Information
Special Care Dentistry is concerned with: “The improvement of oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional, or social impairment or disability or, more often, a combination of a number of these factors” (Joint Advisory Committee for Special Care Dentistry, 2003).
As part of the Oral Health Service (OHS), the Special Care Dentistry service provides Special Care Dentistry for adults (16 years and over) resident within NHS Lothian. Our service can offer:
- Advice
- Assessment and treatment planning for the referrer
- Treatment on referral; either a ‘one-off’ course of treatment or a ‘shared’ or ‘continuing care’ arrangement.
Patients meeting our acceptance criteria are allocated to clinics based on geographical proximity and / or special care needs. Locations include:
- NHS Lothian hospitals (acute and non-acute)
- Community dental clinics / health centres
- Drop-in clinics in specific facilities
- Domiciliary settings (please note that referrals are only accepted for those with severe or significant special care needs and that very limited care can be provided in this way)
Treatment is provided under General Dental Service (GDS) terms and conditions with strict adherence to the Statement of Dental Remuneration (SDR).
We are unable to provide:
- Private treatment options
- Implants
We are unable to routinely provide:
- Cosmetic dentistry
- Molar endodontics or fixed prosthodontics under conscious sedation or general anaesthesia.
- Hygiene therapy in isolation under conscious sedation or general anaesthesia.
NHS fees apply to all dental treatment unless the patient is entitled to free dental treatment.
Who can refer:
Referrals to Special Care Dentistry are accepted from primary and secondary health and social care professionals.
Who to refer:
The Special Care Dentistry service accepts referrals for adults from the following priority groups:
- Patients with severe or significant special care need(s) in one or more of the following categories:
- Physical impairment or disability
- Sensory impairment or disability
- Intellectual impairment or disability
- Mental impairment or disability
- Medical impairment or disability (ASA classification III, IV and V)
- Emotional impairment or disability
- Social impairment or disability
- Patients whose care cannot reasonably be delivered in a GDS setting as follows:
- Patients who require a multidisciplinary approach between medical and dental teams to facilitate safe dental care.
- Patients registered with the ‘Edinburgh Haemophilia and Thrombosis Centre’ who require haematological cover to be provided for dental treatment (e.g. extractions, minor oral surgery, inferior dental block (IDB) or lingual local anaesthesia).
- Patients with an impairment or disability that cannot be overcome by the use of accessible physical aids.
- Patients whose complexity necessitates domiciliary care that can only be fulfilled by the skills / facilities of the OHS. For patients registered and referred by their General Dental Practitioner (GDP), a contemporaneous oral health assessment must be carried out prior to referral.
- Patients whose weight exceeds the safe working limit of the referrer’s dental chair. Bariatric dental care facilities are located at St John’s Hospital and Wester Hailes Healthy Living Centre. Please note, for patients over 31 stone (200kg), care can only be provided at St John’s Hospital.
- Patients with significant communication difficulties.
- Patients whose impairment or disability is a barrier to accessing GDS care (e.g. those who are homeless or have drug dependency issues).
Who not to refer:
The Special Care Dentistry service will not accept referrals for the following:
- Patients 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.
- Patients with mild or moderate special care need(s) whose care can be reasonably delivered in a GDS setting.
- Registered GDS patients requiring domiciliary care unless:
- the complexity of the patient / treatment necessitates the skills / facilities of the OHS, and
- a contemporaneous oral health assessment has been carried out by the referring dental practitioner.
- Patients who are at low risk of Medication-related Osteonecrosis of the Jaw (MRONJ).
- Patients taking anticoagulants or antiplatelet drugs whose INR is maintained below 4 and have no other relevant medical complications.
- Adults whose dental anxiety necessitates behavioural / pharmacological management beyond that provided in the GDS. Referral should be made to the ‘Adult Dental Anxiety Management Service‘ via SCI Gateway.
- Patients under the age of 16 years with special care need(s) or dental anxiety. Referral should be made to ‘Paediatric Dentistry‘ via SCI Gateway.
- Patients resident outwith the boundaries of NHS Lothian (applies to primary health and social care referrals).
How to refer:
Referrals to Special Care Dentistry are accepted from primary and secondary health and social care professionals.
- GDPs providing NHS dentistry must refer to Special Care Dentistry via SCI Gateway. Any other route of referral will be rejected.
- If you are a primary / secondary care health or social care 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 rejected. 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
Discharge criteria:
Patients will be discharged from the care of the Special Care Dentistry service for the following reasons:
- Their care can be reasonably delivered in a GDS setting.
- They have completed a course of treatment under conscious sedation or general anaesthesia.
- They fail to attend or repeatedly cancel their appointments at short notice. The referrer will be duly informed. For patients still wishing to be treated by the Special Care Dentistry service, a new referral will be necessary.
