Secondary Care Paediatric Dentistry Service

• Children with complex dento-alveolar trauma (e.g. crown-root fractures) in the permanent dentition, likely to require complex endodontic procedures or multi-disciplinary management
• Complications arising from dental trauma such as management of non-vital teeth with open apices, root resorption and intrinsic tooth discolouration of aesthetic concern to an extent as to have a detrimental effect on the child or young person’s quality of life

• Progressive cases where specialist management is required and where aetiology (e.g. intrinsic and extrinsic sources of acid) have been investigated and/or identified
• Please refer with as much information as possible and also provide photographs

• Significant dental hard-tissue developmental defects e.g. amelogenesis imperfecta, dentinogenesis imperfecta
• Patients with a complex presentations of tooth morphology (including macrodontia, double teeth, dens-in-dente, talon cusps)
• Patients with anomalies in tooth eruption (including failure of eruption, impacted and infraoccluding teeth) where orthodontic assessment has been undertaken. Please note: a copy of the orthodontic assessment letter must be attached to the referral and should clearly indicate the need for Paediatric Dentistry Consultant input.
• Molar Incisor Hypomineralisation (MIH): Please see ‘Undergraduate Teaching’ section
• Treatment of MIH will be undertaken on supervised undergraduate dental student clinics

• Soft tissue lesions including granulomas, mucocele(s) - please provide photographs
• Oral ulceration where haematinic deficiency has been excluded/managed following investigation by General Medical Practitioner
• Dry mouth of unknown cause
• Saliva gland enlargement

• Non-plaque induced gingival conditions
• Drug induced gingival overgrowth
• Periodontal disease which can be demonstrated as progressive despite appropriate cause-related therapy and where modifiable risk factors have been controlled in line with national guidance

• In-/out-patient assessment and management of children with a medical co-morbidity, who require liaison with other hospital-based teams to meet their dental health needs, including children under the care of Cardiology, Haematology and Oncology
• Provision of urgent dental treatment prior to significant medical interventions e.g. cardiac surgery, stem cell transplantation, chemotherapy
• Dental assessment and management of children diagnosed with cancer including treatment of mucositis
• Assessment and treatment of complex dental or craniofacial conditions requiring a multidisciplinary treatment planning and care provision such as cleft lip and/or palate
• Children ASA III or above requiring comprehensive dental treatment under general anaesthesia, including where the child is undergoing joint procedures with another surgical specialty

• Assessment and provision of dental care for neonates
• Tongue tie release where the fraenum is a clear barrier to the establishment of feeding
• Urgent referrals must be within the first 4 weeks and detail issues with feeding

General Points:

• Prior to referral to the undergraduate dental student clinic please explain the nature of referral to the child/young person/individual with parental rights and responsibilities and ensure they consent to assessment +/- treatment upon an undergraduate dental student clinic
• Any dental treatment deemed unsuitable for completion upon the undergraduate dental student clinic will be returned to referring General Dental Practitioner for management
• Acceptance for assessment +/- treatment upon the undergraduate dental student clinic is based upon the need for undergraduate dental student clinic patients and relates to a single course of dental treatment. Emergency management of the patient remains the responsibility of the referring General Dental Practitioner.
• Referral to the Paediatric Student Clinic can be facilitated via SCI Gateway Student Referral section, selecting the Paediatric Dentistry option

Cooperative children requiring primary care dental treatment

Molar Incisor Hypomineralisation (MIH)*:

• Children under the age of 8 years: permanent molar teeth with significant symptoms of pain and sensitivity and multi-surface post-eruptive breakdown where local measures including glass ionomer coverage and desensitising advice have been provided but are ineffective
• Children over the age of 8 years with evidence of significant symptoms of pain and sensitivity and multi-surface post-eruptive breakdown affecting one or more first permanent molar teeth
• All children where the aesthetics of affected permanent incisor teeth are having a detrimental effect on the child or young person’s quality of life

* All MIH referrals must be accompanied by clinical photographs

• Non-complex dental trauma in the permanent dentition e.g. crown fractures, endodontic treatment of teeth with mature apices
• Trauma to the primary dentition

• Treatment of non-neonate children with tongue-tie even if perceived to be interfering with feeding or speech
• Management of abnormal frenal attachments

• Please refer the below to Oral Medicine (RHC) via SCI Gateway:
  • Mucosal conditions that may require systemic management e.g. severe RAS, blistering conditions (PV, MMP)
  • Suspected orofacial granulomatosis with systemic or gut symptoms
  • Ulceration recurrent or persistent
  • Chronic benign salivary gland disease
  • Orofacial pain e.g. neuralgia, where dental causes have been excluded

• Patients requiring extractions solely for orthodontic reasons will not be accepted for treatment by any modality

• Unerupted supernumery teeth delaying eruption of permanent teeth, please refer for orthodontic assessment and/or planning in first instance.
• Patients with Molar Incisor Hypomineralisation (MIH)

Note: Patients with MIH may be accepted upon the undergraduate dental student clinic. Please see ‘Undergraduate Teaching’ section for further details

• Prevention should be carried out in Primary Care as per SDCEP guidelines
• Caries management should be carried out within Primary Care including endodontic treatment of permanent teeth with closed apices.

Note: May be accepted upon the undergraduate dental student clinic. Please see ‘Undergraduate Teaching’ section for further details

• Children and young people with non-complex medical issues (ASA I/II) should be managed in primary care
• If treatment under general anaesthetic is indicated:
  1. Primary teeth will not be restored
  2. Endodontic treatment will not be undertaken

• Children who will be older than 2 years and 11 months of age on appointment and ASA I/II requiring treatment under general anaesthesia for exodontia and who live out with NHS Greater Glasgow & Clyde should be managed within their home Health Board
• Children who will be over the age of 15 years and 11 months on appointment

• Urgent extraction of carious teeth under General Anaesthesia - multiple episodes pain/infection and multiple courses of antibiotics or where pain cannot be controlled with analgesia (ASA I & II)
• Dental treatment under inhalation sedation due to anxiety.
• Behavioural issues - where the management is beyond the scope of the GDP - patient acclimatisation should have been attempted by the referring GDP
• Intellectual Disabilities - where the management is beyond the scope of the GDP and the level of care required requires referral
• Dental anxiety - where the management is beyond the scope of the GDP - acclimatisation must have been attempted by GDP in first instance
• Routine extraction of carious teeth under General anaesthesia - A child in pain/recurrent episodes of pain and/or sepsis and all treatment options have been considered and attempted and where pain can be controlled with analgesia