Information
As part of the Oral Health Service (OHS), the Orthodontic Department provides specialist treatment for children and adults with significant malocclusion whose needs cannot be managed by their General Dental Practitioner (GDP) or Specialist in primary care. This includes patients with:
- Cleft lip and palate
- Multiple missing teeth (hypodontia)
- Skeletal disproportion requiring jaw surgery *Please note that we are currently unable to accept new referrals for the orthognathic surgery pathway. Practitioners will be updated when new referrals can be resumed again*
- Disorders such as impacted teeth
- Dental anomalies
- Complex problems requiring multidisciplinary care
- Special care needs whose treatment cannot be accomplished in primary care.
Depending on the needs of the patient, the Orthodontic Department can offer:
- Advice
- Assessment and treatment planning for the referrer
- Treatment within the department
- Second opinions requested by NHS National Services Scotland
The Orthodontic Department has clinics based at the Edinburgh Dental Institute (EDI). Patients meeting our acceptance criteria are allocated to clinics based on the severity of their problem and / or treatment needs. A certain number of routine orthodontic patients are accepted each year for training purposes.
Depending on the complexity of the malocclusion, the patient may be allocated to an orthodontic therapist, a postgraduate orthodontic student, a Specialist Registrar trainee, or a Consultant.
Please inform your patients that not all patients accepted for consultations will be offered treatment in the EDI.
As an NHS Hospital Dental Service (secondary care), treatment provided by the EDI is free of charge for patients.
Who can refer:
Referrals to the Orthodontic department are accepted from General Dental Practitioners (GDPs), Specialist Practitioners and other primary and secondary health, education and social care professionals.
Who to refer:
The Orthodontic Department accepts referrals for advice and treatment for the following:
- Any patient whose malocclusion exceeds the criteria used in primary care for treatment e.g.
- IOTN grade 4 & 5 needing consultant led care
- Complex malocclusions not suitable for treatment in specialist practice
- Advice for management of developing complex malocclusions
- Dental anomalies which may require complex orthodontic and restorative treatment e.g.
- Moderate/Severe Hypodontia
- Amelogenesis imperfecta
- Dentinogenesis imperfecta
- Molar incisor hypomineralisation
- Micro / macro-dontia
- Delayed eruption.
- Cleft lip and palate and other cranio-facial abnormalities
- Patients with skeletal disproportions of the jaws and who need a combination of orthodontics and jaw surgery
- Orthodontic cases which may also require oral surgery input e.g.
- Supernumeraries
- Odontomes
- Impacted teeth
- Infra-occluded teeth
- Abnormal frenal attachments
- Teeth which require surgical management
- Patients with special needs e.g.
- Patients with a medical condition(s) or impairment that necessitates treatment in a specialist environment.
- Extreme dental anxiety and proven to be unable to co-operate with routine dental treatment.
- Patients in foster or residential care who are not registered with a GDP or have unmet dental needs.
Referrals can be made in the mixed dentition when any of the following are present:
- Anterior or posterior crossbite with displacement on closure
- Class III malocclusion
- Class II malocclusion with large overjet
- Asymmetry in the pattern of tooth eruption (especially upper incisors)
- Severely hypoplastic or carious first permanent molars of poor long term prognosis
- Lack of palpable canine’ bulges’ buccally at 10-11 years indicating palatal canine impaction
- Hypoplastic teeth
- Supernumerary teeth
- Submerged deciduous molars and /or impacted first permanent molars
- Periodontal problems caused by severely ectopic tooth eruption
Who not to refer:
The Orthodontic Department will not accept referrals for the following:
- Any patient whose orthodontic treatment need is less than the criteria used in primary care for treatment.
- Patients with untreated caries or periodontal disease.
- Replacement retainers for patients discharged from their orthodontic provider.
- Patients who have undergone a course of orthodontic treatment and experienced relapse due to cessation of retainer wear.
How to refer:
Referrals to the Orthodontic department are accepted from primary and secondary health, education and social care professionals.
- GDPs providing NHS dentistry must refer to Orthodontics via SCI Gateway. Any other route of referral will be rejected.
- If you are a primary / secondary care health professional without access to SCI Gateway, please download, complete and send the referral form.
- Please note that the secure transmission of emails containing patient information is the referrer’s responsibility
Referrals should be completed as fully as possible, with poorly completed forms risking rejection. Referrals should include the following information:
- Patient demographics
- Reason for referral (e.g. for advice / treatment / second opinion)
- Salient features of the patient’s malocclusion
- History of any previous treatment
- Details of patient’s GDP if referred from Specialist Practice
Relevant radiographs / images should be included in your referral. These can be sent as an ‘attachment’ in SCI Gateway (maximum file size of 2MB, with a total attachment capacity of 5MB). If you are not registered with SCI Gateway, have images exceeding the file size or have relevant non digital images, please use an alternative option for the transfer of images.
Please note that it remains the responsibility of the referrer to provide or secure any necessary treatment or advice (including emergency / urgent care) until the patient is assessed by the Orthodontic Department.
Discharge criteria:
Patients will be discharged from the care of the Orthodontic Department for the following reasons:
- Treatment completed and retention monitored for one year post completion.
After discharge from the orthodontic department, if the patient is wearing a retainer, they will be advised to continue wearing this at night for as long as they wish their teeth to remain straight. They will be discharged to their GDP with the advice that their GDP will provide them with new retainers and there may be charge for this.
- Treatment completed and patient referred for continuing treatment with another department.
- Lack of co-operation during treatment e.g. failure to attend or poor oral health.
