{"id":4216,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralsurgery\/"},"modified":"2026-10-12T13:15:32","modified_gmt":"2026-10-12T12:15:32","slug":"oralsurgery","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/oralsurgery\/","title":{"rendered":"Oral Surgery"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">The specialty of Oral Surgery deals with the diagnosis and management of pathology of the mouth and jaws that&nbsp;requires surgical intervention, but where cancer is not suspected.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Referrals tend to be from GDPs rather than GPs, and the following guidance reflects that.<\/em> <em><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 &amp; Maxillofacial Surgeons as the clinical competencies of these two specialties overlap.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">All those suspected of having cancer must be referred to<\/mark><\/strong> <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\"><\/a><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Oral surgery is delivered on two sites in NHS Lothian:<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Edinburgh, Mid- and East Lothian patients \u2013 Oral Surgery at the Edinburgh Dental Institute. SCI Gateway access is via Lauriston (Oral Health). Please note that care may be delivered within the Public Dental Service and the site may vary with NHS Lothian.<\/li>\n\n\n\n<li>West Lothian patients \u2013 refer to Oral Surgery at St John\u2019s Hospital, Livingston, where patients are managed by the Oral &amp; Maxillofacial Surgical team &#8211; <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a>.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Associated specialties are:<\/span><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/restorativedentistry\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Health Service<\/a><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The Oral Health Service (OHS) delivers specialised oral health care, leads oral health improvement for the population of Lothian and provides excellent training of oral health professionals for the future <\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><br><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/oralmedicine\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Medicine<\/a> <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>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. This specialty treats medical conditions affecting the oral mucosa, salivary glands, nervous system and systemic conditions which involve the oral and maxillofacial region<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><br><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery (OMFS)<\/a>  <\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>OMFS deals with the diagnosis and management of benign and malignant diseases affecting the mouth, jaws, face and neck. The team at St John\u2019s Hospital delivers the only\u00a0OMFS service for NHS Lothian and does so for patients of all ages, including children.\u00a0<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.M &amp; L.B &#8211; 12-10-26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Urgent Suspicion of Cancer.<\/mark><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><br><strong><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Patients with lesions in their mouth considered urgent suspicious of cancer should be referred directly to the OMFS service at St John\u2019s Hospital using the specific SCI Gateway pathway. They should not be referred to Oral Surgery but to \u00a0<\/mark><\/strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Emergency referrals<\/span><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">If a GP or a dentist needs to access an emergency referral for a patient, please contact either: &nbsp;&nbsp;<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Oral Surgery\u00a0\u2013 Edinburgh Dental Institute \u2013 0131 536 2221. Calls will be accepted Monday to Friday (9:30 \u2013 12:00 and 1:30 \u2013 16:00). Clinicians only. Calls from patients will not be accepted via this phone.\u00a0<\/li>\n\n\n\n<li>Oral and Maxillofacial Surgery \u2013 via St John\u2019s Hospital switchboard. 01506 523 000.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Patients with a\u00a0dental infection with systemic involvement\u00a0or significant facial swelling should be referred to OMFS as an\u00a0emergency &#8211; please phone the specialty directly.\u00a0<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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 service.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em>These details are not for use by patients who should contact their dentist or GP if they need help.<\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Urgent referrals<\/span><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Conditions that <strong>may<\/strong> be prioritised for urgent referral:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Delayed healing of tooth sockets<\/li>\n\n\n\n<li>Suspected established MRONJ<\/li>\n\n\n\n<li>Large cystic or bone lesions<\/li>\n\n\n\n<li>Fractured tuberosity<\/li>\n\n\n\n<li>Displaced roots \/ teeth<\/li>\n\n\n\n<li>Oro-antral communication<\/li>\n\n\n\n<li>Impacted canines with adjacent tooth resorption<\/li>\n\n\n\n<li>Minor oral surgery for medically complex patients needing timely intervention.