Special Care Dentistry Referral Guidance

Special Care Dentistry is concerned with: “The improvement of 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 a number of these factors.” (Joint Advisory Committee for Special Care Dentistry, 2003).

The special care dental service provides oral healthcare for those patients who, for a variety of reasons require specialist management either exclusively, in conjunction with their general dental practitioner or on an occasional basis.

Some patients may have a diagnosis that does not impact directly on their dental health or care unless their condition progresses. As long as they continue to be well, they may continue to be managed in general dental practice. Where no special precautions are required to manage a patient, they should be managed in a general dental practice.

For some patients it is appropriate that their care is exclusively provided by a special care dental service. For others it may be possible to share care with their general dental practitioner. We also provide advice to general dental practitioners, general medical practitioners and hospital doctors and nursing staff.

Patients may require Special Care Dentistry to provide:

• advice
• a one-off treatment or course of treatment
• some of their care on an ongoing basis, sharing care with their GDP
• all of their dental care

Access

Patients requiring routine treatment whose weight exceeds the maximum weight of the practice’s dental chairs. Please provide an up to date patient weight, height and BMI.

Physical disability

• Disability creates barrier to care e.g. Movement disorder
• Significant physical deformity
• Patients who require mechanical aids not available in general dental practice (e.g. Hoist)

Learning disability

• Significant communication difficulties
• Co-operation compromised
• Sedation or general anaesthesia required for examination or any intervention

Mental health problems

• Long term in-patient
• Current admission requiring urgent/emergency care
• Significant mental health problems impacting on daily living which preclude attendance at a general dental practice

Significant medical compromise

• Current hospital in-patient requiring urgent/emergency care such as management of continuous pain which is not relieved with analgesia, facial swelling or infection
• Treatment required in a hospital setting
• Medical intervention that can only be provided in a hospital required before dental treatment
• Dental assessment required prior to medical intervention as per prior arrangements with the Special Care department

Long stay Hospital Patients

Those admitted to Hospital care units

• All urgent/emergency care
• Routine care if admitted for >2 months
• Routine care if this forms part of their rehabilitation

Anxiety/ behavioural management

• Patients with moderate/severe systemic disease who cannot tolerate treatment with local anaesthetic and are not suitable for sedation in general dental practice settings ( the majority of patients who are ASA I and II will be suitable for sedation in a general practice setting)
• Advanced sedation technique required beyond which is available in general dental practice

Patients with mild/moderate systemic disease who are suitable for treatment within general dental practice setting

Patients with mild or moderate special care needs whose care can reasonably be delivered in a GDS setting. This includes patients requiring domiciliary care.

Patients who cannot access their registered practice due to stairs – these patients should be sign posted to a ground floor practice or one with a lift.

Patients taking anti-coagulants or anti-platelet drugs whose INR is maintained below 4 who have no other relevant medical complications. See guidance: http://www.sdcep.org.uk/published-guidance/anticoagulants-and-antiplatelets/

Patients that may require antibiotic prophylaxis prior to dental treatment. See guidance: https://www.sdcep.org.uk/published-guidance/antibiotic-prophylaxis/

Patients who require dental assessment prior to starting anti-resorptive medications or those requiring assessment prior to cardiac surgery.

Patients taking anti-resorptive drugs who have no other relevant medical complications. See guidance: http://www.sdcep.org.uk/published-guidance/medication-related-osteonecrosis-of-the-jaw/ 

Routine dental care as per the SDR – Determination 1

Shared care arrangements where specialist intervention is required for particular procedures. Patients referred for treatment under sedation will be offered one course of treatment. We are unable to provide molar endodontics (exceptional circumstances considered), regular hygiene phase therapy or advanced restorative care under sedation.

GDP and GMP referrals: SCI Gateway

Other outpatients: NHSGG&C outpatient referral form

Inpatients: SCI gateway or NHSGG&C inpatient referral form

Patients whose care can be reasonably managed in a general dental practice will be discharged.