Christchurch Orthodontics

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Christchurch Orthodontics

  1. 1. GUIDELINES FOR REFERRAL TO THE SPECIALIST HOSPITAL AND SPECIALIST PRIMARY DENTAL CARE SERVICES IN EAST DORSETMay 2006
  2. 2. GUIDELINES FOR REFERRAL TO THE SPECIALIST HOSPITAL AND SPECIALIST PRIMARY DENTAL CARE SERVICES IN EAST DORSET Page NoSECTION 1 Foreword 1 National Health Service (NHS) Referral CentresSECTION 2 Poole Hospital NHS Trust/ The Royal Bournemouth Hospital NHS Trust 2/3 • Maxillofacial SurgerySECTION 3 Dorset Healthcare NHS Trust Primary Care Dental Services including • Community Dental Service 4/5/6 • Intermediate Dental Service 7 • Restorative Dentistry 8SECTION 4 The Royal Bournemouth Hospital NHS Trust • Orthodontics 9/10/11SECTION 5 Independent Orthodontic Referral Guidelines • Only Orthodontics 12/13 • CHRISTCHURCH ORTHODONTICS 14APPENDICES 15Appendix A The Royal Bournemouth Hospital NHS Trust Orthodontic Referral Form 16Appendix B Dorset Healthcare NHS Trust Community Dental Service Referral Form Poole Community Health Clinic 17Appendix C Community Dental Service Referral Form
  3. 3. Page No Parkstone Health Centre 18Appendix D Community Dental Service Special Needs Referral 19 FormAppendix E Community Dental Service Domiciliary Referral Form 20If you require further copies of this document please contact:The Primary Care Contracts TeamFamily Health Services AuthorityVictoria HousePrinces RoadFerndownDorset BH22 9JR(01202) 893000
  4. 4. SECTION 1 GUIDELINES FOR REFERRAL TO THE SPECIALIST HOSPITAL AND SPECIALIST PRIMARY DENTAL CARE SERVICES IN EAST DORSETForewordThis guide is to be sent to all dentists in East Dorset to assist with the appropriatereferral of patients to the comprehensive secondary care specialist services that areavailable.The guide details current NHS specialist centres and every effort has been made toensure that the information given is correct.Documents such as this become rapidly outdated and it is intended that revisions arepublished from time to time. Your comments and suggestions for future guidelineswould be welcome.
  5. 5. SECTION 2 NATIONAL HEALTH SERVICE (NHS) REFERRAL CENTRESMaxillofacial SurgeryPoole Hospital NHS TrustLongfleet RoadPoole DorsetBH15 2JBTelephone (01202) 442145Fax (01202) 442230Consultants Mr W J Peters Mr A F Markus Mr V Ilankovan Mr P L RamchandaniServices also provided at Consultants Royal Bournemouth Hospital WP, AFM, PR Dorset County Hospital VI Wimborne Hospital AFM Blandford Hospital AFMScope of the specialityOral and maxillofacial surgery is the surgical specialty concerned with the diagnosisand treatment of diseases affecting the mouth, jaws, face and neck. Consultantspecialists working in this area are variously termed oral surgeons, maxillofacialsurgeons or oral and maxillofacial surgeons. The specialty is unique in requiring adual qualification in medicine and dentistry and is a recognised surgical specialtywithin Europe, as defined under the medical directives. The scope of the specialty isextensive and includes facial injuries, head and neck cancers, salivary glanddiseases, facial disproportion, facial pain, temporomandibular joint (TMJ) disorders,impacted teeth, cysts and tumours of the jaws as well as numerous problemsaffecting the oral mucosa such as mouth ulcers and infections. BAOMS(www.baoms.org.uk) has produced specialty specific standards, criteria and evidencefor the practice of oral and maxillofacial surgery in the UKReferrals accepted for: • Temporomandibular joint (TMJ) disorders. • Salivary gland disorders. • Maxillofacial/head and neck. • Lumps and bumps: Dermoids, sebaceous cysts, heamangiomata, vascular lesions, branchial cysts, etc.