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Routine or Urgent Referrals\u00a0via Sci Gateway:<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Edinburgh, Mid- and East Lothian Lauriston Oral Health Oral Surgery.<\/li>\n\n\n\n<li>West Lothian St John\u2019s Oral Surgery see <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a><\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer \u2013 summary (detailed account follows below):<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>The following conditions are managed:<\/strong><strong><\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Third molar assessment and surgery<\/li>\n\n\n\n<li>Surgical removal of buried roots, failed extractions or fractured retained roots not amenable to non- surgical removal<\/li>\n\n\n\n<li>Assessment and management of ectopic teeth (including supernumerary teeth)<\/li>\n\n\n\n<li>Surgery relating to Orthodontic Treatment to facilitate orthodontic treatment plan such as exposure of ectopic teeth<\/li>\n\n\n\n<li>Assessment and management of intra-oral benign soft and hard-tissue lesions, including cystic lesions, with no suspicion of cancer<\/li>\n\n\n\n<li>Diagnosis and management of benign soft tissue lesions, with no suspicion of cancer<\/li>\n\n\n\n<li>Management of suspected or diagnosed oro-antral communications or fistulae, tuberosity fractures or teeth and roots displaced into the maxillary antrum<\/li>\n\n\n\n<li>Medication related osteonecrosis of the jaw (MRONJ)<\/li>\n\n\n\n<li>Non-surgical management of temporomandibular joint (TMJ) disorders\u2019<\/li>\n\n\n\n<li>Management of infections of the orofacial region including localised dental abscesses<\/li>\n\n\n\n<li>Management of post-operative bleeding.<\/li>\n<\/ol>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer &#8211; details:<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>1. Third molar assessment and surgery<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Third molar assessment and surgery where surgical intervention is indicated according to national guideline, please see guidance for information regarding appropriate referral <a href=\"https:\/\/www.rcseng.ac.uk\/-\/media\/Files\/RCS\/FDS\/Guidelines\/3rd-molar-guidelines--April-2021-v4.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Third Molar Guidance<\/a>. Erupted non-surgical third molars with radiographic evidence of a potentially intimate relationship with the respective inferior alveolar canal can be referred. Please manage acute dental problem in line with guidance <a href=\"https:\/\/www.sdcep.org.uk\/media\/ixlpeakb\/sdcep-madp-guidance-march-2013.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">SDCEP Acute Dental Problems<\/a> and document acute management in referral <a href=\"https:\/\/www.sdcep.org.uk\/published-guidance\/acute-dental-problems\/\" target=\"_blank\" rel=\"noreferrer noopener\">Acute Dental Problems<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Please include relevant radiographs. A minimum of a periapical radiograph, bitewing radiograph or OPT (OPT if available) or reason why this was not possible must be included. Bitewing radiographs are valuable for third molar assessment, please include these where relevant and available.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Clinical information specific to third molars must be included with your referral and this includes (where relevant):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Eruption status<\/li>\n\n\n\n<li>Caries status of third molar, or other adjacent teeth<\/li>\n\n\n\n<li>Frequency of symptoms<\/li>\n\n\n\n<li>Angulation<\/li>\n\n\n\n<li>Probing depth to mandibular second molar or adjacent tooth<\/li>\n\n\n\n<li>Considered differential diagnoses, eg. TMD<\/li>\n\n\n\n<li>Presence of opposing upper third molars.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>2. Surgical removal of buried roots, failed extractions or fractured retained roots not amenable to non surgical removal<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Routine extractions should be carried out in general dental practice. They may be referred in certain circumstances. We do not accept routine extractions in our service, and this includes teeth and roots that are amenable to simple elevation, and extractions based on the need for anxiety management. Complicated extractions with anticipated difficulty due to extent of disease, local anatomy or associated pathology will be triaged on an individual referral basis and may be returned. Please provide all relevant supporting information with the referral.<\/li>\n\n\n\n<li>Failed extractions must include a relevant radiograph (post-extraction) and description of the failed procedure and the date of the procedure.<\/li>\n\n\n\n<li>Please include information relating to whether a claim has been submitted where applicable, in line with GDS terms and conditions.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><br><strong>3. Assessment and management of ectopic teeth (including supernumerary teeth)<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Clinical information should be included including eruption status, caries status, assessment of adjacent teeth, symptomology.