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Contents Page Summary of the 4 Referral Routes Quick Reference Chart for Primary Care Patient Groups 3 5 1. Emergency & Out of Hours Dental Care 7 9 (Part of the Unscheduled Dental Care Service) Accessing Emergency Dental Care: Information for the Public 2. Oral and Maxillofacial Surgery and Oral Medicine, Oral/Head and Neck Imaging (inc X-rays) 11 13 15 17 19 Pathology Laboratory Services Oral & Maxillofacial Surgery Referral Form + Additional Fast Track Appendix for Urgent OMFS 3. Restorative Dentistry 21 23 Referral Form for Restorative Dentistry 4. Orthodontics 25 31 Referral Form for Hospital Service Orthodontics 5. NHSG Children’s Dental Services Children’s Anxiety Management including general anaesthetic services Referral Form for ADS Paediatric or NHSG Dental Services Referral Form for Children’s Anxiety Management inc GA Service Child Protection Service Contact Information 6. Dental Primary Care Intermediate Referral Service (DPCIRS) 6.1 Special Care Dentistry (including Anxiety Management) Referral Form for Special Care Referral Form for Domiciliary Care 6.2 Surgical Dentistry Services 7. Aberdeen Dental School 7.1 Student Clinics Advice on Dental Laboratory Topics 53 53 Referral Form for Adult Patients for Student Clinics 7.2 Paediatric Dentistry at Aberdeen Dental School 8. Smoking Cessation Referrals 54 55 57 59 61 63 Referral Form for Smoking Cessation Smoking Advice Service 9. Guidance Notes for Referral Specialties & Other Information Periodontal Referral Guidance Risks and Benefits of Orthodontic Treatment Management of Dento-Alveolar Trauma in Children Children’s Dentistry General Anaesthetic Guidelines 10. Links & Other Information including use of CHI numbers Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email 41 41 45 47 49 51 Referral Form for Surgical Dentistry services Last updated 23/06/11 33 34 35 37 39 65 65 67 69 73 75 [email protected] 1 Make sure you receive regular updates of this Guide The content of this Guide will be reviewed by the NHS Grampian Oral and Dental Health Managed Clinical Network every 6 months (June & December) and updates will be available via email through the Referral Centre. Email [email protected] For security purposes a nhs.net email address is required to send out this information electronically. It is intended that all referrals will move to e-referrals as soon as practicable. The advantages of sending high quality referrals Good quality referrals allow patients to be referred to the most appropriate service as soon as possible. The use of forms in this Guide is designed to help with this process. If the Referral Accepting clinic does not receive adequate information, then the form will be returned to allow the referring clinician to submit clear details and a focused request. “Please see and treat” is not adequate! Development of e-Referral Services With the provision in most Dental Practices of a PC with a secure NHS connection via the N3 IT infrastructure the opportunities for e-referral is being developed using the latest NHSG dental referral guidance. Various referral templates will be placed on the PC connected via N3 in your practice. The appropriate information will be typed in and the referral sent electronically to a central storage point where it will be picked up by the relevant department. It will be possible to attach files such as digital radiographs or clinical photographs. e-Referrals are • received by the referral department more quickly • legible • likely to be of better quality given the fields provided in the referral template, and should give the consultant a better idea of the degree of urgency for certain patients / conditions. A “receipt” that the referral has been received will be sent to the referrer. A parallel system already exists for medical practitioners to refer electronically. How to ensure you will have access to e-Referral Services. All practices or dental clinics must have a current email account with nhs.net You can register via the www.nhs.net site. Further information is available from Lorraine Smith, IT Facilitator Or contact the Dental Advice and Referral Centre on Email NHS Grampian IT Helpline Phone Number Email: [email protected] 01224 553738. 01224 556301 [email protected] 01224 554444 Comments Your comments and suggestions for improving any aspect of the guidance are welcome and should be sent to NHS Grampian Dental Advice and Referral Centre email [email protected] Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 2 Where to send your Oral, Dental or Surgical Specialty Referrals There are 4 Referral Routes. Please refer directly through the appropriate one. PRIMARY CARE 1. DENTAL ADVICE & REFERRAL CENTRE - WOODEND HOSPITAL The primary care referral centre manages and distributes referrals to appropriate services throughout Grampian depending on where services are best delivered this may include any dental service in Grampian including the independent dental practitioners. • Child patients requiring dental extractions and dental treatment, including general anaesthetics, sedation or anxiety management. • Child and adult patients with Special Care Dentistry requirements including domiciliary care patients • Adult failed extractions and routine surgical dentistry • Children and adults requiring urgent and emergency dental care including in partnership with NHS 24 out of normal hours services. • IF YOU HAVE ANY CHILD PATIENTS REQUIRING CONSULTANT-LED CARE, PLEASE REFER DIRECTLY TO PAEDIATRIC DENTISTRY AT ABERDEEN DENTAL SCHOOL (See Main Referral Guide for details) 2. INDIVIDUAL INDEPENDENT SPECIALIST PRACTICES Presently the only NHS referral services available are the orthodontic practitioner services Refer routine Orthodontic directly to individual practices (see detailed orthodontic guide) SECONDARY CARE 3. ORAL & MAXILLOFACIAL SURGERY AT ARI Aberdeen Royal Infirmary manage consultant referrals to the Maxillofacial Unit for:Oral or Maxillofacial Surgery (OMFS) Services including head and neck cancer and oral medicine (see main text for detailed referral guide and for information on urgent referrals and how to contact a member of staff for advice.) Exclude failed extractions & routine surgical dentistry - refer to Dental Primary Care Intermediate Referral Service (DPCIRS) 4. ABERDEEN DENTAL SCHOOL & HOSPITAL Aberdeen Dental School and Hospital manage consultant referrals for:• Restorative Dentistry services including periodontal and prosthetic problems • Orthodontic Services; complex cases (see detailed referral guide in main text ) Exclude routine cases which are referred to specialist practitioners • Paediatric Dentistry services for specialist child care or student care Exclude routine child patients referred for extractions – refer to NHSG Children’s Dentistry (see detailed referral guide) Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 3 If in doubt about making a referral contact the referral centre for advice When printing your referral forms please print on both sides of a single sheet of A4 paper to minimise paper volumes in hospital files. The only exceptions are a) Oral and Maxillofacial Surgery – up to 3 sides b) Children’s Anxiety Management (including GA) - 1 single side. NB Patient information can be typed in Word on the downloaded forms before printing. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 4 Quick Reference Guide Chart (Page 1 of 2) Primary Care Dental Referrals Version 1 April 2011 (*Patients treated under NHS terms of service and are liable to patients charges*) Minimal details for referral include Name; Date of birth; Address; Tel; Informed consent from parent (if under 16 years); Main problem; Urgency; Patient Group CHILDREN Children at high risk of dental disease 0 - 5 yrs with no dentist Children with untreated dental disease / pain Children requiring special care or complex care including extractions under general anaesthesia Routine care – Children of all ages Service Childsmile practices (NHS Registration) NHS Grampian Public Dental Service Or Independent dental practice Contact Details Who can/should refer Dental Advice and Referral Centre The DARC Administrator Woodend Telephone 0845 45 65 990 Fax 01224 556587 Email [email protected] SCI Gateway: Dental - Referral Centre (link under development March 11) Health Visitors Medical practitioners Refer using nhs.net (preferred method) Education /Social Services Phone Referral Centre Dentists Parents /Carers ADULTS: Priority Groups, Special Care, High Need, Dental Primary Care Intermediate Referral Service (DPCIRS) Priority groups inc people with Consultant led services medical problems requiring General medical practitioners urgent routine dental care Dental Advice and Referral Centre Senior nursing staff e.g. bisphosphonate/cardiac. The DARC Administrator Referred to local Adult Special Care Woodend dental practitioner Dentists, social care /carers People with disabilities, learning Tel 0845 45 65 990 Fax 01224 556587 or difficulties, mental illness. Email [email protected] Dental extractions and surgical Medical and Nursing services SCI Gateway: Dental – Referral Centre NHS Grampian extractions / treatments 7-7 Public Dental Service (link under development March 11) Care of the Elderly 75+ Domiciliary care, Care homes Homeless. Pregnant & nursing mothers EMERGENCY, URGENT, UNSCHEDULED CARE Unplanned and urgent care; Advise patients /carers to contact Last updated 23/06/11 NHS G Unscheduled care service Tel:- 0845 45 65 990 Or out of hours NHS 24 08454 24 24 24 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] Patients /carers medical nursing and dental professionals 5 Quick Reference Guide Chart (Page 2 of 2) - Secondary / Intermediate care referrals Full details required for referrals including Name; Date of birth; Address; Tel; Informed consent from parent (if under 16 years); Main problem; Urgency; Associated medical history Department Service ACUTE SURGICAL SPECIALTY Oral & Maxillo-Facial Surgery Consultant led services for oral lesions, oral surgery, facial fractures, head & neck cancer. Contact Details Who can/should refer Oral & Maxillo-Facial Surgery Aberdeen Royal Infirmary Tel 01224 550673 SCI gateway General medical and general dental practitioners Consultant led acute services Need to speak to an on-call clinician? The Maxillofacial Department is on call 24/7. In an emergency, telephone advice is always available on 0845 4566000 (ARI hospital switchboard) and ask for SHO/FY2 on call – bleep 2340. The consultant on call can also be contacted via the SHO on call or via the departmental secretaries. ABERDEEN DENTAL SCHOOL & HOSPITAL Orthodontic Restorative Dentistry Paediatric Dentistry Correction of dental malocclusions Oral and dental rehabilitation and restoration Child oral and dental rehabilitation and restoration Orthodontic Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZR Tel 01224 551901 Referral direct to independent practice see detailed guidance. Independent practices Dentist Dentist Consultant led acute services Dentists DENTAL PRIMARY CARE INTERMEDIATE REFERRAL SERVICE (DPCIRS) Special care Special care Surgical dentistry Surgical dentistry Last updated 23/06/11 Dental Advice & Referral Centre The DARC Administrator Woodend Tel 0845 45 65 990 Fax 01224 556587 Email [email protected] SCI Gateway: Dental – Referral Centre (link under development March 11) Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 6 Dental and Orofacial consultant services Dental practitioners 1. Emergency & Out of Hours Dental Care (Part of the Unscheduled Dental Care Service) Administration contact details NHS Grampian Westholme Queen's Road Aberdeen, AB15 6LS 01224 556661 01224 556587 Phone Fax Lead Clinician for Unscheduled Care Service Alexandra Lowe [email protected] Services available During the day and out of hours, all patients who are registered with a dentist should contact their practice for urgent or emergency advice and treatment. NHS Grampian operates a service for patients who are not registered or who are visitors to the Grampian area. Daytime service Monday to Friday between the hours of 8.05am and 5.45pm The Dental Information and Advice Line DIAL is available on 0845 45 65 990. DIAL provides a dental triage and appointment booking system for dental urgent and emergency conditions. The staff are also able to provide self-help advice for minor problems and can advise on dental waiting lists and registration. This service is supported by the Salaried Dental Service SDS which provides appointments on a daily basis across the