  6. 6. • Skin and lips Benign: solar keratosis, kerato-acanthoma Malignant: BCC, SCC. • Mouth/tongue Benign: mucosal conditions including lichen planus, pemphigus, pemphigoid, etc. Malignant: SCC, adenocarcinoma. • Facial deformity, facial pain, Maxillofacial trauma • Maxillofacial emergencies: Acute neck swellings Refer to A & E • Dento alveolar Impacted teeth NICE guidelines Warfarinised patients BAOMS guidelines Apical pathology BAOMS guidelines These guidelines are intended to help PCTs and primary care practitioners make an informed decision when contemplating referring patients to a consultant oral and maxillofacial surgeon for advice or treatment.Referrals must be within the abovementioned categories and meet guidelineswhere they exist. The BAOMS website is a useful guide and it is stronglyrecommended that you visit it.Referrals must be accompanied by a letter containing full details of the patient,their complaint, medical history and clinical symptoms, and the reason forrequesting an opinion/further management. Failure to provide this informationwill be met with a request for it be given before an appointment will be sent.Referrals are NOT accepted for: • We do not provide a routine dental service. • We do not accept patients for economic reasons. • We do not make any form of appliance, except diagnostic splints. • We do not accept referrals for routine extractions unless the patient has a medical condition that means their care cannot be reasonably managed within the dental surgery.
  7. 7. SECTION 3DORSET HEALTHCARE NHS TRUSTCommunity Dental Service (CDS)The CDS aims to provide a comprehensive treatment service for children and adultswith disabilities who need special care.ReferralsReferrals are accepted from:General Dental PractitionersGeneral Medical PractitionersAny other Health or Social Care ProfessionalReferrals are not accepted for:Routine treatment on fit/healthy patients.Treatment for AdultsCanford Heath ClinicCulliford CrescentCanford HeathBH17 9DWConsultants Miss Debbie Lewis, Senior Community DentistReferralsWe should be grateful if referrals could be made on the forms provided (Appendix D)as this will give us the information we need to care for the patient in an appropriateand timely manner.Whenever possible, radiographs should accompany the referral.Treatment will be provided for those patients fitting these referral criteria using asuitable modality of pain relief which may include Local Anaesthesia, ConsciousSedation or General Anaesthesia.Referrals should be sent to Miss Debbie Lewis, Senior Community DentistReferrals are accepted for:Adults with disabilities that need special care which would include; • Severe mental health problems • Learning disabilities • Autistic Spectrum Disorders
  8. 8. • Severe medical problems• After head and neck radiotherapy• Significant immunocompromised or immunosuppression• Domiciliary care for housebound patients• Severe bleeding disorders• Severe physical problems• Brain injuries• Life limiting conditionsReferrals are not accepted for:• Adult patients with dental phobias are not usually accepted for treatment and should be referred to local PDS or GDS practices willing to provide sedation.• Adults with blood bourne viruses such as Hepatitis B and C and HIV can be treated without any special precautions and will not be accepted for treatment by the CDS
  9. 9. Treatment for ChildrenPoole Community Health ClinicShaftesbury RoadPooleBH15 2NTTelephone 01202 683363Fax 01202 667009Consultant Miss Anne Williams, Clinical DirectorParkstone Health CentreMansfield RoadParkstonePooleBH14 0DJTelephone 01202 748133Consultant Miss Carol John Senior Community dentistReferralsWe should be grateful if referrals could be made on the forms provided (Appendix B,C) as this will give us the information needed to care for the patients in anappropriate and timely manner.Relevant radiographs should be included if possible.A range of treatment modalities may be used which could include Local Anaesthesia,Conscious sedation, General Anaesthesia.Referrals are accepted for:Children with disabilities that need special care which would include; • Severe medical problems • Learning Disabilities • Autistic Spectrum Disorders • Bleeding disorders • Severe physical problems • Children with repaired cleft lip/palate • Amelogenesis Imperfecta • Dentinogenesis Imperfecta • Hypodontia • Very young children with extensive decay Referrals are not accepted for: • routine treatment for healthy children • orthodontic extractions under general anaesthesia (unless the child has a disability needing special care)
  10. 10. Intermediate Care Dental Service (ICDS)Poole Community Health ClinicShaftesbury RoadPooleDorset BH15 2 NTTelephone 01202 683363Dental Surgeon Mr Chris HawObjectivesThis service provides surgical dentistry suitable for treatment with local anaesthesiaand oral sedation if needed. There is no facility for general anaesthesia.ReferralsWe should be grateful if referrals could be made on the forms provided (appendix B)as this will give us the information we need to care for the patient in an appropriateand timely manner.Radiographs should be included with all referrals.Referrals are accepted for: • Patients requiring the removal of symptomatic third molars that require a surgical approach. • Apicectomy of root filled teeth. • Surgical removal of grossly decayed teeth. • Extractions for patients with medical problems that need special care that cannot reasonably be provided in the dental practice setting.Referrals are not accepted for: • Routine extractions on healthy patients • TMJ problems • Snoring appliances • Extractions under general aneasthesia
  11. 11. Restorative DentistryCanford Heath ClinicCulliford CrescentPooleDorsetBH17 9 DWTelephone 01202 691520Consultant Mr Graham GilmourObjectivesA comprehensive consultation and treatment planning and advice service is availableto all appropriately referred patientsReferralsPlease make referrals to Mr A G Gilmour, Consultant in Restorative Dentistry.Please include in the referral: • The patient’s full name • Date of Birth • Address with postcode • Home and daytime telephone numbers • Clinical history • Nature of the referral. • RadiographsThe majority of patients are returned to the referring practitioner with advice on theirmanagement. Some cases are referred to other specialists or treated within thesalaried dental service if they have a disability needing special care.