<\/li>\n\n\n\n<li>If the referral relates to the orthodontic interface, we require a copy of the treating orthodontist\u2019s treatment plan \/ letter to triage the referral and the contact details of the general dental practitioner (GDP).<\/li>\n\n\n\n<li>Please note that patients under 16 should be referred to Paediatric Dentistry initially <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatrics\/paediatricdentistry\/\" target=\"_blank\" rel=\"noreferrer noopener\">Paediatric Dentistry<\/a>.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\"><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>4. Surgery relating to Orthodontic Treatment to facilitate orthodontic treatment plan such as exposure of ectopic teeth.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Referral should include orthodontic treatment plan including orthodontist details, any further dental treatment or extractions being carried out and any clinical prioritisation or urgency documented (such as resorption).<\/li>\n\n\n\n<li>We require a copy of the treating orthodontist\u2019s treatment plan \/ letter to triage the referral and the contact details of the patient\u2019s general dental practitioner.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>5. Assessment and management of benign intra-oral benign soft and hard-tissue lesions, including cystic lesions<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>The diagnosis and management of pathology of the mouth and jaws that\u00a0requires surgical intervention, but where cancer is not suspected.<\/li>\n\n\n\n<li>Consider referral criteria for <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/oralmedicine\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Medicine<\/a>, and <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a> before making your referral.<\/li>\n\n\n\n<li>Include relevant clinical description and attach relevant radiographs and photographs.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>6. Diagnosis and management of benign soft tissue lesions<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>This includes benign soft tissue overgrowths such as fibroepithelial polyps, denture hyperplasia, drug-induced gingival hyperplasia, mucocele, small vascular lesions or squamous papillomas<\/li>\n\n\n\n<li>All referrals from dentists must have accompanying photographs attached and radiographs if appropriate; ideally referrals from GPs should include photographs too<\/li>\n\n\n\n<li>For referrals for assessment of oro-mucosal disease beyond this please go to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/oralmedicine\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Medicine<\/a><\/li>\n\n\n\n<li>Where there is a suspicion of cancer, these should be directed via the Urgent \u2013 Suspicion of Cancer (USOC) pathway <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>7. Management of suspected or diagnosed oro-antral communications or fistulae, tuberosity fractures or teeth and roots displaced into the maxillary antrum.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Consideration will be given to surgical removal of tooth \/ teeth \/ root(s) that may involve access into the maxillary antrum.<\/li>\n\n\n\n<li>Referrals for traumatic Oro-Antral Communication (OAC) or fractured tuberosity may be considered urgently.<\/li>\n\n\n\n<li><em>Referrers may contact the department on 0131 536 2221 for urgent advice if required. <strong>CLINICIANS ONLY\u00a0<\/strong>can use this advice line.\u00a0 A referral via SCI Gateway is also required.<\/em><\/li>\n\n\n\n<li>If a referral is being made, then please do so via SCI gateway<strong>\u00a0<\/strong>in addition to the above.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>8. Medication related osteonecrosis of the jaw (MRONJ)<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Dentoalveolar surgery for patients requiring a multidisciplinary approach and for assessment and management of established MRONJ:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>This does not include patients at lower risk of MRONJ. Please see SDCEP for appropriate management of these patients in primary care &#8211; <a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/medication-related-osteonecrosis-of-the-jaw\/\" target=\"_blank\" rel=\"noopener\">Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw (SDCEP)<\/a>. Routine extractions in patients at lower risk of medication related osteonecrosis of the jaws (MRONJ) should be managed in general dental practice <a href=\"https:\/\/www.sdcep.org.uk\/published-guidance\/medication-related-osteonecrosis-of-the-jaw\/\" target=\"_blank\" rel=\"noreferrer noopener\">SDCEP MRONJ<\/a><\/li>\n\n\n\n<li>If an extraction socket is not healed at 8 weeks and MRONJ is suspected, please refer with the relevant clinical information, clinical photographs and radiographs (pre and post extraction).<\/li>\n\n\n\n<li>Patients at increased risk of MRONJ requiring dentoalveolar surgery, or dental extraction will be considered on an individual basis <strong>(development work here \u2013 under review)<\/strong>.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\"><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>9. Non-surgical management of temporomandibular joint (TMJ) disorders<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Assessment and management of temporomandibular joint dysfunction in line with national guidance <a href=\"https:\/\/www.rcseng.ac.uk\/-\/media\/FDS\/Comprehensive-guideline-Management-of-painful-Temporomandibular-disorder-in-adults.