Department patients who for

medical or other reasons have special problems associated with their management.

• By liaising closely with other medical and dental consultants to plan treatment for patients requiring multi disciplinary management.

• By providing continuing postgraduate education for local General Dental practitioners and Community Dental Officers.

Referrals

Written referrals are preferred and should give the following information:-

• Name and address of patient.• Date of birth.• Daytime telephone numbers.• The consultant to whom the patient is referred. • Name and address of general dental practitioner.• Name and address of general medical practitioner.• A brief summary of the reasons for referral.• An indication as to whether the referral is urgent or routine.

Referrals can also be made by telephone (01202) 704694.

Guidelines

The Department is always happy to see patients for advice and to provide support for local practitioners. However, to enable us to provide an efficient service and to make the best possible use of the resources available it would be helpful if the following points could be borne in mind when making referrals:-

Referrals are accepted for:

• Diagnosis and treatment planning. This service is provided for practitioners who have received some orthodontic training in the past and would like to provide treatment for their patients in primary care, where this is appropriate.

• Those patients having a Dental Health Component (DHC) of 4 or 5. The Index of Orthodontic Treatment Need (IOTN) is used routinely to identify those patients who will be offered treatment in the Department (further information can be obtained by contacting the Orthodontic Department).

• Adults, if their problem is severe or requires multi-disciplinary care.

• Patients who are aware of the reasons for referral and are prepared to wear orthodontic appliances, if indicated. Orthodontic treatment will not succeed without patient commitment.

• Patients who have an adequate level of oral health. Active dental caries should have been treated and the patient should demonstrate that they are able to maintain satisfactory oral hygiene.

• Patients requiring “interceptive” orthodontic treatment in the mixed dentition. Most orthodontic treatment is undertaken when the majority of permanent teeth have erupted and consequently very early referrals for most patients are unnecessary. Those children with severe class II and class III malocclusion should be referred at age 10 to enable growth modification treatment to be undertaken, if indicated. All new patients will be seen for initial consultation within 12 weeks.

Referrals are NOT accepted for:

• Mild malocclusions, which will not normally be treated.

• Mild lower incisor crowding. Treatment is not normally provided where mild lower incisor irregularity is the only presenting problem.

• A posterior cross bite with no jaw displacement as this is not normally an indication for treatment.

• Adults requiring “routine” orthodontic treatment.

ORTHODONTIC REFERRAL NOTES:

Orthodontic referrals may be passed back to practices with a treatment plan provided that practice has an orthodontic component in their nGDS or nPDS contracts.

However, it should be noted that these can only be at IOTN 3 (with an aesthetic component of at least 6) or higher for NHS treatment. Anything less than this cannot be treated under the NHS.

SECTION 5

Independent Guidelines for referral to Only Orthodontics in 2006

Basic Guidelines for Referral of Orthodontic Patients:

We are very pleased to see your patients and hope that the following guidelines will be helpful to you. We would welcome any feedback you may wish to make.

Timing of referrals:Normal

Most orthodontic patients will benefit from referral at or just before the completion of their permanent dentition (excepting second and third molars). At the latest, please make every effort to refer a patient before the age of 17 years to ensure that treatment can commence before the age of 18 years or we will not be able to accept them for NHS treatment. Treatment to adults or patients with special requirements will be available privately.

Early Referrals

1. Where there is obvious Hard or Soft Tissue Trauma resulting from the malocclusion, for example: wear to incisal edges in the case of a cross-bite; localised gingival recession resulting from labial displacement of a lower incisor.

2. Where there is significantly Delayed Eruption 3. Where it is known that there are Missing Teeth. This will allow the earliest

possible planning of the complete dentition. 4. Class III malocclusion in the mixed dentition. Baseline records should be

taken for growth monitoring especially if an underlying Skeletal III exists. Also it may be wise to remove a cross-bite if there is an anterior displacement (NB 21|12 should all be erupted before attempting this).

