Dundee Dental Hospital specialist services: restorative dentistry - who to refer

Patients must belong to one of the categories detailed below and satisfy the other criteria laid out in this section.

Please note long-term monitoring and maintenance of implant(s) and implant restoration(s) placed at the Dental Hospital is not provided by the Dental Hospital and is delivered within primary care which may incur a cost for the patient. Please ensure patients are aware of possible future costs prior to referral.

For many Endodontic referrals, a shared-care approach is adopted whereby specific stages of treatment are carried out within the hospital and the patient returned to the referring practitioner for completion of treatment.

For all cases, the tooth in question must be:

• Caries free, functional and the tooth considered predictably restorable.
• Within the aesthetic zone or a strategic molar.

It is essential that:

• An up-to-date periapical radiograph of diagnostic value accompanies the referral
• Primary dental disease has been stabilised.

Trauma to permanent teeth

Many traumatic injuries to the permanent dentition can be managed within primary care.

Treatment outcomes are often more favourable if appropriate trauma management is carried out without delay. Therefore, referring clinicians are encouraged to provide immediate trauma management and follow-up, in keeping with guidelines.

Please refer for further advice if needed.

An advice and treatment planning service is offered. This means that unless there is an educational need, only patients requiring fixed prosthesis/prostheses from priority patient groups will be accepted for treatment. For all other cases, it is expected the patient will return to their practitioner for treatment.

We do not routinely remake dentures. Requests for denture construction for patients out with the priority groups will be returned to the referring practitioner with a treatment plan.

Prior to referring, please ensure patients are aware the referral is for advice and treatment planning only. Unfortunately during the current pandemic, referrals for possible routine treatment on a student clinic cannot be accepted and will be returned to the referrer.

Periodontal cases referred will be considered for specialist treatment if the referral criteria are fulfilled. Even if treatment in secondary care is anticipated, initial therapy should normally be carried out in the primary care setting, including:

• Appropriate advice given regarding the control of modifiable risk factors, particularly smoking and oral hygiene levels
• Full mouth supragingival scaling and root surface debridement of pockets, usually under local anaesthetic
• Periodontal charting recorded prior to and 2-3 months after completion of the above, which should be dated within 9 months of referral.

It should be acknowledged that there can be a delay between referral to secondary care and assessment of the patient. It is advised that appropriate periodontal therapy is continued while waiting for the referral to be dealt with.

Patients accepted for treatment of periodontal diseases should continue to receive routine dental check-ups and emergency/ acute dental management with their registered dental practitioner. Management of routine restorations should be attended to by the registered dentist unless contacted by Dundee Dental Hospital to confirm this treatment will be provided within DDH as well.

Courses of periodontal therapy in primary care, including scaling and RSD, should be refrained from while the patient is under the care of the Dundee Dental Hospital for their periodontal condition.

Patients will be discharged:

• On completion of a course of treatment. Thereafter, the patient’s registered practitioner will be responsible for life-long supportive periodontal therapy. This is essential to maintain periodontal stability.
• If insufficient oral hygiene levels for periodontal stability are achieved. Patients who, despite best efforts, have either a level of oral hygiene that is insufficient to maintain periodontal health, or who are unable to comply with the proposed treatment plan, will be discharged back to the referring clinician for supportive periodontal care within the primary care sector, accepting that a gradual deterioration is likely unless there is a significant improvement in oral self-care.
• If the patient fails to attend for appointments or cancels several consecutive appointments.

The resources of the department are limited and repeat courses of periodontal treatment for patients discharged within the previous 2-3 years are not offered unless there is a specific reason that it may be beneficial (receipt of a re-referral letter explaining the exceptional circumstances is required).