  12. 12. SECTION 4Orthodontic DepartmentThe Royal Bournemouth Hospital NHS TrustCastle Lane EastBournemouthDorset BH7 7DWTelephone (01202) 704694Fax (01202) 704645Consultants Mr Jeremy Hodgkins (Whole time) Mrs Mary Short (Monday and Wednesday) Miss Susan Power (Tuesday, Thursday and Friday)DepartmentAdministrator Mrs Lynda FryReception Staff Mrs Dee Hall Mrs Philippa Manley Mrs Nicky ClarkeObjectivesTo provide a comprehensive Consultant Orthodontic Service for the population ofEast Dorset and surrounding area:- • By providing a consultation and advice service. • By retaining for treatment in the Orthodontic Department patients with difficult or complex malocclusions. • By retaining for treatment in the Orthodontic Department patients who for medical or other reasons have special problems associated with their management. • By liaising closely with other medical and dental consultants to plan treatment for patients requiring multi disciplinary management. • By providing continuing postgraduate education for local General Dental practitioners and Community Dental Officers.ReferralsWritten referrals are preferred and should give the following information:- • Name and address of patient. • Date of birth. • Daytime telephone numbers. • The consultant to whom the patient is referred. • Name and address of general dental practitioner. • Name and address of general medical practitioner. • A brief summary of the reasons for referral. • An indication as to whether the referral is urgent or routine.Referrals can also be made by telephone (01202) 704694.
  13. 13. GuidelinesThe Department is always happy to see patients for advice and to provide support forlocal practitioners. However, to enable us to provide an efficient service and to makethe best possible use of the resources available it would be helpful if the followingpoints could be borne in mind when making referrals:-Referrals are accepted for: • Diagnosis and treatment planning. This service is provided for practitioners who have received some orthodontic training in the past and would like to provide treatment for their patients in primary care, where this is appropriate. • Those patients having a Dental Health Component (DHC) of 4 or 5. The Index of Orthodontic Treatment Need (IOTN) is used routinely to identify those patients who will be offered treatment in the Department (further information can be obtained by contacting the Orthodontic Department). • Adults, if their problem is severe or requires multi-disciplinary care. • Patients who are aware of the reasons for referral and are prepared to wear orthodontic appliances, if indicated. Orthodontic treatment will not succeed without patient commitment. • Patients who have an adequate level of oral health. Active dental caries should have been treated and the patient should demonstrate that they are able to maintain satisfactory oral hygiene. • Patients requiring “interceptive” orthodontic treatment in the mixed dentition. Most orthodontic treatment is undertaken when the majority of permanent teeth have erupted and consequently very early referrals for most patients are unnecessary. Those children with severe class II and class III malocclusion should be referred at age 10 to enable growth modification treatment to be undertaken, if indicated. All new patients will be seen for initial consultation within 12 weeks.Referrals are NOT accepted for: • Mild malocclusions, which will not normally be treated. • Mild lower incisor crowding. Treatment is not normally provided where mild lower incisor irregularity is the only presenting problem. • A posterior cross bite with no jaw displacement as this is not normally an indication for treatment. • Adults requiring “routine” orthodontic treatment.
  14. 14. ORTHODONTIC REFERRAL NOTES:Orthodontic referrals may be passed back to practices with a treatment plan providedthat practice has an orthodontic component in their nGDS or nPDS contracts.However, it should be noted that these can only be at IOTN 3 (with an aestheticcomponent of at least 6) or higher for NHS treatment. Anything less than this cannotbe treated under the NHS.