Grampian region for those patients who are not registered with a dentist. Patients at SDS clinics are provided with NHS care and treatment appropriate to their condition and there is the opportunity to provide follow-up urgent care should this be required. For routine care patients are directed to the NHS Grampian dental waiting list. Out-of-hours service The out of hours service is integrated with NHS 24 and the national Scottish Emergency Dental Service SEDS, to provide an additional dental triage between 6.00pm – 8.00am and throughout the weekend. Treatment for urgent and emergency conditions is arranged through the Grampian Emergency Dental Clinic GDENS (via NHS 24). Clinics operate 6.15pm – 9.15pm weekday evenings and 9.00am – 12.30 pm Saturday & Sunday. Patients can contact NHS 24 on 08454 24 24 24 Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 7 GDENS provides care for • • • • unregistered patients, patients of participating General Dental Practitioners patients receiving care and treatment within Aberdeen Dental School and Hospital, including the Restorative Dentistry and Orthodontic departments. in exceptional circumstances, for patients who are not able to contact their own registered dental practitioner. Care and treatment is provided under National Health Service General Dental Services terms and conditions for occasional patients. The usual NHS fee charging system applies. The offer of an appointment will be made on the basis of triaged need (SDCEP guidelines) and whilst every effort is made to see patients as soon as possible and at a convenient location, it may not be possible to see patients on the same day except in cases of severe emergency. The following sheet on how to access unscheduled care can be photocopied for wider distribution Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 8 How to Access Emergency & Out of Hours Dental Care Services During the day and out of hours, all patients who are registered with a dentist should contact their practice for urgent or emergency advice and treatment. NHS Grampian operates a service for patients who are not registered or who are visitors to the Grampian area. Unregistered patients requiring urgent or emergency dental care should make direct contact, in person, with the appropriate daytime or Out of Hours emergency service below. NHS Grampian Dental Information and Advice Line (DIAL) DIAL 0845 45 65 990 8.05 am – 5.45 pm Monday to Friday NHS24 0845 4 242424 (6.00 pm – 8.00 am and weekends) Patient Charges Patients should be informed that normal NHS Dental treatment charges apply. Follow up care and waiting lists Patients do not have direct access to routine dental care or registration via this service. Information on waiting lists for NHS dental treatment can be obtained by contacting DIAL. Patients with no dentist who require urgent dental care Patients who do not have direct access to routine dental care and who have considerable need may be referred by other health professionals to DIAL for assessment. Urgent referral from medical, dental and nursing professionals for assessment & treatment planning. Patients in acute services or under care with general medical practitioners who require assessment prior to medical or surgical care/treatment plans will be assessed and treatment planned to facilitate prompt completion of the medical treatment plan; e.g. those about to have heart surgery or about to start a course of bisphosphonate medication. Patients already registered with a dentist should request an urgent review with their own dentist, as this service is primarily for unregistered patients. These services are part of the NHS Grampian Unscheduled Dental Care Service Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 9 Please photocopy and circulate the notice on the previous page for use wherever required e.g. Community or Health Care Centre noticeboards, pharmacies. etc Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 10 2. Oral and Maxillofacial Surgery & Oral Medicine Contact details Maxillofacial Unit Aberdeen Royal Infirmary Foresterhill Aberdeen AB25 2ZN Main Reception Fax Email: 01224 550673/552655 01224 554865 [email protected] Secretaries Haleigh Scott Louise McKimmie Julie Elrick Annemarie Thom Jeanette Smith 01224 01224 01224 01224 01224 553280 553052 558859 554591 552654 Receptionists Angela Reid Dorothy South Anne Ross Catherine McCarthy 01224 552655 / 01224 550673 Maxillofacial Laboratory 01224 552656 Department Staff: Consultants Mr Terry Lowe Mr Rory Morrison Mr Nick Renny Mr Martin Ryan Staff Grades 1 Specialist Registrar 3 SHOs 2 FY2s 1 DF2 Nursing staff: Maxillofacial technologists Last updated 23/06/11 Subspecialty interest Head and Neck oncology/reconstruction Orthognathic surgery/facial deformity Head and Neck oncology/reconstruction. Orthognathic surgery/facial deformity Janice Boggon Mark Burrell Binnie Ahamat On rotation from Glasgow General and dental nurses. Mike Duncan, Karen Boyd-Glen Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 11 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 12 Dept of Oral and Maxillofacial Surgery - Overview We provide the full range of oral and maxillofacial surgery through • new patient diagnostic clinics, • operative sessions for minor surgery along with • day case and inpatient elective surgery We also provide an emergency service for management of patients with all forms of • craniofacial trauma, • haemorrhage and • acute infections of the head and neck. We offer comprehensive treatment for the vast range of conditions presenting in the anatomical region of the head and neck. This includes but is not limited to: • Maxillofacial / craniofacial injury. • Orofacial cancer and reconstruction including free tissue transfer. • Orthognathic / facial deformity surgery. • Facial aesthetic surgery. • Salivary gland disease. • Minimally invasive surgery. • Distraction osteogenesis. • Preprosthetic surgery / bone grafting techniques and dental/facial implants. • Temporomandibular joint surgery including joint replacement. • Dentoalveolar / oral surgery. • Oral Medicine and treatment of oral mucosal disease. • Management of facial pain. • Maxillofacial prosthetics and technology. Clinics • Out-patient clinics are run every day for the diagnosis and investigation of new patients. • A one stop biopsy/cytology service is available when required. • All new patients are initially assessed at a consultant or staff grade clinic. All general referrals are pooled unless named for a specific reason. Combined Clinics We also conduct combined clinics with other specialty services: • Orthognathic clinics with colleagues in orthodontics and restorative dentistry. (every Thursday morning) • Combined implant clinic with colleagues in restorative dentistry • Head and Neck Oncology clinics with colleagues in ENT, Oncology, Speech and language therapy, Dietetics, Pathology, cytology and MacMillan nursing support. (every Wednesday morning) • Combined clinics with ophthalmology colleagues. • Hyperbaric oxygen therapy clinics including a national tertiary referral service for this facility. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 13 Referrals to the department Referrals can be made in writing or via the electronic portal if this is available to you. • Forms and updates to the information will also be available at www.hi-netgrampian.org/referralformsbyspeciality • Urgent referrals can be faxed on 01224 554865 or emailed to the department on [email protected] if the referrer has an nhs.net email account. All referrals should contain the following essential details: Patient details Include current telephone number so that patient can be contacted to attend a clinic at short notice Include details of patient’s General Medical Practitioner Referring clinicians details Short medical history Including medication and known allergies. Relevant social history Including smoking and drinking status Detailed history of the lesion or of the presenting complaint including • Nature / duration of symptoms • Site and size of the lesion • description of the lesion Clinical diagnosis (or diagnoses) in order to categorise the urgency of the referral If you have any doubts about the urgency of a particular lesion you can phone the local maxillofacial surgery unit to discuss the case with one of the consultants. Need to speak to an on-call clinician? The Maxillofacial Department is on call 24/7. In an emergency urgent advice is always available by telephone. Tel 0845 4566000 (ARI hospital switchboard) and ask for SHO / FY2 on call – bleep 2340. The consultant on call can also be contacted if necessary via the SHO on call or via the departmental secretaries. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 14 Oral and Maxillofacial Imaging 1. Plain dental radiography is provided by the ARI Outpatient X-ray department and can be arranged by telephone 01224 552268 or written referral to the Department of Radiology. Please remember that justification for the radiograph must be included. 2. OPTs can be requested directly if required. 3. CT and MRI imaging can be requested via the Maxillofacial unit where there is a specific indication. Contact the superintendent radiographer, Maureen Tough with any queries. Oral / Head and Neck Pathology Oral / Head and Neck pathology services are available either through the OMFS unit or directly through the Pathology Dept. Information on sending biopsies and utilising pathology services can be found on the NHSG Intranet as follows: Go to NHSG Intranet Homepage, click on: Departments and Services, Then Laboratories, Then Pathology, Then Surgical pathology specimens and biopsies. The website address for this is: http://intranet.grampian.scot.nhs.uk/ccc_nhsg/6221.html?pMenuID=460&#surgical%20pathology% 20specimens%20and%20biopsieS Teaching / training We are all actively involved in undergraduate training of medical and dental students and postgraduate training of doctors and dentists. We have close links with the University of Minnesota, Minneapolis and their maxillofacial trainees who attend Aberdeen biannually for elective training within the unit. We are also keen to continue forging strong links with primary care by providing teaching and training for practitioners who wish to improve their diagnostic and operative skills in oral surgery. This includes provision of approved CPD courses for dentists and Dental Care Professionals. Details available through the NES Dentistry Portal. http://www.dentistryportal.scot.nhs.uk/login.asp Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 15 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 16 Referral Form for Oral & Maxillofacial Surgery Send to: Maxillofacial Unit, Aberdeen Royal Infirmary, Foresterhill Aberdeen, AB25 2ZN Need to speak to an on-call clinician? The Maxillofacial Department is on call 24/7. In an emergency, telephone advice is always available on; 0845 4566000 (ARI hospital switchboard) and ask for SHO/FY2 on call – bleep 2340. The consultant on call can also be contacted via the SHO on call or via the departmental secretaries. The fastest method of referral is via the electronic SCI Gateway: click on Head and Neck Cancer If you do not have access to this, fax a copy of this form to: 01224 554865 DO NOT SEND FORMS BY EMAIL. A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Referral Surname Gender Male Female Forename CHI Number Date of Birth Address Town Postcode Daytime Phone Mobile Home Phone e-mail If your patient needs to communicate in a language or mode other than English please specify: If yes, please specify and state whether an accompanying person can translate or if an interpreter will be needed. URGENT: YES If URGENT, please mark one or more of the following: Malignancy suspected Pain for 48 hours NO Swelling Trauma Other (please specify) To aid compliance with the Disability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance Impairment Is the patient registered at your practice? Yes No Please check box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services Print Name of Referring Clinician Signed (Clinician) REFERRING PRACTITIONER GDP STAMP/DETAILS Last updated 23/06/11 Date GMP STAMP/DETAILS Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 17 PLEASE PRINT Page 1 & 2 on BOTH SIDES OF ONE SHEET. If this is not possible then please re-enter Patient’s name & Date of Birth Patient’s presenting complaint Clinician’s concerns Why are you referring the patient? What outcome do you seek? Medical history, including all drugs being taken and any allergies. Note if NO