Borders Ref Help Toolkit
Who to Refer
We accept referrals for the following conditions:
- Third molar surgery where surgical intervention is indicated according to national guidelines
- Please see FDS Guidance for information regarding appropriate referral criteria here
- Removal of buried or fractured retained roots not amenable to luxation or forceps removal
- Removal of teeth at higher risk of surgical complication requiring specialist management, eg features strongly suggesting close proximity to maxillary antrum or inferior dental canal
- Management and surgical removal of ectopic teeth including supernumerary teeth
- Orthodontic related surgeries including surgical exposure of impacted teeth with or without attachment of orthodontic bracket
- Surgical management of periradicular pathology, where orthograde treatment of infection is not possible with an acceptable coronal restoration and seal, or where cystic change is suspected
- Dentoalveolar surgery for patients with complex medical history, including those requiring a multidisciplinary approach and for assessment and management of established MRONJ
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- This does not include patients at low-moderate risk of MRONJ or those who are on stable anticoagulant or anti-platelet therapies. Please see SDCEP for appropriate management of these patients in primary care - Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw (SDCEP) or Management of Dental Patients taking Anticoagulants or Antiplatelet Drugs (SDCEP)
- Patients who have had at least six infusion/injections of anti-resorptive medication for management of oncological disease, or those with previous MRONJ, may be eligible for procedures to reduce the risk of MRONJ following dental extraction. Full details of medical history and drug history (drug, doses, frequency, duration) must be included in the referral to be considered.
- Management of intra-oral benign soft and hard-tissue lesions, including cystic lesions
- Management of oro-mucosal disease, including manifestations of systemic disease
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- This includes red and white patches, pigmented patches, oral ulceration and blistering conditions, and mucosal infections of the oral cavity
- Useful guidance for referral of soft tissue lesions for oral medicine management can be found here
- Non-surgical management of orofacial pain and temporomandibular disorder (TMD) which have not responded to management in primary care where odontogenic causes have been excluded
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- further information on management of TMD in primary care can be found here
- Management of benign disease of the minor and major salivary glands, including xerostomia
Who not to refer
We will not accept referrals in the following circumstances:
- Where there is suspicion of cancer/malignancy. These should be directed via the Urgent – Suspicion of Cancer (USOC) pathway via SCI Gateway directly to the OMFS team at NHS Lothian > St John’s Hospital > Oral and Maxillofacial Surgery. Patients residing in Northumbria should be referred to pathway detailed here
- Where the referral contains insufficient clinical history or findings, or appropriate radiographic or photographic imaging has not been attached to the SCI Gateway referral. Email imaging is only accepted from referrers outside Scotland who do not have access to SCI Gateway.
- Routine dental extractions which fall within the remit of primary care. This includes teeth amenable to elevation/luxation and/or forceps removal including fully erupted third molars. For patients at low risk of MRONJ or on stable anticoagulant or antiplatelet therapy please see guidance provided by SDCEP for appropriate management of these in primary care.
- Paediatric patients requiring routine dental extractions under local anaesthetic, sedation or general anaesthesia. These should be directed to NHS Borders Public Dental Service.
- Patients requiring restorative dentistry or dental implants.
- Patients requiring comprehensive orthodontic assessment, including orthognathic surgery.
- Patients with painless clicking from TMJs without loss of function or red flags.
- Patients with muscular temporomandibular disorder who have not been managed as per Royal College of Surgeons guidance.
- Patients with primary skin, nose or throat concerns should be directed to their GP for assessment and management.
- The service will not accept referral requesting help in interpreting radiographs. An opinion on an incidental finding on a radiograph should be sought from an oral and maxillofacial radiologist.
Emergency referrals
The following emergency referrals can be accepted when services are available, only following telephone discussion with a NHS Borders Oral Surgery clinical team member . If you cannot speak to a member of staff, onwards emergency referral to Oral and Maxillofacial Surgery team at St John’s Hospital (OMFS) should be considered:
- Management of infections of the orofacial region including localised dental infections
- Management of post-operative bleeding
- Unstable post-extraction oro-antral communication or fractured tuberosity
- Acute temporomandibular joint dislocation
Management of severe acute infection (systemically unwell with pyrexia or malaise, facial or intra-oral swelling with trismus, stridor, voice changes, or difficulty breathing or swallowing) should be directed for emergency management to the Oral and Maxillofacial Surgery team at St John’s Hospital via the on-call team member on 01506 523000. Patients may be directed to their local Emergency Department for assessment prior to transfer. Where direct contact with the team at BGH is not possible, all other emergency referrals should be directed by telephone to SJH.
Please note, it remains the responsibility of the referrer to provide or secure any treatment or advice until the patient is assessed by the service, including urgent and emergency care.
How to refer:
Referrals from dentists and GPs must be made using SCI Gateway. Dental practices outside Scotland who do not have SciGateway access can contact the service for details of how to refer.
Referrals must include sufficient clinical and medical detail to clearly justify referral and urgency, including any additional support needs.
Dentoalveolar referrals
Diagnostic dental radiographs must be attached for dentoalveolar surgery referrals. Attachments of up to 2MB can be attached via SCI Gateway, to a maximum of 5MB. Dental panoramic radiography is the baseline special test for third molar surgery. If you do not have facilities for these, they can be requested from the Radiology Department at the Borders General Hospital free of charge. Referrers need to be registered by the team at BGH. Please contact the Oral Surgery Department for details on how to register as a Referrer.
Soft tissue referrals
High resolution clinical photographs of soft tissue lesions are essential to support safe and appropriate triage and must be included in the SCI Gateway referral. Failure to attach appropriate imaging via SCI Gateway may results in delays to the treatment of your patient. Please contact the department for details for transfer of non-digital images. Images submitted via email will not be accepted.
Referral Priority
All referrals will be triaged by a Consultant Oral Surgeon who will decide the appropriate urgency of each referral. If a referral urgency is downgraded you will be informed in writing.
Routine – Most referrals are routine and will wait in turn to be seen by our team. Current waiting times can be found here.
Urgent – A request for urgent assessment must be justified in the referral. Management of acute dental conditions would only justify urgent care if all primary care management has been exhausted and full details of management to date is required.
Urgent Suspicion of Cancer – We do not provide a service for patients with suspected cancer. Please directe these referrals via SCI Gateway directly to the OMFS team at NHS Lothian > St John’s Hospital > Oral and Maxillofacial Surgery.
Emergency – Emergency referrals are only accepted via telephone call.