  15. 15. F 01202 760126 SECTION 5Independent Guidelines for referral to Only Orthodontics in 2006Basic Guidelines for Referral of Orthodontic Patients: 40 Alumhurst Road Bournemouth BH4 8ER T 01202 765808We are very pleased to see your patients and hope that the following guidelines willbe helpful to you.We would welcome any feedback you may wish to make. Timing of referrals:NormalMost orthodontic patients will benefit from referral at or just before the completion oftheir permanent dentition (excepting second and third molars). At the latest, pleasemake every effort to refer a patient before the age of 17 years to ensure thattreatment can commence before the age of 18 years or we will not be able to acceptthem for NHS treatment.Treatment to adults or patients with special requirements will be available privately. Jeremy Moore & Susan PowerEarly Referrals 1. Where there is obvious Hard or Soft Tissue Trauma resulting from the malocclusion, for example: wear to incisal edges in the case of a cross-bite; localised gingival recession resulting from labial displacement of a lower incisor. 2. Where there is significantly Delayed Eruption 3. Where it is known that there are Missing Teeth. This will allow the earliest possible planning of the complete dentition. 4. Class III malocclusion in the mixed dentition. Baseline records should be taken for growth monitoring especially if an underlying Skeletal III exists. Also it may be wise to remove a cross-bite if there is an anterior displacement (NB 21|12 should all be erupted before attempting this). 5. Class II/I malocclusion where there is an underlying Skeletal II pattern. (This Specialist Referral Practice can quite easily be detected when the patient postures the mandible forwards keeping the teeth lightly in contact. If the profile improves then Functional Appliance treatment may well yield benefits). Most Functional appliances are easiest to wear when upper 4|4 are fully erupted. Such a patient entering his or her pubertal growth spurt should be seen without delay. 6. Class II/ii patients who have a definite Skeletal II pattern. Many of these would benefit from conversion to a Class II/I then treatment with a functional appliance. 7. Where a patient is seeking compromised treatment, e.g. if an acceptable result looks possible by single extraction with or without simple appliance treatment to follow. In this situation you may wish to have this plan checked. Only OrthodonticsUrgent referrals 1. Where a Dental Impaction exists especially canines. 2. Where there are Permanent Teeth with Poor Prognosis; e.g. first molars, which are being considered for early removal, an orthodontic opinion might be sought if there is a co-existing malocclusion.
  16. 16. General ConsiderationsPatients who have inadequate Oral Hygiene or significant sweet intake in their dietsrender themselves unsuitable for active appliance treatment. If such a patient isreferred for advice it should be explained to them that whilst we are happy to advisethem, treatment will not be available until these issues are addressed.Patients who are reluctant for treatment will present a poor prospect for success.Whilst we can advise and encourage a patient who would benefit from treatment,ultimately it is their choice and not ours or their parents’. In many such cases it is farmore desirable to wait for the child to come round to the idea of treatment in theirown time rather than in any way coerce them.We operate a filtering system using IOTN. Malocclusions scoring less than IOTN 3Aesthetic component 6 will not be offered treatment under the NHS.Because of these considerations we cannot guarantee patients the availability oftreatment under the NHS until we have assessed their suitability. It is thereforeessential that you inform your patients that their referral is initially for adviceonly. Thank you.
  17. 17. CHRISTCHURCH ORTHODONTICSFiona Boardman and Ian Coane103 Stour RoadChristchurchDorsetBH23 1JN01202 483768Referral GuidelinesAge at referralWe are very happy to accept referrals of both children and adults, although adults(over 18 years of age) should be aware that treatment would be provided on a privatebasis.Patient awarenessWe feel it is important that the patient has a good level of oral hygiene and dietcontrol, and that they have an awareness of the reason for the referral.Information needed at referralWe would be grateful for the following information at referral:• name, full address, and telephone number of patient• date of birth• brief description of reason for referral• indication whether urgent (eg traumatic bite, impacted teeth, imminent extraction for caries) or routineDentition stage at referralEarly referrals are accepted but the patient should be in the mixed dentition phase.The patient and parent should be aware that treatment is usually carried out whenmost of the permanent dentition has erupted.Index of Treatment Need (IOTN)In accordance with current NHS guidelines we do use the IOTN to identify thosepatients with malocclusions which would show an identifiable health gain if treated. Ifpatients/parents have particular concerns, but the level of need does not scoresufficiently on the IOTN scale, we would be able to offer treatment privately.
  18. 18. APPENDICES
  19. 19. Appendix ADECISION TO REFERI have given a clear and thorough explanation of the risks involved in generalanaesthesia and have given the patient/guardian information on the alternativemethods of pain control available.I enclose details of the relevant medical and dental histories.The patient/guardian agrees to this referral.Signed…………………………………………………. (Referring practitioner)Date……………………………………………………..