relevant history Dental history What treatment has been attempted for this problem before the referral was made? Smoking status Enclosures: Alcohol consumption Radiographs Study models Photographs Details: Would you like these returned? Yes No Is there any other information we need to know? Administrative Information for the Referral Service (Do not write in the box below) Form reviewed March 2011 Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 18 Complete this additional section for Fast Track Referral for Facial and /or Oral Symptoms The fastest method of referral is via the electronic SCI Gateway: click on Head and Neck Cancer If you do not have access to this, fax a copy of all 3 pages of the form to: 01224 554865 Please re-enter patient’s name & Date of Birth Cancer area suspected: (please tick boxes below): Oral cavity Salivary gland Neck Skin of face Appearance: Discrete swelling Ulceration Red patch (erythroplakia) Mixed/red/white patch Facial mass Cranial neuropathy Unresolved neck mass Unexplained tooth mobility Associated with: Pain Bleeding Neck node(s) Tongue fixation Record manually the extent of any pathology on the mouth and describe it below: Further Description & Notes, including duration Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 19 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 20 3. Restorative Dentistry Contact details Restorative Dentistry The University of Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZR Reception: 01224 552707 (Restorative/Orthodontic Reception) 01224 551901 or 551084 (Dental School Main Reception) Department Secretary: Miss Sarah Raffan Tel: 01224 559382 Fax: 01224 550137 E-mail: [email protected] Clinical Staff Consultants: Staff Grade: Specialist Registrars Senior House Officers Dental Hygienists Dental Nurses Dental Technicians Mr Martin Donachie Dr Dean Barker Mr Shahab Rahman Aberdeen Dental School staff will contribute to NHS clinical services in due course. Restorative Dentistry - Overview The work of the Department consists of new patient diagnostic clinics, multidisciplinary clinics with colleagues in Orthodontics and Oral & Maxillofacial Surgery and specialist treatment. Treatment includes: • • • • • • • Fixed & Removable Prosthodontics Prosthetic rehabilitation of cancer/trauma Implant dentistry (placement and restoration) Endodontics, including peri-radicular surgery Periodontics, including periodontal surgery Management of tooth wear cases Treatment of congenital conditions including hypodontia Patients accepted for treatment in the Department are prioritised in terms of need. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 21 Clinics Consultant clinics are held for the assessment and treatment planning of new patients. Maximum waiting time for assessment is 12 weeks from referral. Multidisciplinary clinics held weekly with colleagues in Orthodontics and Oral & Maxillofacial enable planning of cases requiring combined care e.g. • Hypodontia • cleft lip and palate and • facial deformity. Patients who require to be seen on this clinic should first be referred to the most appropriate Department where they will initially be seen within 12 weeks. The waiting time for the combined clinic is currently 12 months. A monthly implant clinic runs with Oral & Maxillofacial Surgery. Refer patients for a new patient consultation initially to assess suitability / eligibility for implant treatment. Each case is assessed on an individual basis but the Department follows the NHS Guidance on Implant Placement within the NHS, which can be broadly divided into rehabilitation of the following groups: • Trauma • Cancer • Hypodontia • Severe denture intolerance • Those patients who simply can not be reasonably treated by an alternative approach Head and Neck Cancer Restorative Dentistry also forms part of the hospital’s multidisciplinary team for the treatment and rehabilitation of patients with Head and Neck Cancer. Teaching The Restorative Dentistry department is actively involved in teaching and training of undergraduates and postgraduate trainees. Referrals Referrals should be made in writing. Please note that named referrals tend to be pooled and could be seen by either consultant. If a referral is urgent a letter can be faxed or preceded by phone or e-mail contact. The following information should be included in a referral letter: • Contact details of the referring practitioner • Patient name, address, date of birth and contact details • Reason for referral, including whether advice or treatment is sought • Relevant history and clinical findings • Relevant medical and social history For Periodontal Referrals please read the guidance in Section 9. Restorative referral forms are available at www.hi-netgrampian.org/referralformsbyspeciality Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 22 ADULT Referral Form for Restorative Dentistry Send to: Restorative Dentistry, The University of Aberdeen Dental School & Hospital, Cornhill Road, Aberdeen, AB25 2ZR. Please insert dates in dd/mm/yyyy format A. Patient’s Personal Details Date of Referral Surname Gender Male Female CHI Number Forename Date of Birth Address Town Postcode Daytime Phone Mobile Home Phone e-mail If your patient needs to communicate in a language or mode other than English please specify: If Yes, please state whether an accompanying person can translate or if an interpreter will be needed. B. Which discipline should see the patient? FOR Select ONE option Conservative Dentistry Endodontics Multidisciplinary Select ONE option Opinion Only Care Plan Specific Treatment Emergency Treatment Total Care Only Periodontology Prosthetics Special Care If URGENT, please give details: To aid compliance with the Disability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance Impairment Is the patient registered at your practice? Yes No Please tick box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services Print Name of Referring Clinician Signed (Clinician) REFERRING PRACTITIONER GDP STAMP/DETAILS Last updated 23/06/11 Date GMP STAMP/DETAILS Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 23 Adult Restorative Referral: Clinical Details & Date of Birth Please re-enter patient’s name Clinician’s concerns Tick box if this is a TRAUMA case Why are you referring the patient? Dental history What treatment has been attempted for this problem before the referral was made? If there are repeated failures, details must be given of deterioration. For tooth wear, is it localised or generalised? Is there an occlusal problem? What treatment are you planning to provide for the patient in their current care plan? Caries status: BPE Scores Oral Hygiene Medical History Please include all current medications and allergies. Note if no relevant history Enclosures: Radiographs Study models Photographs Details: Would you like these returned? Yes No Is there any other information we need to know? Form reviewed August 2010 Administrative Information for the Referral Service (Do not write in the area below) Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 24 4. Orthodontics Orthodontic Referrals may be made to a Specialist Orthodontic Practice or to the Orthodontic Department at Aberdeen Dental School (see ‘Quick’ referral guide). Orthodontic Practices: Contact Details Aberdeen Orthodontics Orthoworld The Orthodontic Clinic 230 George Street Aberdeen AB25 1HN 1st Floor Thistle House 24-26 Thistle Street Aberdeen AB10 1XD Lower Ground Floor 9 Golden Square Aberdeen AB10 1RB Practice Orthodontists Practice Orthodontist Practice Orthodontists Richard Buckle Johann Bell Graham Templeton Practice Dentists Lisa Currie Dipali Patel Mhari Walker Lidia DeSousa Gillian Robertson Orthodontic therapist Orthodontic therapist Catriona Burrell Margaret Davie Michelle Stalker Tel: 01224 611 633 Fax: 01224 611 614 www.theorthodonticclinic.co.uk [email protected] Tel: 01224 641 928 Fax: 01224 656 329 www.aberdeenortho.co.uk [email protected] Sheila McConville Tel: 01224 638 404 Fax: 01224 638 064 www.orthoworld-aberdeen.co.uk [email protected] Practice Manager: Practice Manager: Practice Manager: Sara McQuillan Tel: 01224 656 324 [email protected] Nicola Rattray Alison Daly [email protected] 07921 769 928 The Hospital Orthodontic Service Orthodontic Department Contact details Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZG Tel: 01224 552707 (main reception) Reception: Department Secretary: Mrs Fiona Birnie Tel: 01224 554911 Fax: 01224 550137 E-mail: [email protected] Staff Consultants: Mr Colin Larmour Dr Liz Turbill Ms Mhairi Walker Dr Khaled Khalaf (Senior Lecturer/Hon. Consultant) Staff Grade: Mrs Helen Shaw Clinical Assistants: Mrs Ann Ovall Orthodontic Therapist: Mrs Catriona Burrell Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 25 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 26 ‘Quick’ Orthodontic Referral Guide This is a guide only. Please identify the main presenting problem on the left and then select the specific problem. The corresponding white box will indicate the most appropriate referral pathway. NHS Grampian January 2009 Presenting Problem Increased Overjet Crossbite Specific presenting problem. Overjet 6mm or under at any age Posterior crossbite Crowding Crowding in mixed dentition Crowding in permanent dentition Moderate or severe crowding Mild crowding, significant aesthetic detriment Mild crowding, little significant aesthetic detriment Not palpable buccally 10+ years Palatally placed on radiographs Cs retained, not mobile 11+ years More than 1 tooth missing per quadrant One buccal tooth missing per quadrant Cleft lip and palate and syndromes Medical history or management issues complicating treatment Problems likely to need specialist surgical or restorative care Severe Skeletal Discrepancy / Facial Disharmony Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email Refer to Hospital Overbite traumatic to tissues, or open bite >3mm Hypodontia (ignore 8’s) Refer to Specialist practice Overjet over 6mm 10+ years Overjet over 9mm 10+ years or with significant skeletal discrepancies Anterior crossbite with no/or mild skeletal discrepancies Overbite Canines Referral probably not indicated [email protected] 27 Who is Likely to Benefit from Orthodontic Treatment? Guidance on who is likely to benefit from orthodontic treatment is discussed in Section 9 (page 67). The Hospital Orthodontic Service Overview The Orthodontic Department provides a referral and advice service for all of the Grampian region and Northern Isles. The main base is Aberdeen Dental School with weekly peripheral clinics to Dr Gray’s Hospital, Elgin and quarterly visits to clinics in the Northern Isles. Patients requiring treatment are prioritised according to individual clinical need. Historically the hospital orthodontic service was ‘overloaded’ with routine orthodontic cases which reduced the capacity for the management of complex malocclusions including multidisciplinary cases. At present, the hospital service only offers treatment of more complex cases especially those likely to require multidisciplinary treatment. Orthodontic Department Clinics New Patient All referrals to the Department are triaged by a Consultant Orthodontist according to the clinical information provided in the referral letter and accompanying radiographs. There are four consultants and a pooled waiting list is in operation. New Patients are assessed and treatment planned at a Consultant clinic. If a referring practitioner requires more urgent advice about a patient then this can be provided by telephoning/fax or emailing the department directly to discuss with a Consultant. Multidisciplinary clinics are held weekly with colleagues in Restorative Dentistry and Oral & Maxillofacial Surgery for cases requiring combined care e.g. hypodontia and facial deformity. Patients should be referred to the most appropriate department initially for preliminary assessment. Cleft Clinic The Regional Cleft Clinic is held on a monthly basis at Royal Aberdeen Children’s Hospital. The cleft team is a multidisciplinary team including orthodontics and provides a comprehensive assessment and treatment service for patients with cleft lip and/or palate and any associated anomalies or medical problems. It functions within a managed clinical network (CleftSiS) which manages cleft care for all patients throughout Scotland. Teaching Clinics The orthodontic department is actively involved in both undergraduate and postgraduate training. Dental students may attend Consultant new patient and treatment clinics as part of their course to observe and assist. Postgraduate trainees at both basic speciality stage and advanced preconsultant stage also work in the department in shared posts with Dundee Dental Hospital. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 28 Making referrals For direct referrals to Specialist Orthodontic Practices, please contact the relevant practice directly. Hospital referrals should be made in writing or via the e-Referral system if available. Referrals tend to be pooled and could be seen by any consultant. If a referral is urgent a letter or referral form can be faxed or preceded by phone or e-mail contact. The following information should be included in the referral document • Contact details of the referring practitioner • Contact details of General Dental Practitioner (if different from Referrer) • Patient name, address, date of birth and contact details • Reason for referral, including whether advice or treatment is sought • Relevant clinical findings (salient features of malocclusion) • Relevant medical and social history • History of previous orthodontic treatment or referrals • Study models if requesting a treatment plan or second opinion • Recent relevant radiographs if available • Stability of oral health: Caries free for 12 months (exception for opinion e.g. compromised 6s) No active Periodontal Disease, Excellent oral hygiene* *NB: If your patient has severe disease in permanent teeth, you may request an orthodontic opinion to help with planning extractions as part of your patient’s treatment. Please note All patients referred for orthodontic treatment should be: • Appropriately motivated to maintain good oral health • In a stable healthy oral state • Understanding of the complexity and length of orthodontic care and treatment • Clearly aware of their relationship with dental and orthodontic services i.e. NHS or private • Referred to one orthodontic provider only. • Advised that the initial appointment will be for orthodontic assessment only and does not guarantee that treatment will be offered. • Aware that they may be referred on to another provider within the local network depending on the complexity of their problem. Referral Forms An example of the Referral Form for the Orthodontic Department is on the following page. Further copies of referral forms are available at www.hi-netgrampian.org/referralformsbyspeciality Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 29 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 30 Orthodontic Referral Form for Aberdeen Dental School & Hospital Send to: Orthodontic Department, The University of Aberdeen Dental School & Hospital, Cornhill Road, Aberdeen, AB25 2ZR. Please insert dates in dd/mm/yyyy format A. Patient’s Personal Details Date of Referral Surname Gender Male Female CHI Number Forename Date of Birth Address Town Postcode Daytime Phone Mobile Home Phone e-mail If your patient needs to communicate in a language or mode other than English please specify: State whether an accompanying person can translate or if an interpreter will be needed B. Service requested Advice only Treatment Plan Treatment request Medical or Special need For remote areas: preliminary advice from a dentist with orthodontic experience Multidisciplinary clinic URGENT: YES NO Please specify reasons for urgency To aid compliance with the Disability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance Impairment Is the patient registered at your practice? Yes No Please tick box to confirm I confirm the patient is dentally fit with excellent oral hygiene and I shall remain responsible for their general dental care (except requests for advice on teeth of poor prognosis). Print Name of Referring Clinician Signed (Clinician) REFERRING PRACTITIONER GDP STAMP/DETAILS Date GMP STAMP/DETAILS Continued overleaf Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 31 Orthodontic Referral: Clinical Details Please re-enter patient’s name & Date of Birth Medical history: Please list all current medications taken, allergies and any specialist medical clinics attended. Note if no relevant history Clinician’s concerns Mark box if this is a TRAUMA case Please refer the document “Who is likely to benefit from Orthodontics?” and state which of the conditions specified in the “Likely to benefit” list applies to your patient: PLEASE CONFIRM: S/he is interested in having orthodontic treatment. S/he is maintaining excellent Oral Hygiene. S/he has had no new carious lesions detected during the last 12 months. All his/her first premolars have erupted All second premolars (unless congenitally absent) are erupting OR: I would like advice on a mixed dentition problem or extractions only Additional information/concerns Treatment you would wish to provide in this case Please mark types of orthodontic treatment you could provide in this case: Removable Functional Fixed Enclosures (e.g. radiographs, study models, photographs) Would you like these returned? Administration. Please do not write below. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email Yes No Form reviewed August 2010 [email protected] 32 5. NHSG Children’s Dental Services All referrals should be made through Dental Advice and Referral Centre to Children’s Dental Primary Care Service NHSG Dental Advice and Referral Centre Westholme, Queen's Road Aberdeen, AB15 6LS Phone 01224 556301 Email [email protected] All referrals should be made in writing. Further copies of the customisable referral forms for Children’s Dentistry are available on NHSG Hi-Net. It is important that all referrals include a full medical history and clear reasons for referral. Referrals with insufficient information may be rejected. The referral will be acknowledged by letter to the referrer giving details of the allocated clinic and / or clinician. Clinical Staff NHSG Lead clinician: Consultant/Senior Lecturer: Malcolm Stewart Contact through Dental Advice and Referral Centre Dr Jennifer Foley University of Aberdeen Dental School & Hospital See Section 7.2 for contact details Children’s Dental Services Overview The salaried primary care dental service accepts child patients for • • • routine care by self referral (see below) where a child has a special need or medical issue which makes it inappropriate to have care provided in a general practice setting, please use the Children’s Dentistry referral form. care requiring anxiety management including anxiety management, inhalation sedation and general anaesthetic, please use the Anxiety Management referral form. Self Referral Patients requiring an Urgent Appointment 1. Patients should contact their registered dentists in the first instance or 2. DIAL on 0845 45 65 990 Monday – Friday 8.05- 5.45 or 3. NHS24 on 0845 4 24 24 24 outwith these times. Non Urgent Referrals Currently routine children’s care should be arranged by contacting 1. The salaried primary care dental services via DIAL on 0845 45 65 990 Monday – Friday 8.05- 5.45 or 2. NHS24 on 0845 4 24 24 24 outwith these times. Waiting times All patients should receive an initial appointment within 12 weeks. Management of Dental & Dento-Alveolar Trauma For a brief overview of the initial management of dental trauma to both the primary and permanent dentitions see Guidance Notes in Section 9 of the Guide. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 33 Anxiety Management Referrals (including inhalation sedation & general anaesthetic) These should only be made as a last resort when other methods of anxiety management or sedation have been attempted. Please read Guidelines for Referring Child Patients for Dental Extractions under General Anaesthetic in Section 9 of this guide. Pre Assessment For Children’s Dental Anxiety Management including General Anaesthetics In order to reduce the risk involved in children’s extractions under general anaesthetic NHS Grampian provides a pre-assessment service for all children referred for General Anaesthetic. All referrals should be sent to Children’s Dental Primary Care Service NHSG Dental Advice and Referral Centre Westholme Queen's Road Aberdeen, AB15 6LS Phone 01224 556301 Patients will then be offered a pre-assessment appointment in or near their locality in • Aberdeen • Peterhead • Banff • Inverurie • Stonehaven • Elgin Please tell your patients that the first appointment is for assessment and consultation only. At this appointment, they will be seen by a suitably trained dentist, who will assess them for GA according to GDC guidelines. Treatment plans may be changed at this stage, and you will be informed of any changes in writing prior to the GA session. Patients will then be referred on for treatment under LA, RA or GA. If you need your patient to be seen urgently please contact the clinic directly at RACH for urgent arrangements. Dental Anaesthetic Clinic, First Floor, Royal Aberdeen Children’s Hospital, Foresterhill Westburn Road, Aberdeen AB25 2ZG Tel 01224 550426 Please follow the GA Guidance for Child Patients in Section 9 and ensure that all urgent and emergency patients have been carefully assessed by their referring dentist before contacting the clinic. Dental pain should be alleviated, if at all possible, before a referral is made. Emergency Referrals for Child GAs. If an emergency referral for a child GA is required, please contact the Maxillofacial Service. This would only be used in case of trauma, haemorrhage or swelling affecting the airway. Referral forms • Children’s Anxiety Management referral form and • Children’s dentistry referral form are available at www.hi-netgrampian.org/referralformsbyspeciality or email the Referral Hub for further copies at [email protected]. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 34 Children’s Dentistry Referral Form - excluding Orthodontics Send to: Children’s Dental Primary Care Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS. Please insert dates in dd/mm/yyyy format A. Patient’s Personal Details Date of Referral Surname Gender Male Female Date of Birth Forename CHI Number Address Town Postcode Daytime Phone Mobile Home Phone e-mail If your patient needs to communicate in a language or mode other than English please specify: State whether an accompanying person can translate or if an interpreter will be needed. B. Preferred Referral Pathway (Select ONE option of the two available) NHSG Children’s Primary Dental Care Aberdeen Dental School Paediatric Department (Specialist Advice/Treatment) Service requested Opinion Only Care Plan Treatment Request Care requiring anxiety management including Sedation Special need or medical issue URGENT: YES NO If a malignancy is suspected, refer directly to Maxillofacial Unit, not Children’s Dentistry Please specify reasons for urgent referral to Children’s Dentistry To aid compliance with the Disability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance Impairment Is the patient registered at your practice? Yes No Please check box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services Print Name of Referring Clinician Signed (Clinician) REFERRING PRACTITIONER GDP STAMP/DETAILS Date GMP STAMP/DETAILS Form reviewed August 2010 Continued overleaf Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 35 Children’s Dentistry Referral - excluding Orthodontics: page 2 Please re-enter patient’s name & Date of Birth Clinical Details Patient’s presenting complaint - if a young child, parent/carer’s concerns and expectations: Clinician’s concerns Check box if this is a DENTAL TRAUMA case Why are you referring the patient? Has the child been in pain or had swelling? Medical history: Please list all current medications taken and any specialist medical clinics attended Note if NO relevant history. Dental history What treatment has been attempted in this course of treatment before referral was made? How has the child coped with treatment? Does the child attend for scheduled care dental appointments? Yes No Has local anaesthesia been used for dentistry? Yes No Has patient received inhalation sedation or general anaesthesia previously for dentistry? Yes No Have antibiotics been prescribed in the past six months? Yes No Details of antibiotics and the number of courses prescribed: Social history Who is the principal carer/legal guardian? With whom does the child live? Has the child received dental health home or community support or intervention from other agencies? Summary of oral health status (e.g. caries and oral hygiene) Ongoing care In addition to your referral request, please include details of care that you are able to provide e.g. prevention. Enclosures (e.g. radiographs, study models, photographs) Would you like these returned? Yes No Is there any other information we need to know? Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 36 Referral Form for Child Extractions with Anxiety Management incl General Anaesthesia Send to: Children’s Dental Primary Care Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS. A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Referral Surname Gender Male Female CHI Number Forename Date of Birth Address Town Postcode Daytime Phone Mobile Phone Home Phone e-mail Mark the box and comment where appropriate Medical History Teeth to be extracted or requiring treatment Any Heart complaint/disease Epilepsy Bronchitis/Asthma Hepatitis Excessive bleeding Any serious illness Allergies Alternatives offered Regular medication Which alternative treatment methods have been offered Steroids in the last 3 months Any history of behavioural problems Family history of problems with GA Any other comments Enclosures: Radiographs Must be sent when treatment plan involves permanent extractions Appliances Instructions: • Hospital will send details Reason for referral 1. Anxiety/phobia 2. Age/lack of understanding 3. Multiple extractions 4. Sepsis 5. Other Justification Expected difficulties THE PATIENT/PARENT HAS BEEN FULLY INFORMED OF ALL DETAILS AND HAS CONSENTED TO THE ABOVE TREATMENT – WHICH MAY BE SUBJECT TO CHANGE BY THE OPERATING DENTIST. THE PATIENT/PARENT ALSO UNDERSTANDS THAT AFTERCARE CAN ONLY BE PROVIDED BY YOUR PRACTICE. Signed Parent Date Signed (Clinician) Date Keep a copy of this form for your records. REFERRING PRACTITIONER GDP STAMP/DETAILS Form reviewed September 2010 Name, address and telephone of patient’s GP Name: Dr Address: : Clinician’s Checklist Consent obtained Instructions given Relevant risks Last updated 23/06/11 Office use: Form rec’d Comments Date of appointment Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email Appt sent [email protected] 37 Child Protection All practices should have a Yellow Box containing information on Child Protection Services in Northeast Scotland. A one page summary of important contact information follows on the next page. Further copies of Child Protection documents are downloadable from NHSG Intranet. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 38 NHS Grampian Child Protection – Important Contact Information Protecting Children Everyone’s job Matters for Concern What to do Children can come into contact with a range of health service staff, not only those working in children’s services, e.g. Children can be at risk through Specific guidance is contained in the NESCPC Guidelines. As a minimum, all staff should A Commitment from • • • Keep this card with you for future reference Children visiting relatives Children of women receiving treatment for domestic violence Children of carers receiving treatment or support for mental health, alcohol or drug abuse problems So every member of staff, and the public, has a role to play in protecting children; it’s not just doctors, nurses, social workers, teachers and the police Revised August 2010 Aberdeen City Social Work Joint Child Protection Unit 01224 306879 Area teams Kincorth 01224 874278 Tullos 01224 241050 K’gate House 01224 264200 Quarry Centre 01224 694554 Mastrick 01224 690404 Royal Abdn Children’s Hosp 01224 552994 Aberdeen Maternity Hospital 01224 552613 Emergency Out of Hours Children’s Reporter Social Work Reception Team 01224 693936 0300 2002166 01224 264198 To Contact Grampian Police as part of the IAF process, or to invite them to attend a multiagency meeting: [email protected] Last updated 23/06/11 • • • • Physical abuse Emotional abuse Sexual abuse Neglect • • • You may see or hear things which make you worry about a child’s care, welfare or safety. If you have any such concerns, you must do something about them Moray Social Work 01339 01330 01261 01358 01346 01466 01467 01467 01779 01224 01569 01771 01888 887096 824991 812001 720033 513281 799600 625555 641297 477333 783880 763800 638200 569260 Emergency Out of Hours Children’s Reporter 0845 840 0070 0300 2002166 Buckie Elgin Forres Keith Lossiemouth 01542 01343 01309 01542 01343 Emergency Out of Hours Children’s Reporter 837200 557222 694000 886174 557222 08457 565656 01343 550015 To Contact Grampian Police as part of the IAF process, or to invite them to attend a multiagency meeting: [email protected] . To Contact Grampian Police as part of the IAF process, or to invite them to attend a multiagency meeting: [email protected] Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email • Further advice and support can be obtained from one of the contacts shown on the back of this leaflet. Aberdeenshire Social Work Aboyne Banchory Banff Ellon Fraserburgh Huntly Inverurie Kemnay Peterhead Portlethen Stonehaven Strichen Turriff • Listen to what is said Observe what is happening Write down exactly what you see and hear Refer to your nearest social work office, Child Protection Unit or Police If child requires urgent medical attention call 999 or on-call paediatrician at Royal Aberdeen Children’s Hospital [email protected] NHS Grampian: Designated Doctor Child Protection and Nurse Consultant Child Protection can be contacted on 01224 551706 during office hours In an emergency dial 999 For Out of Hour urgent medical referral contact Royal Aberdeen Children’s Hospital receiving Consultant Paediatrician Via Medical Registrar on Tel: 0845 456 6000 Moray: Contact ‘Named Doctor’ Consultant Paediatrician, at Dr Gray’s Hospital Elgin Tel: 0845 456 6000 Out of hours or urgent medical referral Tel: 0845 456 6000 – ask for Duty Consultant Paediatrician Dr Gray’s 39 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 40 6. Dental Primary Care Intermediate Referral Service (DPCIRS) Referrals to primary care staff with a special interest / specialist. All these patients are treated under General Dental Services and are liable to normal NHS charges as per the Statement of Dental Remuneration. Services include • Adult Special Care • Surgical dentistry • Restorative/special care dentistry (under development) 6.1 Special Care Dentistry Contact Details All referrals should be made through NHSG Dental Woodend Referral Hub indicating which service you wish to access: Special Care Dental Services NHSG Dental Advice and Referral Centre Westholme Queen's Road Aberdeen AB15 6LS Referral Hub Phone Referral Hub Fax 01224 556301 01224 556587 Clinical Staff (in alphabetical order) Senior Dentist Senior Dentist Senior Dentist Senior Dentist Senior Dentist Iain Bovaird [email protected] Francis Collier [email protected] Clare Donachie [email protected] Lois Gall [email protected] Bob Hamilton [email protected] Special Care Services Overview All referrals for Special Care are triaged by senior clinical staff according to the description of the case and urgency with which the patient needs to be seen. The referral will be acknowledged by letter to the referrer giving details of the allocated clinic and or clinician. Treatment Services / Advice Available • • • • • • Conscious sedation – inhalation sedation, intravenous sedation Full clinical care under general anaesthesia Wheelchair platform and recliner availability Domiciliary services Information and care support packs Prevention and rehabilitation service (normally dental nurse led) Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 41 Referrals to Special Care Dental Services Please advise your patients that the first appointment for Special Care Dentistry Services is for assessment and consultation only. Referrals can be made in writing either by form or letter to the Woodend Dental Advice and Referral Centre or via the electronic portal if this is available to you. If your patient needs to be seen urgently you may obtain advice from the Special Care Dental Team directly at Aberdeen Dental School Reception Tel 01224 551901 All referrals should contain the following essential details; • Contact details of referring practitioner • Patient name, address, date of birth and telephone numbers • Relevant clinical findings • Reason for referral • Relevant medical and social history Referral for Sedation – Guidelines for Referral • • • • • • • • • Dental anxiety/dental phobia Learning disability with or without challenging behaviour (where this adversely affects the patient’s ability to accept dental treatment) Involuntary movements, e.g., Parkinson’s disease, Huntingdon’s disease, cerebral palsy (where patient’s involuntary movements make operative dentistry difficult) Exaggerated gag reflex Underlying medical conditions exacerbated by anxiety related to dental procedures, e.g., epilepsy, angina, asthma, psychiatric illness Unusually traumatic dental procedures in patients otherwise comfortable with dental treatment, e.g., surgical extractions, apicectomy Repeated failure of local anaesthetics Repeated fainting prior to or during local anaesthetics or dental procedures Any patients who may have been traditionally referred for general anaesthetic treatment but who may benefit from being offered alternatives to this. Patients who require sedation Referred through the Dental Advice and Referral Centre as above Lead Clinician for this service is Francis Collier who would be willing to discuss patients with you should you wish. He is available at Seafield Road Dental Practice Seafield Road Aberdeen AB15 7YT Tel: 01224 846745 OR Bayview Dental Practice Academy Drive Banff AB45 1BP Tel: 01261 819849 Referral forms Referral forms are downloadable at www.hi-netgrampian.org/referralformsbyspeciality Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 42 General Anaesthetic Referrals for Adult Special Care Dentistry These should only be made as a last resort when other methods of anxiety management or sedation have been attempted. Waiting Times All referrals for adult Special Care Dentistry are triaged by senior clinical staff according to the description of the case and the urgency with which patients need to be seen. Radiographs Up to date, relevant radiographs, if appropriate, should be provided. Patients/Carers requiring an Urgent Appointment 1. Patients should contact their registered dentist in the first instance or 2. DIAL on 0845 45 65 990 Monday – Friday 8.05 - 5.45 or 3. NHS24 on 0845 4 24 24 24 outwith these times. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 43 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 44 Primary Care Dental Services Referral Form – Special Care Dentistry Send to: Special Care Dental Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS. Normal NHS Patient Charges Apply A. Patient’s Personal Details Referral date Surname Gender Male Female CHI number Forename Date of birth Address Town Postcode Daytime Phone Mobile Phone Home Phone e-mail If your patient needs to communicate in a mode or language other than English please specify: Please state whether an accompanying person can translate or if an interpreter will be needed: Name of contact person: Relationship / status e.g. relative / key worker / social worker etc: Address Tel: Is the patient registered at your practice? Yes No Please mark box to confirm I confirm this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services Print Name of Referring Signed (Clinician) REFERRING PRACTITIONER GMP or GDP STAMP/DETAILS inc Phone Date OR Other Referrer’s DETAILS inc Phone Form reviewed March 2011 Administration for the Referral Service (Do not write in the area below) Continued overleaf Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 45 Special Care Dentistry Referral Form Page 2 If unable to print form double sided, then please re-enter Please re-enter patient’s name & DoB Reason for referral: Access Medical complications Anxiety / phobia Learning disability Does the person go out at all? Living arrangements: Mobility: Yes No Alone Walks unaided With family Needs walking aid In care Wheelchair user Bedbound What transport arrangements would be required to allow them to attend a dental surgery adapted to cater for special care patients: Medical history Please list all current medications taken and any specialist medical clinics attended: Physical Disability: Mental Disability: Sensory Disability: Communication Difficulties: Any other relevant information: Summary of oral health status (e.g. caries and oral hygiene) Help that you can provide Please include details of dental care that you are able to provide e.g. prevention, as well as your referral request Enclosures (e.g. radiographs, study models, photographs) Would you like these returned? Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email Yes No [email protected] 46 Primary Care Dental Services Referral Form - Domiciliary Request Send to: Special Dentistry Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS. A. Patient’s Personal Details Referral date Surname Gender Male Female CHI number Forename Date of birth Address Town Postcode Daytime Phone Mobile Phone Home Phone e-mail If your patient needs to communicate in a mode or language other than English please specify: Please state whether an accompanying person can translate or if an interpreter will be needed: Name of contact person: Relationship / status e.g. relative / key worker / social worker etc: Address Tel: Is the patient registered at your practice? Yes No Please mark box to confirm I confirm this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services Print Name of Referring Clinician Signed (Clinician) REFERRING PRACTITIONER GMP or GDP STAMP/DETAILS inc Phone Date OR Other Referrer’s DETAILS inc Phone Form reviewed March 2011 Administration for the Referral Service (Do not write in the area below) Continued overleaf Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 47 Primary Care Dental Services Referral Form Domiciliary Request Page 2 If unable to print form double sided, then please re-enter Please re-enter patient’s name & DoB Reason for referral: Access Medical complications Anxiety / phobia Learning disability Does the person go out at all? Yes No When did they last get out? How do they attend hospital appointments? Living arrangements: Mobility: Alone Walks unaided With family Needs walking aid In care Wheelchair user Bedbound What transport arrangements would be required to allow them to attend a dental surgery adapted to cater for special care patients: Medical history Please list all current medications taken and any specialist medical clinics attended: Physical Disability: Mental Disability: Sensory Disability: Communication Difficulties: Any other relevant information: Summary of oral health status (e.g. caries and oral hygiene) Help that you can provide Please include details of dental care that you are able to provide e.g. prevention, as well as your referral request Enclosures (e.g. radiographs, study models, photographs) Would you like these returned? Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email Yes No [email protected] 48 6.2 Surgical dentistry services Contact Details All referrals should be made through Dental Advice and Referral Centre indicating which service you wish to access: Surgical Dentistry Services NHSG Dental Advice and Referral Centre Westholme Queen's Road Aberdeen AB15 6LS Referral Centre Phone Referral Centre Fax 01224 556301 01224 556587 Clinical Educational Lead/ Senior Dentist: Senior Dentist: Salaried Dentist: Dental Nurse Team Leader Andrew McIntosh Bernice McLaughlin Archana Kavi Jill Greig • Please ensure referrals are made on the appropriate form and accompanied with radiographs where indicated otherwise the referral may be declined. • DO NOT EMAIL FORMS to the service. (E-Referrals under development) • Patients will be treated under the GDS contract and therefore a fee will be incurred for patients eligible for payment Services available The Surgical Dentistry Service will accept NHS or unregistered patients, aged 16 years and over, from the following categories for treatment under local anaesthesia only. • • • • Failed dental extractions Surgical removal of fractured/buried roots Impacted third molars with soft tissue/moderate bone impaction Mild/moderate medically compromised patients; ASA I and II, e.g.: patients on warfarin, cardiac, respiratory & other medications, fit for treatment under local anaesthesia. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 49 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 50 Referral Form for Surgical Dentistry Send to: Surgical Dentistry Services, NHSG Dental Advice & Referral Centre, Westholme, Queens Road, Aberdeen, AB15 6LS. A. Patient’s Personal Details Please insert dates in dd/mm/yyyy format Date of Referral Surname Gender Male Female CHI Number Forename Date of Birth Address Town Postcode Daytime Phone Mobile Home Phone e-mail If your patient needs to communicate in a language or mode other than English please specify: If yes, please specify and state whether an accompanying person can translate or if an interpreter will be needed. To aid compliance with the Disability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance Impairment Is the patient registered at your practice? Yes No Please check box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services Print Name of Referring Clinician Signed (Clinician) REFERRING PRACTITIONER GDP STAMP/DETAILS Date GMP STAMP/DETAILS Patient’s presenting complaint Clinician’s concerns Why are you referring the patient? What outcome do you seek? Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 51 PLEASE PRINT FORMS on BOTH SIDES OF ONE SHEET. If this is not possible then please reenter please re-enter patient’s name & Date of Birth Medical history, including all drugs being taken and any allergies. Note if no relevant history Dental history What treatment has been attempted for this problem before the referral was made? What treatment are you planning to provide for the patient in their current care plan? Summary of oral health status (e.g. caries and oral hygiene) Smoking status Enclosures: Alcohol consumption Radiographs Study models Photographs Details: Would you like these returned? Yes No Is there any other information we need to know? Form reviewed March 2011 Administrative Information for the Referral Service (Do not write in the box below) Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 52 7. University of Aberdeen Dental School & Hospital Contact details Reception: Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZR Tel: 01224 551901 Staff Director & Head of Aberdeen Dental School: Clinical Director Professor James Newton Mr Martin Donachie The University of Aberdeen Dental School and Hospital opened in November 2009. It comprises the University of Aberdeen Dental School, Secondary Care consultant dental services including Restorative Dentistry, Children, Orthodontics and Oral Surgery. The building has its own laboratories, LDU and radiology facilities. In addition primary care services for patients with special needs, emergency dental care and other sub consultant support staff are co-located on the same site in a purpose-built, state-ofthe-art institution. At full student complement, the centre will have 80 Dental Students, 8 trainee Dental Nurses and 2 trainee Dental technicians. 7.1 Student Clinics The Dental School requires patients for the training of dental students. This treatment is provided free of charge. All patients recommended for treatment by dental students will be assessed by a clinical member of staff. If they are not suitable, for any reason, then the treatment will not be offered and the patient discharged. It is important to note that the patient will not be assessed by a consultant and a treatment plan will not be provided. If you think that the patient requires a consultant opinion then please make a referral in the usual way using the proforma. If you are recommending a patient for assessment you must tell the patient that they will be treated by students who are obviously relatively inexperienced and take longer than an experienced dentist. The patient must be able to attend regularly during the working week. The patient must be told that: • they must attend for an assessment visit to assess their suitability for treatment • they are being recommended for free treatment by dental students • requests for treatment are not always accepted • they must be able to be regularly available during the working week (Monday to Friday between 9am5pm) to attend their appointments • students take longer than experienced dentists. If you have any queries with regard to University of Aberdeen Dental School and Hospital please contact: Administrator Layla Smith E-mail [email protected] Tel: 01224 558845 Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 53 Dental Technician Advice at Aberdeen Dental School & Hospital Contact details Keith Ewan University Dental Instructor Aberdeen Dental School and Hospital Cornhill Road Aberdeen AB25 2ZR Email [email protected] Any member of the dental team who would like advice on any aspect of preparation or handling of laboratory work is welcome to contact Mr Ewan, if you are unable to obtain advice from your usual dental laboratory. He can give advice or direct you towards the appropriate route for your requirements. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 54 ADULT Referral Form for DENTAL STUDENT TREATMENT Send to: Aberdeen Dental School and Hospital, Cornhill Road, Aberdeen, AB25 2ZR This form should be used to recommend an adult patient for treatment by dental students. It should only be used for patients who require routine primary care. The Dental School requires patients for the training of dental students. This treatment is provided free of charge. All patients recommended for treatment by dental students will be assessed by a clinical member of staff. If they are not suitable, for any reason, then the treatment will not be offered and the patient discharged. It is important to note that the patient will not be assessed by a consultant and a treatment plan will not be provided. If you think that the patient requires a consultant opinion then please make a referral using their specialty form or by letter. If you are recommending a patient for assessment you must tell the patient that they will be treated by students who are obviously relatively inexperienced and take longer than an experienced dentist. The patient must be able to attend regularly during the working week. Please confirm that you have provided the following information (incomplete forms will be returned). The patient has been told that: • They must attend for an assessment visit to assess their suitability for treatment • They are being recommended for free treatment by dental students • Requests for treatment are not always accepted • They must be able to be regularly available during the working week (Mon- Fri between 9am5pm) to attend their appointments • Students take longer than experienced dentists • If accepted for treatment they will be re-registered as an NHS patient with the Dental School A. Patient’s Personal Details Date of Referral Gender Surname Male CHI Number Female Forename Date of Birth Address Town Postcode Daytime Phone Mobile Home Phone e-mail If your patient needs to communicate in a language or mode other than English please specify: If YES, please specify & state whether an accompanying person can translate or if an interpreter will be needed. To aid compliance with the Disability Discrimination Act, please indicate if patient has any special mobility requirements : Mobility Assistance Impairment Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 55 Adult Dental Referral to Dental Student Clinics page 2 Reasons for referral Medical history, including all drugs being taken and any allergies. Note if no relevant history BPE Scores Oral Hygiene Smoking status Alcohol consumption Treatment required Simple periodontal care Routine fillings (including composites) Partial Dentures Routine crowns (including resin bonded and metal ceramic) Upper Complete dentures Lower (Alveolar ridge morphology must be appropriate for undergraduates ) Endodontics (anteriors and premolars only) Tooth Seen and agreed by patient: Name: (please print) Signature Date: _________________ ** NB REQUESTS FOR TREATMENT MAY NOT ALWAYS BE ACCEPTED ** Is the patient registered at your practice? Yes No Please tick box to confirm I confirm that this patient referral comes within the current referral guidelines issued by NHS Grampian Dental Services Print Name of Referring Clinician Signed (Clinician) if manual copy REFERRING PRACTITIONER GDP STAMP/DETAILS Date GMP STAMP/DETAILS Form reviewed August 2010 Administrative Information for the Referral Service (Do not write in the box below) Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 56 7.2 Paediatric Dentistry at Aberdeen Dental School Contact Details Tel: Dr J Foley Senior Lecturer/Honorary Consultant Department of Paediatric Dentistry The University of Aberdeen Dental School and Hospital Cornhill Road Aberdeen, AB25 2ZR 01224 555155 Reception Tel: Fax: E-mail: 01224 551901 or 01224 551084 01224 551096 or 01224 550137 [email protected] Clinical Staff Consultant/Senior Lecturer: NHSG Lead clinician: Dr J Foley Dr M Stewart Paediatric Dentistry Department Overview The Department was established within The University of Aberdeen Dental School and Hospital in 2010 and aims to provide an undergraduate education in Paediatric Dentistry as part of the four-year, graduate-entry BDS degree programme. In addition, the Department will accept referrals for those patients whose practitioners require advice on treatment and where indicated, specialist treatment for children within the Grampian region. The appointment of a second specialist within the region is imminent with the recruitment of a Fixed Term Training Appointment/Development Consultant in Paediatric Dentistry post which should facilitate postgraduate educational opportunities in the discipline. Currently links are being created with the Royal Aberdeen Children’s Hospital for multi-disciplinary dental care as follows: • general anaesthetic for minor oral surgical procedures and comprehensive dental treatment of anxious- and medically compromised patients; • cleft lip and palate and dento-facial anomalies; • haematological and oncological patients, including organ transplant recipients. Referrals The Department will accept referrals for the following types of patient: Children up to sixteen years at initial referral who have • Dental trauma; • Dental anomalies, e.g. hypodontia and hypoplastic teeth; • Advanced restorative treatment, e.g. discoloured non-vital teeth, tooth wear; • Minor oral surgery for pathology and orthodontic treatment, e.g. non-erupted incisor teeth, impacted canine units, infra-occluded primary molar teeth; • Restorative treatment of dental caries and pulpal therapy for children who are not medicallycompromised; • Orthodontic extractions either with local anaesthetic or inhalation sedation; • Individuals with intellectual, medical, physical, psychological and/or emotional problems. Referral of Patients with Dental Caries: The Department will accept as a referral those patients who meet the following criteria: • Less than four carious teeth and who are not medically-compromised; • Children with caries who are medically-compromised. Those children who have been diagnosed with multiple carious teeth, i.e. in excess of four carious teeth should be referred to the NHSG Children’s Dental Service. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 57 Consultant/Treatment Planning Clinics All patient referrals will be triaged by the Consultant and subsequently assessed and treatment planned within 12 weeks of the initial referral on a Consultant/Treatment Planning Clinic. Arrangements will be made to see those patients who due to the nature of their referral require a more urgent consultation. A detailed report will be forwarded on to the referring practitioner within two weeks of each patient’s initial consultation. Where advice only has been sought, a detailed plan of treatment will be included within this letter. Joint Paediatric/Orthodontic Clinic The Department will accept patients who require a joint paediatric and orthodontic opinion for patients with the following dental problems: • Supernumerary teeth • Non-erupted teeth, e.g. central incisors • Impacted teeth, e.g. canine units • Dilacerated teeth • Infra-occluded primary molar teeth • Hypodontia The clinic is run jointly by Drs J Foley and Dr K Khalaf, Senior Lecturer/Honorary Consultant in Orthodontics. Dental Trauma Clinic The Department has established a monthly trauma clinic which will accept referrals for patients who have sustained oro-dental trauma which may either be for advice or treatment. Treatment Clinics If indicated and deemed necessary, treatment will be organised as follows: • Treatment will be undertaken on the student teaching clinic under staff supervision; • Specialist treatment will occur within either the Aberdeen Dental School and Hospital or the Royal Aberdeen Children’s Hospital; • Referral of a patient to the Salaried Dental Service. At the end of a course of treatment within the Hospital Dental Service, each patient will be returned to their referring practitioner and a letter indicating all treatment which has been undertaken will be sent within two weeks of patient discharge. Where a patient is no longer registered with their referring practitioner, arrangements will be made for a patient’s recall either within Aberdeen Dental School and Hospital or the patient will be referred to the Salaried Dental Service. Department Referrals All patients should be referred to Dr J Foley, Department of Paediatric Dentistry, in writing (by Children’s Dentistry Referral Form or a letter) to include the following information: • • • • • • Contact details of the referring practitioner; Patient name, address, date of birth and contact details; Reason for the referral, including whether advice or treatment is being sought; Relevant clinical history and findings; Relevant medical- and social history; Relevant and up-to-date radiographs which will be copied and the originals returned. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 58 8. Smoking Cessation Referrals Stop Smoking Guidance in Scotland If a patient is a smoker they should be advised on both the health risks of continuing and the benefits of giving up. There is evidence of links not only with oral cancers in adults but also increased incidence of decayed and filled teeth in children who live with smokers. Smokers who express a desire to quit should be informed of the value of NHS Smoking Cessation Services for specialist help with their quit attempt. NHS Grampian Smoking Advice Service Room G27, Summerfield House 2 Eday Road, ABERDEEN, AB15 6RE Phone 0500 600 332 e-mail [email protected] www.justfiveminutes.com/nhsgrampian The Smoking Advice Service (SAS) is NHS Grampian’s smoking cessation service. Smoking cessation sessions are provided across Grampian at a range of healthcare and community venues. The client attends a course of six 1-hour sessions, designed to help them to plan and manage their attempt to quit smoking. The SAS can offer advice on choosing and managing medication. With a 79% success rate at 4 weeks, this is one of the most effective Stop Smoking Services in Scotland. The Community Pharmacy Scheme is available from community pharmacies across Grampian on a “walk-in” basis. Patients attending this scheme receive 12 weeks of support and nicotine replacement therapy (NRT). With a 41% success rate at 4 weeks, this is one of the most successful pharmacy schemes in Scotland. We also offer a range of training for health professionals. Our most popular course, “Raising the Issue of Smoking” covers knowledge around tobacco, smoking and health, communication skills and how to refer people to local stop smoking services for support. For more information about the Smoking Advice Service, to find out how you can refer to discuss our range of training available, please contact the SAS, free of charge, on 0500 600 332 or by e-mailing [email protected]. You can also visit www.hi-netgrampian.org/sas for more information. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 59 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 60 Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 61 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 62 Smoking Advice Service Room G27, Summerfield House 2 Eday Road, ABERDEEN, AB15 6RE Phone 0500 600 332 e-mail [email protected] www.justfiveminutes.com/nhsgrampian SMOKING ADVICE SERVICE: To attend any of the classes in the Grampian Area please call free phone number 0500 600 332 for further advice. An appointment then can be made for you to attend the next available session. Sessions are available in a range of location across Grampian (see attached map). Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 63 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 64 9. Referral Guidance Notes Periodontics Referral Guidelines Accurate details in the referral helps patients with significant problems to be seen and treated more quickly. Specialist periodontal treatment is provided with priority given to patients with: • Significant medical problems which may increase risk of severe periodontal disease eg organ transplant, diabetes, immunosuppression, renal disease, marked xerostomia. • Risk of complication from periodontal treatment eg due to anticoagulant therapy • Aggressive Periodontitis (previously known as Early Onset or Juvenile Periodontitis) • Complex restorative treatment planning or a multidisciplinary needs • Periodontal surgery including crown lengthening and mucogingival procedures • Furcation involvement associated with active disease • Patients who have failed to respond to initial phase therapy* and who have pockets >5.5mm (BPE/ CPITN score of 4) • Patients <35 yrs with pockets >5.5mm (BPE 4) • Patients <20 yrs with pockets >3.5mm (BPE 3) Treatment is typically not provided for patients: • With chronic marginal gingivitis alone in the absence of pocketing (BPE ≤ 2) • With chronic periodontitis with no pocketing >5.5mm • Who have chronic periodontitis and who have failed to respond to initial phase therapy* • For financial reasons alone *Patients with poor oral hygiene and a diagnosis of chronic periodontitis should receive periodontal treatment and demonstrate motivation to improve periodontal health prior to specialist referral. Typically this treatment should comprise: 1. Oral hygiene instruction, particularly emphasising appropriate interdental cleaning 2. Supragingival scaling and polishing 3. Subgingival scaling and root surface instrumentation to all areas of pocketing >4mm. This may require to be performed over several visits to treat the whole mouth The following information should be included in the referral letter in order to allow an appropriate priority to be placed on the case: 1. 2. 3. 4. BPE scores or other detailed clinical attachment record Information relating to any acute episodes of symptoms Predisposing factors such as relevant medical history or smoking Summary of treatment provided and patient response Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 65 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 66 Who Is Likely To Benefit From Orthodontic Treatment & Who’s At Risk From It? Deciding The Risk: Benefit Balance EA Turbill, NHS Grampian Orthodontic treatment carries risks as well as benefits. The main risks are decalcification & caries around the appliances, gingivitis & loss of periodontal attachment, & root resorption. There is always also the risk of non-improvement or even negative improvement from the treatment; this is a particular risk if a patient’s compliance with treatment is poor. This advice sheet is to help you identify those patients most likely to benefit from an Orthodontic referral, & those it would be best to discourage from Orthodontics. Patients likely to benefit from Orthodontic treatment (as long as their Oral Care is good) are those with: • Cleft Lip or Palate – but they’re probably already registered with the local Cleft Team, unless they have only recently come to the UK. • Teeth (other than 8s) that are ectopic or have their eruption obstructed (impactions). • Missing teeth (hypodontia) resulting in gaps. • Overjets greater than (>) 6mm. • Reverse overjets >3.5mm &/or that cause problems with speech or mastication. • Displacements on closure greater than 2mm if caused by premature contacts. • Scissors-bites with no functional occlusion in one or both buccal segments. • Crowded &/or rotated teeth with contact-point displacements greater than 4mm. • Traumatic overbites (biting the gingivae lingual or labial to the incisors). • Open-bites (anterior or posterior) in excess of 4mm. • Extra teeth or severely submerging deciduous teeth and/or: • Marked disharmony in proportions of mid- &/or lower face. • Severe cosmetic impairment due to arrangement /positions of teeth. (The above patients are also likely to score grade 4 or 5 on the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN), & / or 8, 9 or 10 on its Aesthetic Component – see attached pictures) Patients unlikely to benefit from Orthodontic treatment & at significant risk of nonor negative- benefit are those with: • Any patient with active caries, poor plaque control or who is disinterested in treatment. • Overjets of 6mm or less if the lips are competent. • Overjets of 3.5mm or less whether or not lips are competent. • Displacements on closure of 1mm or less. • Contact point displacements & open bites of 2mm or less. • Mildly increased overbites with no palatal or gingival contact. • Open bites (anterior or posterior) of 2mm or less. and • No, or only mild, cosmetic impairment. (These patients are likely to score 1 or 2 on IOTN Dental Health Component, and 1-4 on IOTN Aesthetic Component). Other patients - the “In-between” group, would be “Borderline Need” cases who may derive some benefit from Ortho if they are keen and compliant patients with excellent oral care, but they would also be at some risk of non- or negative- benefit. Interpretation of Aesthetic Component of IOTN Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 67 Grade 1 Grade 10 = most aesthetic arrangement of the dentition = least aesthetic arrangement of the dentition Grade 1 - 4 = little or no treatment required Grade 5 - 7 = moderate or borderline treatment required Grade 8 - 10 = treatment required Interpretation of Quick Referral Guide Assess main malocclusions – identify in Column 1 Columns 3,4,5 – indicate recommended referral route (ticked box) Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 68 Management of Dental & Dento-Alveolar Trauma Here is a brief overview of the initial management of dental trauma to both the primary- and permanent dentitions. 