Oral Surgery

The specialty of Oral Surgery deals with the diagnosis and management of pathology of the mouth and jaws that requires surgical intervention, but where cancer is not suspected. Referrals tend to be from GDPs rather than GPs, and the following guidance reflects that.

Oral surgeons manage treatment of children, adolescents and adults, and those who are dentally anxious or medically complex. Oral Surgery care is provided by both Oral Surgeons and Oral & Maxillofacial Surgeons as the clinical competencies of these two specialties overlap.

Oral surgery is delivered on two sites in NHS Lothian:

• Edinburgh, Mid- and East Lothian patients – Oral Surgery at the Edinburgh Dental Institute (see University of Edinburgh). On SCI Gateway access is via Lauriston (Oral Health).
• West Lothian patients – refer to Oral Surgery at St John’s Hospital, Livingston, where patients are managed by the Oral & Maxillofacial Surgical team.

The following conditions are managed (5 onwards largely dental):

1. Management of intra-oral benign and cystic lesions of the hard and soft tissues.
2. Management of benign disease of the minor salivary glands eg mucoceole.
3. Procedures involving soft / hard tissues where there is an increased risk of complications e.g. nerve damage, displacement of fragments into the maxillary antrum.
4. Non-surgical management of temporomandibular joint (TMJ) disorders and craniofacial pain that have not responded to initial therapy.
5. Surgical removal of third molars involving bone removal (according to national guidelines).
6. Surgical removal of buried roots and fractured or residual root fragments.
7. Management and surgical removal of ectopic teeth (including supernumerary teeth).
8. Management and surgical exposure of teeth to include bonding of orthodontic bracket or chain.
9. Surgical endodontics (apicectomy) / excision of jaw cysts.
10. Surgical removal of tooth / teeth / root(s) that may involve access into the maxillary antrum.
11. Management of infections of the orofacial region including localised dental abscesses.
12. Management of post-operative bleeding.
13. Patients with significant anxiety or dental phobia requiring oral surgery.
14. Patients with complex medical history requiring extractions.
    
    The Oral Surgical team will manage patients whose care cannot reasonably be delivered in a General Dental Service (GDS) setting, such as patients who require a multidisciplinary approach between medical and dental teams to facilitate safe dental care.Associated specialties are:
    
    ORAL MEDICINE deals with the diagnosis and non-surgical management of patients with chronic / recurrent, benign conditions of the oral mucosa and facial pain. These conditions are often intractable and related to systemic disease requiring multi-disciplinary care.

• ORAL & MAXILLOFACIAL SURGERY (OMFS) – the diagnosis and management of benign and malignant diseases affecting the mouth, jaws, face and neck. The team at St John’s Hospital delivers the only OMFS service for NHS Lothian and does so for patients of all ages, including children. 

All those suspected of having cancer must be referred to Oral & Maxillofacial Surgery at St John’s Hospital. 

Dental Charges. 

Please note that some of the care provided is delivered under General Dental Service (GDS) terms and conditions with strict adherence to the Statement of Dental Remuneration (SDR).    Accordingly, NHS fees will apply to dental treatment in some locations unless the patient is entitled to free dental treatment.

If your referral relates to a previous failed extraction(s), please state clearly if you have already claimed for the attempted extraction(s).