  20. 20. Appendix B Dorset Healthcare NHS Trust POOLE COMMUNITY HEALTH CLINICDENTAL DEPARTMENT Shaftesbury Road, Poole BH15 2NT Telephone 01202-683363 Fax 01202-667009REFERRAL FOR DENTAL TREATMENT PATIENT DETAILSName of PatientAddress…………………………………………………………………………………………………………….…………………………………………………………………………………………………….PostCode………………………….Telephone No. Date of BirthName of Parent/legal guardianReferred under capitation/continuing care Name & Address of Referring Dentist Name & Address of Doctor REASON FOR REFERRAL (To be accompanied by relevant X-rays which will be returned after treatment)Disability needing special careMedical condition needing specialcaree.g. amelogenesis imperfectaDental condition needing specialcare
  21. 21. Extensive decay in a very youngchild- specify ageRelevant Medical HistoryPrevious general anaesthetic historyNB ROUTINE TREATMENT FOR HEALTHY PATIENTS WILL NOT BE ACCEPTEDSigned Date (Referring Dental Surgeon)
  22. 22. Appendix C Dorset Healthcare NHS Trust PARKSTONE HEALTH CENTRE Mansfield Road, Parkstone, BH14 0DJ Telephone : 01202-748133 Referral for Dental Treatment PATIENT DETAILSName of PatientAddressTelephone No. Date of BirthName of Parent/Legal GuardianReferred under capitation/continuing care?Name & Address of Referring Dentist Name & Address of DoctorTREATMENT REQUEST (To be accompanied by relevant X-rays which will be returned after treatment)Reason for ReferralRelevant Medical HistoryPrevious General Anaesthetic HistorySigned…………………………………………………………… Date……………………………………. (Referring Dental Surgeon) Appendix D
  23. 23. Dorset Healthcare NHS Trust SPECIAL NEEDS REFERRAL FORMDate ……………………………………Patient’s name……………………………………………… D.O.B. …………………Address…………………………………………………………………………………….……………………………………………………………Tel No: ……………………….Contact person ………………………………………………………………...Address if different from above……………………………………………………….…………………………………………………....Tel No………………………….Treatment requested (please enclose X-rays)Please state whether LA/GA/Sedation Please state whether Urgent/Non-urgentReason for referral ……………………………………………………………………………Salient medical history ……………………………………………………………………….………………………………………………………………………………………………….Name and address of Doctor …………………………………………………………………………………………………………………………………………………………………Physical disability ……………………………………………………………………………Mental disability ……………………………………………………………………………..Is hospital transport required? Yes/No Type: Car/Ambulance/Tail-lift AmbulanceReferred by ……………………………………………………………………………………..PRACTICE STAMP IF REFERRAL IS FOR A GENERAL ANAESTHETIC, PLEASE SIGN BELOW.I HAVE GIVEN A CLEAR AND THOROUGH EXPLANATION OF THE RISKSINVOLVED IN GENERAL ANAESTHESIA AND HAVE GIVEN THEPATIENT/GUARDIAN INFORMATION ON THE ALTERNATIVE METHODS OFTREATMENT AVAILABLE.
  24. 24. I ENCLOSE DETAILS OF THE RELEVANT MEDICAL AND DENTALHISTORIES.THE PATIENT/GUARDIAN AGREES TO THIS REFERRAL.Signed …………………………………………………………………………(Referring Practitioner)RETURN TO: CANFORD HEATH DENTAL CLINIC, NEIGHBOURHOOD CENTRE,CULLIFORD CRESCENT, CANFORD HEATH, POOLE BH17 9DW
  25. 25. Appendix E Dorset Healthcare Trust DOMICILIARY REFERRAL FORMDate ……………………………………Referred by ………………………………………………………………………………………………………………………… Tel No:………………………...Patient’s name…………………………………………………………………..D.O.B. ……………………………….Address…………………………………………………………………………………………………………………………………………………………………Post code………………………………….…….Tel No: ………………………Contact person ………………………………………………………………...Address if different from above……………………………………………………………………………………………….. Tel No………………………….Treatment requestedPlease state whether Urgent/Non-urgentDoes the person go out at all? Yes/ NoIf Yes, can they travel to a dental surgery if transport is arranged? Yes/ NoSalient medical history …………………………………………………………………………………………………………………………………………………….Medication ……………………………………………………………………….……………………………………………………………………………………...Physical disability …………………………………………………………………Mental disability …………………………………………………………………..Sensory disability …………………………………………………………………Speaking language ………………………………………………………………..Any other relevant information …………………………………………………..RETURN TO: CANFORD HEATH DENTAL CLINIC, NEIGHBOURHOOD CENTRE,CULLIFORD CRESCENT, CANFORD HEATH, POOLE BH17 9DW

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