1. Primary Dentition Dental Trauma Enamel Infraction • Review Enamel Fracture • Smooth • Composite resin, if co-operative Enamel-Dentine Fracture • Smooth • Composite resin, if co-operative Complicated Coronal Fracture • Extraction • Pulpectomy, obturation with zinc oxide eugenol and composite resin, if co-operative Coronal-Radicular Fracture • Extraction Radicular Fracture • Review if non- or minimal mobility and no displacement • Extraction of the coronal fragment if either of the following apply: o Coronal fragment is non-vital o Marked displacement and mobility Dento-Alveolar Trauma Concussion • Review Subluxation • Review Extrusion • Extraction, if marked mobility Lateral Luxation • • Review if non- or minimal mobility and no occlusal interference Extraction if either of the following apply: o Excessive mobility and/or interference with the occlusion o Buccal displacement of the crown, i.e. palatal displacement of the root Intrusion • • Review if the root is displaced buccally Extraction if either of the following apply: o Palatal displacement of the root o Non-eruption of an intruded tooth after six months Avulsion • Do not re-implant Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 69 2. Permanent Dentition Dental Trauma Enamel Infraction • Review Enamel Fracture • Smooth • Composite resin, if co-operative Enamel-Dentine Fracture • Temporize with either a composite- or composer dressing • Composite resin • Re-attachment of coronal fragment o If fracture line not close to the pulp, immediate re-attachment o If the fracture line is close to the pulp, dress with tooth with calcium hydroxide and a temporary composer or composite dressing. Store the tooth fragment in saline, which is changed weekly and the fragment is re-attached after one month Complicated Coronal Fracture: Vital Pulp Therapy • Pulp capping with calcium hydroxide if < 24h exposure, • Pulpectomy with calcium hydroxide if > 24h exposure Coronal-Radicular Fracture • Extraction of the coronal fragment(s) • Space maintain Radicular Fracture • Review if apical third, although if mobile, splint for two weeks • Re-position coronal fragment and splint for two weeks if mid-third fracture • Re-position coronal fragment and splint for two weeks or extraction if coronal third fracture and space maintain Dento-Alveolar Trauma Concussion • Review Subluxation • Review Extrusion • Re-position and splint for two weeks Lateral Luxation • Re-position and splint Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 70 Intrusion • • Open apex tooth: o Review if intruded < 3mm o Allow spontaneous eruption or orthodontic extrusion if intruded 3-6mm o Orthodontic extrusion or surgical repositioning and splint if intruded > 6mm Closed apex tooth o Orthodontic extrusion if intruded < 3mm o Orthodontic extrusion if intruded 3-6mm o Surgical repositioning and splint if extruded > 6mm Avulsion • • • • Ideally, re-implanted at the time of injury If not re-implanted immediately, store in milk, saliva, saline or Viaspan® Re-implant and splint Endodontic treatment for the following clinical situations: o Open apex tooth with an extra-alveolar time of > 30-45 minutes o Closed apex tooth Notes • • • • • • • • Treatment may vary depending on for example, the patient’s medical history, cooperation for treatment etc. All patients should be advised regarding symptomatic care which includes the use of a soft diet, simple analgesia etc. Appropriate reviews should be organised for sensibility testing For primary tooth trauma, ensure the following: o that all treatment minimizes the risk of disturbance to the permanent dentition; o that the carer/legal guardian is aware of the risk of trauma to the permanent dentition either from the initial traumatic injury or from subsequent treatment; For permanent tooth trauma, advise the patient/carer/legal guardian regarding the possibilities of loss of vitality and root resorption, relative to the type of trauma; All endodontic treatment should be completed under rubber dam; All splints used for dento-alveolar trauma are flexible, i.e. the splint includes the traumatised tooth/teeth, and also, one tooth unit either side of the traumatised unit(s); Splints should allow for sensibility testing and if necessary, endodontic treatment. Further Information • • Guidelines for the management of traumatic injuries to the primary dentition and for fractures, luxation and avulsion injuries in the permanent dentition are available as pdf files. These may be obtained via e-mail from the Referral Centre, e-mail [email protected] The guidelines define the various injuries, outline both immediate- and follow-up regimes and contain a number of useful photographic images. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 71 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 72 Guidelines for Referring Child Patients for Dental Extractions under General Anaesthetic J Foley Currently accepted best practice for managing the child patient who requires general anaesthetic for dental extractions is to treatment plan the patient to ensure that the use of general anaesthesia is kept to the minimum. The following guidelines should ensure that this occurs: 1. All • • • • • Extraction of Primary Teeth teeth which meet the following criteria should be extracted: All carious primary teeth; All heavily restored primary teeth; All grossly worn primary teeth; All mobile primary teeth; Any primary tooth required for balancing purposes to prevent centre-line shift. 2. Extraction of Carious or Hypoplastic First Permanent Molar Teeth Where no orthodontic treatment is planned in a Class I occlusion with little or no crowding: • Extraction of the mandibular first permanent molar tooth at 8½-9½ years of age. Compensate with extraction of the opposing maxillary first permanent molar tooth. Do not balance with extraction of the contra-lateral tooth. • Extraction of the maxillary first permanent molar tooth at 8½-9½ years of age. Do not compensate with extraction of the opposing mandibular first permanent molar tooth. Do not compensate with a contra-lateral extraction. For any patient with significant crowding and for those with a Class II- or III occlusion, an orthodontic opinion should be attained prior to any extraction. 3. Dental Radiographs Ideally, radiographs should be taken at initial assessment. A set of bitewing radiographs is useful to demonstrate inter-proximal caries in both the primary- and permanent dentition. When treatment planning the carious or hypoplastic first permanent molar tooth, a DPT will demonstrate the prognosis of these teeth and also, the presence and stage of development of the other permanent teeth. If a DPT is not possible, then periapical radiographs can be useful again, to demonstrate the extent of the carious process and the presence of neighbouring teeth. If a patient is not able to tolerate dental radiographs, e.g. due to anxiety then this should be noted in the referral letter. 4. Dental Restorations All dental restorations should be completed prior to referral. Where there is doubt regarding the long-term prognosis of a restored tooth and following radiographic review, any such tooth will be extracted. 5. Orthodontic Extractions General anaesthetic will not be provided for the orthodontic extraction of non-carious teeth. In extenuating circumstances, e.g. a medically-compromised patient who is not suitable for orthodontic dental extraction with sedation and following consultation with their Medical/Paediatric Consultant and the Consultant Anaesthetist, orthodontic extractions may be organised. Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 73 Blank page Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 74 10. Useful links • Use of Community Health Index (CHI) Numbers The SCI Gateway system uses the NHS CHI patient ID system and a dental “CHI LOOK UP Service” will be available as part of the Dental e-Referral Programme. • Updates on Referral Guidance These will be available on the NHS Grampian Hi-Net: www.hi-netgrampian.org/referralformsbyspeciality Check the site for availability of • Downloadable Dental Referral Forms for different specialties • Downloadable Information Sheets for Patients will be downloadable from here soon. This service is still under development (September 2010) • Teeth TLC NHS Grampian's latest oral health campaign. www.teethtlc.com • Scottish Dental Website http://www.scottishdental.org/ A useful starting point for any practising dentist in Scotland. Also has useful links for patients who should click on the “Public” button for easy access to topics including: • Emergency dental services • Finding a dentist • Treatment charges • Dental Topics explaining various oral conditions. These links are very informative but perhaps more user-friendly explanations for patients of oral health and disease are found at: • NHS24 website: Health Information and Self Care Advice for Scotland The Health Library section is at: http://www.nhs24.com/content/default.asp?page=s5 • Scottish Dental Clinical Effectiveness Programme (SDCEP) http://www.sdcep.org.uk/ Downloadable evidence based guidance including: • Emergency Dental Care • Conscious Sedation • Drug Prescribing for Dentistry • Management of Dental Caries in Children • Practice Support Manual • British National Formulary (BNF) www.bnf.org • Knowledge Network www.knowledge.scot.nhs.uk • Scottish Intercollegiate Guideline Network (SIGN) www.sign.ac.uk • e-Den Dental learning free to all NHS dental staff and available 24 hours a day. Make use of this while it is still available as it is under government budgetary review (2010). www.e-lfh.org.uk/projects/dentistry/ Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 75 • Foreign languages: The British Red Cross Emergency Multilingual Phrasebook The Emergency multilingual phrasebook contains 62 common medical questions and statements in 36 languages and is used to enable basic communication between first contact carers and patients in medical emergency situations. Copies of this can be purchased for £20 from the British Red Cross but online versions are downloadable from The Department of Health Website at http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/ DH_4073230 The phrasebook can be downloaded in Portable Document Format. For ease of access, it has been loaded as separate chapters for each of these languages: Albanian, Amharic, Arabic, Bengali, Bosnian-Bosanski, Chinese, Czech, English, Farsi, French, German, Greek, Gujarati, Hindi, Hungarian, Italian, Japanese, Korean, Kurdish, Lingala, Macedonian, Pashto, Polish, Portuguese, Punjabi, Romanian, Russian, Slovak, Somali, Spanish, Swahili, Tamil, Turkish, Ukrainian, Urdu, Vietnamese, Welsh. • Foreign languages: The NHS Language Line NHS Grampian subscribes to the following service: http://www.languageline.co.uk/page/industry_healthcare/ • Foreign languages: The NHS “Health in My Language” Resource Information about health and health related services in Scotland which has been translated into different languages. http://www.healthinmylanguage.com/home.aspx • Foreign languages: “How to Say in?” Language Resource Online translation for common phrases in 24 languages: http://www.howtosayin.com/hello.html And finally • A Chairside Communication Guide in English, Spanish, French and Chinese courtesy of Crest Toothpaste http://www.dentalcare.com/en-US/patient/comm_guide.jspx Last updated 23/06/11 Customisable forms at www.hi-netgrampian.org/referralformsbyspeciality or email [email protected] 76