5. Class II/I malocclusion where there is an underlying Skeletal II pattern. (This can quite easily be detected when the patient postures the mandible forwards keeping the teeth lightly in contact. If the profile improves then Functional Appliance treatment may well yield benefits). Most Functional appliances are easiest to wear when upper 4|4 are fully erupted. Such a patient entering his or her pubertal growth spurt should be seen without delay.

6. Class II/ii patients who have a definite Skeletal II pattern. Many of these would benefit from conversion to a Class II/I then treatment with a functional appliance.

7. Where a patient is seeking compromised treatment, e.g. if an acceptable result looks possible by single extraction with or without simple appliance treatment to follow. In this situation you may wish to have this plan checked.

Urgent referrals

1. Where a Dental Impaction exists especially canines.

2. Where there are Permanent Teeth with Poor Prognosis; e.g. first molars, which are being considered for early removal, an orthodontic opinion might be sought if there is a co-existing malocclusion.

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General Considerations

Patients who have inadequate Oral Hygiene or significant sweet intake in their diets render themselves unsuitable for active appliance treatment. If such a patient is referred for advice it should be explained to them that whilst we are happy to advise them, treatment will not be available until these issues are addressed.

Patients who are reluctant for treatment will present a poor prospect for success. Whilst we can advise and encourage a patient who would benefit from treatment, ultimately it is their choice and not ours or their parents’. In many such cases it is far more desirable to wait for the child to come round to the idea of treatment in their own time rather than in any way coerce them.

We operate a filtering system using IOTN. Malocclusions scoring less than IOTN 3 Aesthetic component 6 will not be offered treatment under the NHS.

Because of these considerations we cannot guarantee patients the availability of treatment under the NHS until we have assessed their suitability. It is therefore essential that you inform your patients that their referral is initially for advice only. Thank you.

CHRISTCHURCH ORTHODONTICS

Fiona Boardman and Ian Coane

103 Stour RoadChristchurchDorset BH23 1JN01202 483768

Referral Guidelines

Age at referral

We are very happy to accept referrals of both children and adults, although adults (over 18 years of age) should be aware that treatment would be provided on a private basis.

Patient awareness

We feel it is important that the patient has a good level of oral hygiene and diet control, and that they have an awareness of the reason for the referral.

Information needed at referral

We would be grateful for the following information at referral:

• name, full address, and telephone number of patient• date of birth• brief description of reason for referral• indication whether urgent (eg traumatic bite, impacted teeth, imminent extraction

for caries) or routine

Dentition stage at referral

Early referrals are accepted but the patient should be in the mixed dentition phase. The patient and parent should be aware that treatment is usually carried out when most of the permanent dentition has erupted.

Index of Treatment Need (IOTN)

In accordance with current NHS guidelines we do use the IOTN to identify those patients with malocclusions which would show an identifiable health gain if treated. If patients/parents have particular concerns, but the level of need does not score sufficiently on the IOTN scale, we would be able to offer treatment privately.

APPENDICES

Appendix A

DECISION TO REFER

I have given a clear and thorough explanation of the risks involved in general anaesthesia and have given the patient/guardian information on the alternative methods of pain control available.

I enclose details of the relevant medical and dental histories.

The patient/guardian agrees to this referral.

Signed…………………………………………………. (Referring practitioner)

Date……………………………………………………..

Appendix B

Dorset Healthcare NHS Trust

POOLE COMMUNITY HEALTH CLINIC

DENTAL DEPARTMENTShaftesbury Road, Poole BH15 2NT

Telephone 01202-683363 Fax 01202-667009

REFERRAL FOR DENTAL TREATMENT

PATIENT DETAILSName of Patient

Address

…………………………………………………………………………………………………………….………………

…………………………………………………………………………………….Post Code………………………….Telephone No. Date of Birth

Name of Parent/legal guardian

Referred under capitation/continuing care

Name & Address of Referring Dentist Name & Address of Doctor

REASON FOR REFERRAL(To be accompanied by relevant X-rays which will be returned after treatment)

Disability needing special care

Medical condition needing special caree.g. amelogenesis imperfecta

Dental condition needing special care

Extensive decay in a very young child- specify ageRelevant Medical History

Previous general anaesthetic history

NB ROUTINE TREATMENT FOR HEALTHY PATIENTS WILL NOT BE ACCEPTED

Signed Date

(Referring Dental Surgeon)

Appendix C

Dorset Healthcare NHS Trust

PARKSTONE HEALTH CENTRE Mansfield Road, Parkstone, BH14 0DJ

Telephone : 01202-748133

Referral for Dental Treatment

PATIENT DETAILS

Name of Patient

Address

Telephone No. Date of Birth

Name of Parent/Legal GuardianReferred under capitation/continuing care?

Name & Address of Referring Dentist Name & Address of Doctor

TREATMENT REQUEST(To be accompanied by relevant X-rays which will be returned after treatment)

Reason for ReferralRelevant Medical History

Previous General Anaesthetic History

Signed……………………………………………………………(Referring Dental Surgeon)

Date…………………………………….

Appendix D

Dorset Healthcare NHS TrustSPECIAL NEEDS REFERRAL FORM

Date …………………………………… Patient’s name……………………………………………… D.O.B. ………………… Address……………………………………………………………………………………. ……………………………………………………………Tel No: ………………………. Contact person ………………………………………………………………... Address if different from above……………………………………………… ……….…………………………………………………....Tel No…………………………. Treatment requested (please enclose X-rays) Please state whether LA/GA/Sedation Please state whether Urgent/Non-urgent

Reason for referral ……………………………………………………………………………

Salient medical history ……………………………………………………………………….

………………………………………………………………………………………………….

Name and address of Doctor ………………………………………………………………

…………………………………………………………………………………………………

Physical disability …………………………………………………………………………… Mental disability …………………………………………………………………………….. Is hospital transport required? Yes/No Type: Car/Ambulance/Tail-lift Ambulance

Referred by ……………………………………………………………………………………..

PRACTICE STAMP

IF REFERRAL IS FOR A GENERAL ANAESTHETIC, PLEASE SIGN BELOW.

I HAVE GIVEN A CLEAR AND THOROUGH EXPLANATION OF THE RISKS INVOLVED IN GENERAL ANAESTHESIA AND HAVE GIVEN THE PATIENT/GUARDIAN INFORMATION ON THE ALTERNATIVE METHODS OF TREATMENT AVAILABLE.

I ENCLOSE DETAILS OF THE RELEVANT MEDICAL AND DENTAL HISTORIES.THE PATIENT/GUARDIAN AGREES TO THIS REFERRAL.

Signed ………………………………………………………………………… (Referring Practitioner)

RETURN TO: CANFORD HEATH DENTAL CLINIC, NEIGHBOURHOOD CENTRE, CULLIFORD CRESCENT, CANFORD HEATH, POOLE BH17 9DW

Appendix E Dorset Healthcare Trust

DOMICILIARY REFERRAL FORM

Date …………………………………… Referred by ………………………………………………………………………

………………………………………………… Tel No:………………………... Patient’s name………………………………………………………………….. D.O.B. ………………………………. Address…………………………………………………………………………… …………………………………………………………………………………… Post code………………………………….…….Tel No: ……………………… Contact person ………………………………………………………………... Address if different from above……………………………………………… ……………………………………………….. Tel No…………………………. Treatment requested Please state whether Urgent/Non-urgent

Does the person go out at all? Yes/ No

If Yes, can they travel to a dental surgery if transport is arranged? Yes/ No

Salient medical history …………………………………………………………… ……………………………………………………………………………………….

Medication ……………………………………………………………………….

……………………………………………………………………………………...

Physical disability ………………………………………………………………… Mental disability ………………………………………………………………….. Sensory disability …………………………………………………………………

Speaking language ……………………………………………………………….. Any other relevant information …………………………………………………..

RETURN TO: CANFORD HEATH DENTAL CLINIC, NEIGHBOURHOOD CENTRE,CULLIFORD CRESCENT, CANFORD HEATH, POOLE BH17 9DW