Dentistry Routine

Paediatric Dentistry Routine

Information

As part of the Oral Health Service (OHS), the Paediatric Dental Service, provides specialised and specialist oral health care for children and young people under 16 years of age whose needs cannot be managed by their General Dental Practitioner (GDP). This includes the routine management of:

Extensive oral disease.
Developmental disorders of the teeth and mouth.
Those whose oral healthcare is complicated by intellectual, medical, physical, social, psychological or emotional disability or impairment.
Those who are either too anxious or too young to accept dental treatment.

The Paediatric Dental Service is an integrated service uniting the Public Dental Service (PDS) and Hospital Dental Service (HDS). Depending on the needs of the patient, our service can offer:

Advice.
Assessment and treatment planning for the referrer.
Treatment on referral; either as a ‘one-off’ course of treatment or as an ongoing ‘shared’ or ‘continuing’ care arrangement.

Patients meeting our acceptance criteria are allocated to clinics based on geographical proximity and / or their treatment needs. Our locations include:

Community dental clinics
- Bonnyrigg Dental Clinic
- Duncan Street Dental Centre
- Howden Health Centre
- Musselburgh Primary Care Centre
- Pennywell All Care Centre
- Wester Hailes Healthy Living Centre
Edinburgh Dental Institute (EDI)
Royal Hospital for Children and Young People (RHCYP)
St John’s Hospital

For patients accepted to the PDS, treatment is provided under General Dental Service (GDS) terms and conditions with strict adherence to the Statement of Dental Remuneration (SDR). There are no NHS charges for patients under 16 years of age.

Who can refer:

Referrals to the Paediatric Dental Service are accepted from primary and secondary health, education and social care professionals.

Who to refer:

The Paediatric Dental Service is the first point of referral for specialised and specialist dental care for any child or young person in NHS Lothian, unless the referral is for orthodontic care or lesions in the mouth considered ‘urgent suspicion of cancer’ (see section on ‘Who not to refer’).

We accept routine referrals to the PUBLIC DENTAL SERVICE for patients with:

Severe or unstable extensive caries in pre-cooperative or pre-school children.

Additional support needs which make dental care more difficult to provide.
Extreme dental anxiety and have proven unable to co-operate with routine dental care treatment in a primary care setting.
Unmet dental needs whilst living in foster or residential care and not registered with a General Dental Practitioner.

We accept routine referrals to the HOSPTIAL DENTAL SERVICE for patients with:

Dental anomalies which may require complex, multi-disciplinary specialist treatment e.g.
- Hypodontia
- Amelogenesis imperfecta
- Dentinogenesis imperfecta
- Molar incisor hypomineralisation
- Micro / macrodontia
- Delayed eruption
Oral medicine conditions (excluding potential malignant / suspected dysplastic oral lesions).
- Non-carious tooth surface loss requiring specialist intervention
- Periodontal disease which can be demonstrated as progressive despite appropriate cause related therapy and where modifiable risk factors have been controlled in line with national guidance.
- This would usually include patients with stage II-IV disease who demonstrate a rapid rate of disease progression (Grade C)* and /or those with Molar-Incisor pattern disease (Classification of Periodontal and Peri-implant Diseases and Conditions, 2017), and other less common periodontal / gingival conditions. *Aggressive periodontitis (generalised or localised) under the previous periodontal classification system.
Cleft lip and / or palate or other craniofacial abnormality.
Need for surgical management e.g.
- Supernumerary teeth
- Odontomes
- Impacted teeth
- Infraoccluding teeth
- Abnormal fraenal attachments including tongue-tie
Dento-alveolar trauma requiring specialist follow-up. Wherever possible, patients should receive emergency treatment within 24 hours of the injury.
Complex medical conditions that place them at risk from dental disease and / or its treatment.

Who not to refer:

The Paediatric Dental Service will not accept referrals for the following:

Patients over 16 years of age.
Children or young people with lesions in their mouth considered ‘urgent suspicion of cancer’. Referral should be made directly to the Oral & Maxillofacial Surgery service at St John’s Hospital using the specific SCI Gateway.

Emergency and / or urgent dental care for pain, infection or simple trauma.
Routine dental care for healthy, co-operative children.
Orthodontic extractions under general anaesthesia.
Patients requiring an orthodontic assessment only. Please consider referral to ‘Orthodontics’ via SCI Gateway.

How to refer:

Referrals to the Paediatric Dental Service are accepted from primary and secondary health, education and social care professionals. Referrals are made to EITHER the Public Dental Service (PDS Paediatrics) or the Hospital Dental Service (OHS Paediatric Dentistry) dependent upon the above criteria.

General Dental Practitioners (GDPs) providing NHS dentistry must refer to EITHER the Public Dental Service (PDS Paediatrics->PDS Paediatric Dentistry) or the Hospital Dental Service (OHS Paediatric Dentistry->EDI Paediatric Dentistry) 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. The responsibility for making an appropriate referral rests with the referring health / education / social care professional. In order for the Paediatric Dental Service to effectively triage and prioritise the referral, the following information is considered essential:

A current telephone number (home / mobile / both) so the patient can be contacted at short notice.

The medical history to include details of all current prescribed medication and known allergies.
Relevant social history. Where applicable, this must include clarification of parental authority, details of social work / health visitor involvement and / or the need for an interpreter.

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 child / young person’s registered dentist to provide or secure any necessary treatment or advice including emergency / urgent care.

For children / young people not registered with a dentist and requiring emergency dental treatment, please refer to the RefHelp guidance ‘Paediatric Dentistry: Emergency care’.

Discharge criteria:

Patients will be discharged from the care of the Paediatric Dental Service for the following reasons:

Their care can be reasonably delivered in a General Dental Service (GDS) setting.

They have completed a course of treatment.
They are not brought to their appointments or repeatedly cancel at short notice. In such circumstances, the referrer will be informed so that welfare concerns can be followed up appropriately.

In the event of a patient with specialised or specialist care needs being discharged, a new referral to the Paediatric Dental Service will be necessary.

Patient Information Leaflets: