Paediatric dental specialist pathway

Please feel free to contact us for a specialist advice by emailing: Clinical_Specialty_DentalServices_AA@aapct.scot.nhs.uk

This referral pathway: AA Paediatric Specialist, is for patients requiring specialist advice or treatment. Help with treatment planning is always available.

Please feel free to contact us for a specialist advice by emailing:  Clinical_Specialty_DentalServices_AA@aapct.scot.nhs.uk

Examples of Paediatric Specialist Criteria are listed in the section below.

N.B. For caries management, and for patients who the referrer feels may require general anaesthetic (GA) or sedation, please refer to AA Paediatric PDS instead. AA Paediatric PDS is also for paediatric patients with treatment that is unable to be managed in practice, due to patient behavioural difficulties, anxiety or additional support needs, despite the practitioner’s best attempts at providing care.

All categories of patients referred to the service will first have a clinical assessment and treatment plan. Please advise patients/parents that no treatment will be carried out at the initial assessment visit.

It is the responsibility of the GDP to provide any emergency management of acute pain/infection, and stabilisation of dental trauma* (see Who to refer section). Please refer to our local dental trauma guidance. International guidelines can be found here: Guidelines – International Association of Dental Traumatology.

Please ensure that you carry out immediate trauma management prior to referring any trauma patient.

Paediatric specialist criteria

The paediatric specialist referral pathway is to refer a patient who requires specialist opinion/treatment.

The age range covered by the specialty is normally regarded as 0-15 years; children will start the transition process to adult oral health services some time before their 16th year.

Referral to the AA Paediatric Specialist can be made for patients under the age of 16, under the following categories :

• Children with complex medical problems that place them at risk from dental disease and/or its treatment. (e.g. bleeding disorders/ congenital cardiac defects)
• Children who have sustained complex dental trauma (for example pulp involvement in immature teeth). Please note, patients who have suffered dento-alveolar trauma are expected to have received emergency treatment within 24 hours of the trauma. Referral for specialised trauma management should done once the patient is stabilised.
• Children with congenital or acquired dental anomalies who may require complex restorative or orthodontic treatment (for example hypodontia, amelogenesis imperfecta, dentinogenesis imperfecta, micro /macrodontia and delayed eruption)
• Children with molar incisor hypomineralisation (MIH) at age 8 years and above (unless they are symptomatic) N.B. MIH teeth should be fissure sealed once erupted – see the following MIH advice leaflet: NHS Ayrshire & Arran. Advice for clinicians on managing molar hypomineralisation in primary care. 2020
• Children with soft or hard tissue pathology such as ulceration, swellings, and cysts.
• Children with severe non-carious tooth surface loss, requiring specialist intervention.
• Children with periodontal disease.
• Children with cleft lip and palate and other cranio-facial anomalies.
• Supernumeraries, odontomes, impacted teeth, submerging teeth, abnormal fraenal attachments, and tongue-ties which may require surgical management.

Exclusion criteria

We regret that we are unable to accept referrals for:

• Routine or emergency dental care for healthy, co-operative children (for example caries in cooperative children, endodontic treatment in permanent teeth with closed apex)
• Root canal treatment in permanent molars unless there is good clinical indication for retention of the compromised tooth e.g. severe hypodontia.
• Orthodontic extractions in co-operative children.
• Any patient aged 16 years or older.
• Orthodontic assessment or treatment (with the exception of patients being referred for opinion on first permanent molars of poor prognosis)

As mentioned previously, please refer patients in the following categories to AA Paediatric PDS instead:

• Caries management.
• General anaesthesia (GA) or sedation.
• Anxiety or behavioural difficulties.

Additional support needs where treatment not possible in GDS (e.g. autism) – these will be triaged by the PDS dental team to determine if specialist input is necessary.

Once patients are seen and assessed by the service, the patient will either be:

• Provided with a course of treatment within Ayrshire and Arran PDS (either by the paediatric specialist or other members of the team)
• Provided with a treatment plan and referred back to the referring GDP with advice on the patient’s management.
• Provided with a shared care approach for treatment between the PDS and GDP (a combination of treatment from PDS and GDS)
• Referred onwards to the Hospital Dental Service at either the Royal Hospital for Children Glasgow or the Dental Hospital.

*Referral for patients under 16 years who have experienced dento-alveolar trauma

• Practitioners can access the full international guidelines on dental trauma using the following link: Guidelines – International Association of Dental Traumatology which does not require membership of IADT to view. 
• The guidelines should be followed in the first instance and emergency care delivered including provision of local anaesthesia, tooth repositioning and splint placement dependent on injury (see above international guidelines)

Urgent referrals can be made via SCI Gateway in the following circumstances:

• Patients who have facial swelling
• Patients with severe pain despite analgesics
• Patients who have sustained trauma (please provide immediate management of trauma in practice).

• Following initial management, the following cases should be referred via SCI Gateway to the A&A Paediatric Specialist Service for follow-up and intermediate/long-term management:
  • avulsion
  • lateral luxation
  • intrusion
  • extrusion
  • root fracture
  • enamel-dentine-pulp fracture
  • dento-alveolar fracture.

For injuries older than 5 days, the GDP should make a referral marked Urgent via SCI gateway in the first instance, a telephone call is not necessary.

Note: A SCI gateway referral can be always be made for advice on treatment planning

The role of the general dental practitioner

The majority of dental care for children in NHS Ayrshire & Arran is provided with the general dental service.

The following treatment would normally be expected to be completed by the patient’s general dental practitioner (N.B. A SCI Gateway referral can be always be made for advice on treatment planning):

• Oral health assessment of need and circumstances. This includes caries-risk screening and treatment planning including appropriate onward referral where necessary for children who should require it.
• Evidence-based preventive care, advice and interventions. (Please see most recent version of Scottish Dental Clinical Effectiveness Programme Guidance on Prevention and Management of Dental Caries in Children, 2025)
• Restorations of primary and permanent teeth, including biological management of caries. (Please see most recent version of Scottish Dental Clinical Effectiveness Programme Guidance on Prevention and Management of Dental Caries in Children)
• Uncomplicated endodontic treatment of permanent teeth.
• Simple partial dentures and removable space maintainers.
• Routine extraction of primary and permanent teeth under local anaesthesia.
• Emergency and / or urgent treatment and management of pain, infection and dentoalveolar trauma including avulsed teeth* (see Who to refer section)
• Timely identification and referral of significant developmental defects of the dental tissues and disturbances of the developing dentition.
• Acute and longer-term review of mild dental traumatic injuries to the primary and permanent dentition (for example subluxation and mild luxation injuries of primary and permanent teeth; uncomplicated crown fracture of primary or permanent incisors)*(see Who to refer section) 

The key priorities for all children and young people accessing both GDS and PDS services in NHS Ayrshire & Arran are as follows:

1. Ensuring all children have a caries risk assessment carried out by their GDP and all aspects of caries preventive care provided for their risk category (see relevant SDCEP guidelines)
2. Practices should actively promote “Dental Check by One” i.e. encouraging registration of all children with a dentist by the age of 12months and regular attendance thereafter. This should be promoted by health visitors.
3. Fissure sealants applied to the first permanent molars for all children, aiming to do so within 12 months of eruption (see relevant SDCEP guidelines, 2025)
4. At every attendance with the child’s GDP, all opportunity to provide evidence-based caries preventive care should be taken by the practice team (see relevant SDCEP guidelines, 2018)
5. There should be an emphasis on gaining co-operation for a good dental exam as early as possible.
6. When primary tooth caries is detected, even at the “stained fissure” phase, the treatment aim should be a fissure sealant and regular fluoride varnish application, along with instructing the parent/carer on this diagnosis and increased oral hygiene.
7. Small sized bitewing films and holders should be available in all dental practices. Early detection of caries is essential in reducing the need for extractions under general anaesthetic. Bitewings should be attempted in most cases from age 5 and onwards. Where this is not possible due to patient co-operation, temporary use of orthodontic separators should be considered to allow direct visualisation of interproximal surfaces. (see relevant SDCEP guidelines, 2025)

 Children experiencing a sleepless night because of severe dental pain or infection should be able to access appropriate urgent and/or emergency care with their GDP within 24hrs.

Service Delivery Model, NHS Ayrshire & Arran Paediatric Dental Care

Scottish Dental Clinical Effectiveness Programme. Prevention and management of dental caries in children. Dental clinical guidance. 3rd edition. 2025. Available from: https://www.sdcep.org.uk/published-guidance/caries-in-children/

Scottish Dental Clinical Effectiveness Programme. Prevention and management of dental caries in children. Dental clinical guidance. 2^nd edition. 2018. Available from: https://www.sdcep.org.uk/media/2zbkrdkg/sdcep-prevention-and-management-of-dental-caries-in-children-2nd-edition.pdf