Dundee Dental Hospital Specialist Services: Oral Medicine - Who to Refer

✔ The following cases are likely to be accepted for assessment within Oral Medicine
✔ TMD	Which has not responded to conservative measures e.g. rest, analgesia, splint provision. Please see information related to Temporomandibular disorder (TMD) - Management of Temporomandibular Disorders Bulletin for GDPs
✔ Orofacial Pain	For example: Trigeminal neuralgia, idiopathic facial pain, burning mouth syndrome Essential that any possible dental causes are excluded in Primary Care prior to referral
✔ Oral mucosal conditions	Oral lichen planus Vesiculobullous disorders, recurrent oral ulceration White patches, red patches, multiple pigmented lesions
✔ Oral manifestations of systemic disease	Rheumatological conditions e.g. systemic lupus erythematosus Gastro-intestinal tract disease e.g. Crohn’s disease Immunosuppressed/Immunocompromised states
✔ Xerostomia	Challacombe scale score >3, if reasons for dryness not clear Check to see if dry mouth linked to medication (page 62) Adverse Drug Reactions
✔ Viral and fungal infections presenting in the oral cavity	Which have not responded to treatment in Primary Care, including management of local risk factors e.g., leaving out dentures at night and improved denture hygiene; rinsing and gargling after using steroid inhaler, smoking cessation.
✔ Numbness of the orofacial region	Which is not directly related to dental disease.

✘ Referrals not accepted to Oral Medicine
✘ Suspected oral malignancy	Suspicion of Oral Malignancy should be referred as per urgent referral guidelines to the local Oral and Maxillofacial Department.
✘ Local anaesthetic allergy	Oral medicine is not the appropriate speciality to refer patients with suspected local anaesthetic allergy to. For guidance see: SPS Managing reactions to dental local anaesthetic injections

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