All those suspected of having cancer must be referred to Oral Maxillofacial Surgery at St Johns. The head and neck section of the Scottish Referral Guidelines for Suspected Cancer outlines that this includes anyone with 3 or more weeks of unexplained:
- Red or mixed red and white patches of the oral mucosa (not oral thrush)
- Ulceration or swelling/induration of the oral mucosa
- Neck or parotid lump.
Red flag throat symptoms require referral to ENT.
Patients with lesions in their mouth considered urgent suspicious of cancer should be referred directly to the OMFS service at St John’s Hospital using the specific SCI Gateway pathway. They should not be referred to oral medicine or oral surgery.
The Edinburgh Oral Medicine Unit is based at Edinburgh Dental Institute outpatient clinic at Lauriston. It provides a secondary care specialist consultant led service.
Oral medicine is the specialty concerned with the diagnosis and non-surgical (medical) management of patients who suffer chronic, recurring or medically-related illnesses of the oral and maxillofacial region. Our Specialist Consultants are dual qualified in Medicine and Dentistry. We treat medical conditions affecting the oral mucosa, salivary glands, nervous system and systemic conditions which involve the oral and maxillofacial region. Oral Medicine is an outpatient-based specialty, and we do not offer an acute on call out of hours service.
We accept referrals for Lothian patients who are 16 years and older from primary and secondary care. Patients under the age of 16 years should be referred to the Paediatric Dentistry Team.
The Oral Medicine service is delivered in Edinburgh Dental Institute at Lauriston for all Lothian patients. All those suspected of having cancer must be referred to Oral & Maxillofacial Surgery at St John’s Hospital.
Associated specialties are:
- 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.
- 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.
C.M & W.H – 7-9-26
Who to refer:
| Oral Mucosal Conditions | Oral lichen planus Oral lichenoid reaction Vesiculobullous disorders Recurrent oral ulceration White patches Multiple pigmented lesions Mucosal lesion referrals should ideally have clinical photographs attached. The team’s experience is that photos can help identify lesions where cancer needs excluding and those patients then urgently redirected to OMFS. Referrers must include examination findings on palpation of mucosal lesions. |
| Temporomandibular Disorders (TMD) | Please refer to the Royal College of Surgeons Management of Painful TMD GIRFT Guidelines August 2025 for appropriate first line treatment strategies and justification of secondary care referrals. Referrers must outline what conservative, or medical management has been provided prior to the referral, and confirm that patients are willing to trial medical management if they have not already done so. |
| Orofacial Pain | For example: Trigeminal neuralgia, persistent idiopathic facial/ dento-alveolar pain, burning mouth syndrome. It is essential that any possible dental cause of pain is assessed by a Dentist. Patients who present to a GMP, should have a full dental assessment completed by a Dentist to exclude dental pathology prior to their referral. Referrals will not be accepted if it is not clear that dental pain or dental pathology has been excluded. If there is any doubt over non-dental pain, the triage team may request further information from the assessing Dentist, including radiographs and vitality testing results. |
| Oral Manifestations of Systemic Disease | Rheumatological conditions (e.g. SLE, Sjogren’s disease) Gastroenterology conditions (e.g. Crohn’s disease) Immuno-compromised states (e.g. Mucositis, HIV) |
| Dry Mouth & Salivary Gland Conditions | We will only accept referral for patients who have a Challacombe Score >3, where reasons for dryness are not clear. We do not accept referrals for medication related salivary hypofunction. Please see SCDEP guidelines for local management of dry mouth symptoms. We do not accept referrals for salivary gland stone treatment – please refer to OMFS. |
| Oral viral and fungal infections | We only accept referrals for patients who have not responded to treatment given in primary care. This must include management of local risk factors such as oral and denture hygiene, rinsing with water following steroid inhaler use, and smoking cessation. Please see SCDEP guidelines for further guidance. Please also consider whether HIV might be an underlying cause. |
| Orofacial Altered Sensation | We only accept referrals which are not in relation to dental pathology, dental injury or because of oral/ facial surgery. |
Who not to refer:
- Oral cancer – any patients suspected of having oral cancer must be referred to the Oral and Maxillofacial Surgery Team at St John’s Hospital Livingston. For further details please see OMFS
- Dental pain
- Diseases and conditions affecting the teeth
- Referral for dental treatment
- Periodontal disease
- Soft or hard tissue lumps/ growths including tori, mucoceles and polyps
- Conditions requiring surgical management
- Denture induced hyperplasia
- Painless clicking of the temporomandibular joint with no other symptomology
- Confirmation of normal anatomical structures/ variants
- Referrals for Botox treatment
- Conditions relating to dental implants
- Local anaesthetic allergy.
How to refer:
Referrals relating to mucosal conditions must ideally include clinical photographs and may not be accepted without clinical photographs. Photographs may be requested to appropriately and safely triage referrals. Patient photographs are acceptable if they are clear.
Facial pain referrals should have the pain history outlined using the SOCRATES tool, and for dental referrals, include relevant radiographs and vitality testing results: incomplete referrals will not be accepted. All referrals must include an up to date medical, medication and social history.
Urgent Suspicion of Cancer
All such referrals should be directed to Oral and Maxillofacial Surgery, St John’s Hospital via SCI Gateway.
Routine and Urgent referrals via SCI Gateway:
Refer to Oral Health –> Oral Medicine.
Emergency referral to Oral Medicine
If a Lothian GP or a Dentist needs to access an emergency referral for a patient, please contact:
- Edinburgh Oral Medicine Unit, EDI at Lauriston – 0131 536 1129. THIS PHONELINE IS FOR PROFESSIONAL USE ONLY.
Practitioners working out with the NHS
The referral should be sent via email to loth.edireferrals@nhs.scot.
- The British & Irish Society for Oral Medicine (BISOM): this website has produced patient information leaflets for a number of oral conditions.
- British Association of Dermatologists: patient information leaflets available.
