Paediatric dentistry

Who can refer:

Referrals to the Paediatric Dental Service are accepted from primary and secondary health, education and social care professionals.

Who to refer:

We accept routine referrals to the PUBLIC DENTAL SERVICE for patients with:

• Severe or unstable extensive caries in pre-cooperative or pre-school children.
• Additional support needs which make dental care more difficult to provide.
• Extreme dental anxiety and have proven unable to cope with routine dental care treatment in a primary care setting. 
• Unmet dental needs whilst living in foster or residential care and not registered with a General Dental Practitioner.

Who not to refer:

The Paediatric Dental Service will not accept referrals for the following:

• Children or young people with lesions in their mouth considered ‘urgent suspicion of cancer’. Referral should be made directly to the Oral & Maxillofacial Surgery service at St John’s Hospital using the specific SCI Gateway.
• Trauma or an acute dental condition that cannot be managed in a primary care setting. Emergency and / or urgent dental care
• Routine dental care for healthy, co-operative children (These children should be signposted for registration with a general dental practitioner.
• Orthodontic extractions under general anaesthesia.

How to refer:

• Referrals to Public Dental Service are accepted from primary and secondary health and social care professionals.
• GDPs (with NHS Borders) providing NHS dentistry must refer to Public Dental Service via SCI Gateway. Any other route of referral will be rejected.
• If you are a primary / secondary care health or social care professional without access to SCI Gateway, please email pdsreferrals@borders.scot.nhs.uk. or refer to:

Public Dental Service Department,

Borders General Hospital,

Melrose,

TD6 9BS

• If a referral is urgent in addition to the above, please contact the Oral/Dental/Orthodontic Secretary on 01896 826201

Please note that the secure transmission of emails containing patient information is the referrer’s responsibility

Referrals should be completed as fully as possible, forms with incomplete information will be rejected.  The responsibility for making an appropriate referral rest with the referring health / education / social care professional.  For the Paediatric Dental Service to effectively triage and prioritise the referral, the following information is considered essential:

• A current telephone number (home / mobile / both) so the patient can be contacted at short notice.
• The medical history to include details of all current prescribed medication and known allergies.
• Relevant social history. Where applicable, this must include clarification of parental authority, details of social work / health visitor involvement and / or the need for an interpreter.

Required information to be included in referrals:

• Reason for referral – why the procedure cannot be managed in the routine practice setting
• Details of any oro-dental pathology
• History of presenting complaint including any pain, swelling
• Full medical history including medication, allergies (a scanned up to date form is entirely acceptable)
• Previous dental history (previous successfully completed treatment, which modality – LA / IHS / IVS / GA) 
• What treatment has been attempted in GDS (and what modalities used) including details of emergency care provided if patient in pain/other symptoms
• Summary of oral hygiene level, BPE score, any proactive preventative measures undertaken
• Stability of dentition
• What is the GDP asking for, both dental and anxiety management?

Discharge criteria:

Patients will be discharged from the care of the Paediatric Dental Service for the following reasons:

• Their care can be reasonably delivered in a General Dental Service (GDS) setting.
• They have completed a course of treatment.
• They are not brought to their appointments or repeatedly cancel at short notice. In such circumstances, the referrer will be informed so that welfare concerns can be followed up appropriately.

Preventative advice and basic acclimatisation should be undertaken by GDP

The third edition of the SDCEP Prevention and Management of Dental Caries in Children guidance aims to assist and support primary care practitioners and their teams in improving and maintaining the oral health of their young patients from birth up to the age of 18 years. The guidance provides clear and practical recommendations and advice on the provision of dental care to prevent and, if necessary, manage dental decay in children.

Caries in children | Scottish Dental Clinical Effectiveness

Please note that it remains the responsibility of the child / young person’s registered dentist to provide or secure any necessary treatment or advice including emergency / urgent care.

For children / young people not registered with a dentist and requiring emergency dental treatment, they should contact/ be signposted to the Dental Enquiry Line 0300 7900 710 or dental.enquiry@borders.scot.nhs.uk  (Open Monday to Friday, 8.30am – 5:30pm). 

Out-of-Hours : If you require advice on dental pain, please contact NHS 24 on 111.

As part of the Oral Health Service (OHS), NHS Lothian Specialist Paediatric Dental Service provides advice, assessment and treatment for children and young people under 16 years of age who present with an acute dental condition that cannot be managed in a primary care setting. Please see the below link.

Dentistry Emergency – RefHelp (nhslothian.scot)

• Indications for the use of General Anaesthesia in children:
  
   There are essentially only two indications for GA:
• The child needs to be fully anaesthetised before dental treatment procedures
  can be attempted
• The surgeon needs the child fully anaesthetised before dental treatment can
  be performed. 
  Circumstances and conditions suitable for Paediatric GA:
   
  Please note 1-3 are suitable following unsuccessful attempts with behavioural
  management techniques and local anaesthetic.
   
  1. Severe pulpitis requiring immediate relief
  2. Acute soft tissue swelling requiring removal of the infected tooth/teeth
  3. Surgical drainage of an acute infected swelling
  4. Single or multiple extractions in a young child unsuitable for conscious
  sedation
  5. Symptomatic teeth in more than one quadrant.
  6. Moderately traumatic or complex extractions e.g. ankylosed or infra-occluded
  primary molars, extraction of broken-down permanent molars
  7. Established allergy to local anaesthesia
  8. Post operative haemorrhage requiring packing and suturing
  9. Examination under GA, including radiographs, for a special needs child where
  clinical evidence exists that there is a dental problem which warrants
  treatment under GA.
   
   N.B. Severe pulpitis and acute infection are by far the most common conditions
  treated under GA.
   
   Circumstances and conditions which rarely justify Paediatric GA:
   
  • Carious, asymptomatic deciduous teeth with no clinical or radiographic signs of sepsis
  • Orthodontic extraction of sound permanent premolar teeth in a healthy child
  • Patient/carer preference, except where other techniques have already been
  tried.
   
   Extenuating circumstances that override the above limitations are:
   
  • Physical, emotional, learning impairment or a combination of two or more of
  these
  • Children who have attempted treatment using LA alone or LA combined with
  conscious sedation and been unable to co-operate
  • Medical problems which are better controlled with the use of GA.

Caries in children | Scottish Dental Clinical Effectiveness (sdcep.org.uk)

UK National Clinical Guidelines in Paediatric Dentistry, Guideline for the Use of General Anaesthesia (GA) in Paediatric Dentistry. Caroline Davies, Mike Harrison, Graham Roberts. The Royal College of Surgeons of England 2008

PDS Special Care Department, BGH, Melrose, TD6 9BS Tel no: 01896 826201

All Public Dental Service Clinics central contact number: 0300 7900 710

Dental Enquiry Line Tel no: 0300 7900 710 E-mail: dental.enquiry@borders.scot.nhs.uk

Special care inbox: Dental.SpecialCare@borders.scot.nhs.uk