Download Orthodontics - Birmingham Community Healthcare

Service Specification
Specialty - Orthodontics
Specialty
Orthodontics is a consultant led specialty service concerned with the
Information development of the teeth, jaws and management of established malocclusion.
Orthodontic Treatment involves the use of orthodontic appliances (‘braces’) to
produce changes in tooth positioning, alignment and relationships, within a dental
arch and between dental arches. Typically in the late mixed or early permanent
dentition (ages 10-14 years) active treatment will take about 2 years, followed by
a period of passive retention; earlier or later orthodontic intervention might be
appropriate.
The orthodontic specialty works closely with other dental specialties to deliver
integrated treatment which requires multi-disciplinary assessment, treatment
planning and treatment delivery.
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Orthodontic treatment in conjunction with Restorative Dentistry
Children and adults with absent or malpositioned teeth may require
orthodontic treatment to change tooth positioning prior to restorative tooth
replacement.
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Orthodontic treatment in conjunction with Paediatric Dentistry
These specialties work closely together in the management of the
developing dentition.
Severe Hypodontia (congenital absence of many teeth) requires multidisciplinary planning and treatment by the Orthodontic Paediatric and
Restorative Dentistry specialties.
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Orthodontic treatment in conjunction with Oral Surgery
Joint assessment and planning is required in the management, in
particular, of un-erupted and ectopic teeth, submerging deciduous teeth,
supernumeracy teeth and other dental pathology.
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Orthodontic treatment in conjunction with Oral & Maxillofacial Surgery
Major variants in jaw, and therefore tooth, relationships can only be treated
with elective orthognathic surgery. This requires integrated case
assessment and treatment planning for a phased treatment delivery
involving both specialties. Can only be considered in the adult patient.
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Orthodontic Treatment and Craniofacial Surgery
Birmingham is one of four regional craniofacial referral centres in England.
The orthodontic department aims to be involved in the management of
patients with severe craniofacial deformity.
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Orthodontic treatment of the Cleft Lip and Palate Patient
The orthodontic service is closely integrated with the Regional Cleft Lip
and Palate Centre based at Birmingham Children’s Hospital. The majority
of orthodontic treatment for cleft patients in Birmingham, Solihull and the
Black Country is carried out at Birmingham Dental Hospital.
As a secondary and tertiary treatment service, all referrals are made by primary
care practitioners or consultant colleagues and accepted according to referral
criteria. Patients vary in complexity and many may require multi-disciplinary
management.
Referral
Criteria
The department provides Consultant Orthodontic advice and treatment planning
service for referring practitioners. For most patients the late mixed dentition will
be the appropriate time; an early referral at age 9-10 should be considered for
marked skeletal discrepancies. Unerupted or ectopic teeth in adolescence should
be considered an Orthodontic problem.
In addition to the generic information given in the Hospital referral guidelines, for
an Orthodontic referral you should also include: 1.
2.
3.
4.
5.
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7.
Nature of malocclusion
Reason for referral
History of dental attendance
Level of oral hygiene and attitude to appliance treatment.
Any radiographic findings and, if x-rays have been taken within the
past year, the x-rays or copies.
If it is anticipated that orthodontic appliance therapy might be
appropriate it must be confirmed that the patient is dentally fit, has
good oral hygiene and is receiving regular, routine dental care
over a period of time.
When possible and appropriate an estimate of the Index of
Orthodontic Treatment Need (IOTN)
Patients initially, be seen for an assessment and opinion only
Referral letters are expected to comply with a minimum data set that has been
previously identified to general dental practitioners. Failure to comply will result in
the referral letter being returned with a request for the missing information.
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Treatment Acceptance Criteria
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IOTN5
IOTN4 (but NOT routinely 4d)
Craniofacial Anomalies
Cleft Lip and Palate (managed via the Cleft Service)
Multidisciplinary cases including
o Orthognathic
o Hypodontia
o Requiring minor oral surgery
o Complex restorative
Complicating medical histories
Special needs
The Index of Orthodontic Treatment Need (IOTN) is an index of treatment need
and not an indication of treatment complexity. Therefore, where a patient has a
high objective treatment need but the orthodontic management is relatively
straightforward, the patient will be returned to primary care for treatment with
appropriate advice.
Treatment will only be offered to patients in the above categories if he or she:
o Is at an appropriate stage of dental development
o Has a good standard of oral hygiene and dental health
o Has a regular primary care dentist
o Is deemed sufficiently motivated to support orthodontic treatment
Adult patients (over 18) who require multidisciplinary management may be
accepted, but not adult patients where there is a straightforward malocclusion that
could be corrected in primary care.
The department cannot routinely accept patients for the continuation of treatment
that has been commenced outside the UK Hospital Service. This includes
patients who commence treatment in primary care or abroad.
Post-op
Discharge
Patient
Information
(leaflets)
At the end of active orthodontic treatment virtually all patients are provided with
removable orthodontic retainers whilst the occlusion is allowed to settle.
Typically retention is managed in the hospital for one year, after which patients
are referred back to their General Dental Practitioner for continued retainer
management.
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