Please note that cases which appear routine in nature may be booked onto a student clinic.
Referrals accepted / not accepted to oral surgery
✔ The following referrals are accepted in Oral Surgery
✔ Tooth removal
Dental extractions
Extraction of impacted third molars
Extraction of unerupted teeth which are symptomatic or causing resorption of nearby teeth
✔ Tooth exposure
Exposure of unerupted teeth for orthodontic purposes.
NB: Orthodontic treatment plan/planned extractions must be clear
✔ Complications of tooth removal
Repair of oro-antral communication/fistula
Retrieval of roots displaced into maxillary antrum
Fractured tuberosity
Post-operative bleeding
✔ Bony conditions
Radiolucent lesions of the jaw
Suspected medication related osteonecrosis of the jaw
Pre-prosthetic surgery (e.g. removal of mandibular tori)
✔ Soft tissue lesions of the oral mucosa
For best practice attach a photograpgh to your refferal
Fibroepithelial polyps
Squamous cell papillomas
Salivary gland mucoceles
White patches & pigmented lesions
Small vascular lesions such as haemangiomas
Other soft tissue lesions of concern
✔ Other
Peri-radicular surgery
Obstructive salivary gland disease
✔ Treatment of anxious patients under IV sedation
Extractions/surgical treatment under IV sedation
✘ Referrals not accepted to Oral Surgery
✘ Antiplatelet drugs
Patients on antiplatelet drugs such as aspirin and/or clopidogrel are not a special risk of the excessive bleeding and therefore, can be treated in practice without cessation of their therapy. Suturing and use of haemostatic agents may be necessary. Anticoagulants guidance
✘ Anticoagulant drugs:
Patients on Warfarin can be treated by a GDP if their INR is <4.
Patients on NOACs (new oral anticoagulants) such as Dabigatran (direct thrombin inhibitor) or Rivaroxaban or Apixaban (Factor Xa inhibitors) where INR testing is not effective, should be managed as having an INR between 2.0 and 3.0. These patients can be treated in primary care. Anticoagulants guidance
✘ Anti-resorptive medications
E.g. Bisphosphonates
Teeth can be extracted safely in practice and patients should be reviewed after 8 weeks to ensure socket healing.
In cases where there is difficulty reaching a treatment plan, patients will be accepted for assessment +/- treatment in the department of oral surgery. Broken link MRONJ guidance
✘ Suspected oral malignancy
Suspicion of Oral Malignancy should follow be referred as per urgent referral guidelines to the local Oral and Maxillofacial Department.
Telephone / urgent referrals for oral surgery
Persistent post-operative bleeding:
Refer urgently/as an emergency following a telephone conversation:
08.30 to 16.30: Contact the Oral Surgery Team on: 01382 635971
Out of Hours: Contact the Oral and Maxillofacial Team at Ninewells: Pager Number: #3104
Large fascial space infections:
Refer to the Department of Oral and Maxillofacial Surgery at Ninewells: Pager Number: #3104
Dental extraction information
✔We accept the following referrals:
The patient will most likely receive a virtual appointment first; ALL the relevant information is required to make this a successful appointment. Please add all relevant radiographs/photographs to your original referral.
✔ Failed extraction
Where a previous unsuccessful attempt at extraction has been made by referrer
Referral will be rejected if a post XLA attempt radiograph has not been sent with a referral
✔ Complex extraction
Please provide any radiographs you have of the tooth in question
Increased difficulty due to abnormal root morphology
Increased risk of damage to adjacent anatomical structure, for example the inferior alveolar nerve / maxillary antrum
Teeth associated with significant periapical radiolucencies needing histological analysis
Retained roots which require surgical approach/flap/bone removal
Extractions in patients with a history of radiotherapy to the head and neck region
Third molar information
✔We accept the following for assessment / treatment
Acceptable radiographs - Periapical showing complete root length and IDN location or an OPT only.
✔ Dental disease
Dental Disease
Severe or recurrent pericoronitis
Unrestorable caries in the third molar
Wisdom tooth contributing to periodontal disease
Difficulty restoring caries in second molar due to position of third molar
Periapical pathology in relation to the third molar
✔ Other
Internal or external resorption of third molar or adjacent tooth
Presence of cyst in relation to third molar
Prior to orthodontic treatment or orthognathic surgery
✘We do not accept third molars for assessment / extraction in the following situations:
✘ Unerupted third molars
Which are asymptomatic & or cannot be probed distal to the second molar
✘ Other
Anterior crowding alone
Temporo-mandibular joint dysfunction
Peri-radicular surgery information
✔Peri-radicular surgery guidance
✔ Radiographs
Provide any radiographs you have of the tooth in question.
✔ Teeth with no evidence of a root canal treatment in situ
Root canal treat in Primary Dental Care first
Refer for an Endodontic assessment and advice within the Restorative department if needed.
✔ Teeth with root canal treatment in situ
Attempt root canal re-treatment in Primary Dental Care first or if complications present refer for an Endodontic assessment and advice within the Restorative department
✔Peri-radicular surgery will be considered for teeth in the following situations:
✔ Teeth with root canal treatment in situ with:
Pre-existing root canal filling within 3mm of the radiographic apex
Adequate coronal seal
✔ Extra-radicular reasons for failure
Biopsy of the peri-radicular tissues is required, e.g. cyst
Foreign body reaction e.g. mass extrusion of sealer, gutta percha (treatment also offered within the Restorative department)
NHS Tayside RefGuide