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">RCS Eng TMD Guidance<\/a><\/li>\n\n\n\n<li>Consider and exclude dental causes for symptoms by a dentist (this information should be shared in the referral including relevant images\/x-rays), and evidence of supportive self-management followed prior to the point of referral in line with published national guidance.<\/li>\n\n\n\n<li><em>Patients presenting to their GP should be referred to their dentist in the first instance.<\/em> <\/li>\n\n\n\n<li>Any red flags requiring urgent investigation should be referred appropriately immediately to the appropriate service.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><em>Please note that the Oral Surgery, Oral Medicine or OMFS services do NOT offer Botulinum Toxin injections for the management of TMJ dysfunction currently.<\/em> <em><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>10. Management of infections of the orofacial region including localised dental abscesses.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please follow available guidance on SDCEP <a href=\"https:\/\/www.sdcep.org.uk\/published-guidance\/acute-dental-problems\/\" target=\"_blank\" rel=\"noreferrer noopener\">SDCEP Acute Dental Problems<\/a> initially.<\/li>\n\n\n\n<li>Referrals will be considered on an individual basis. <\/li>\n\n\n\n<li>Consider utilising the urgent triage telephone line. <\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>11. Management of post-operative bleeding.<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Please follow available guidance on SDCEP <a href=\"https:\/\/www.sdcep.org.uk\/published-guidance\/acute-dental-problems\/\" target=\"_blank\" rel=\"noreferrer noopener\">SDCEP Acute Dental Problems<\/a> initially.<\/li>\n\n\n\n<li>Referrals will be considered on an individual basis. Consider utilising the urgent triage telephone line.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-alert-red-color\">Where there is a suspicion of cancer, these should be directed via the Urgent \u2013 Suspicion of Cancer (USOC) pathway <\/mark><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Management of benign or malignant tumours of minor or major salivary glands or obstructive disease of major saliva gland,<\/strong> please direct these patients to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Patients with complex medical history requiring Oral Surgery input.<\/strong> We do not accept patients with medical complexity for routine dental extractions. However, patients who require a multidisciplinary approach between medical and dental teams to facilitate Oral Surgery care may be considered and please review referral guidance for the associated specialties before making referral. <\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Surgical management of periradicular pathology \/ surgical endodontics.<\/strong> Consideration for periradicular surgery in the absence of cystic pathology will not be considered in the Oral Surgery service. Periradicular surgery will be considered in cases where there is apical pathology that requires histo-pathological assessment. Please consider <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/restorativedentistry\/\" target=\"_blank\" rel=\"noreferrer noopener\">Restorative Dentistry<\/a>.\u00a0<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Temporomandibular joint (TMJ) dysfunction\u00a0where supportive self-management has not been provided in line with national guidance <a href=\"https:\/\/www.rcseng.ac.uk\/-\/media\/FDS\/Comprehensive-guideline-Management-of-painful-Temporomandibular-disorder-in-adults.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">RCS Eng TMD Guidance<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Routine extractions in otherwise healthy patients.<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Routine extractions in patients who are at lower risk of MRONJ\u00a0 <a href=\"https:\/\/www.sdcep.org.uk\/published-guidance\/medication-related-osteonecrosis-of-the-jaw\/\" target=\"_blank\" rel=\"noreferrer noopener\">SDCEP MRONJ<\/a><\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Routine extractions where the patient is on a single anticoagulant or where the INR is maintained below 3.5 (see SDCEP guidance on Management of Dental Patients Taking Anticoagulants or Antiplatelet drugs)<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients with dental problems that require restorative treatment.\u00a0 RefHelp guidance for \u2018Oral Health Service: <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/restorativedentistry\/\" target=\"_blank\" rel=\"noreferrer noopener\">Restorative Dentistry<\/a>.\u00a0<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients for whom a purely radiographic opinion is requested. Please direct these to Radiology via SCI Gateway<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Patients for placement of dental implants. Internal referrals may be made for Oral Surgery input into multidisciplinary care for priority group patients in line with guidance from associated specialties\u00a0 <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/restorativedentistry\/\" target=\"_blank\" rel=\"noreferrer noopener\">Restorative Dentistry<\/a>.\u00a0<\/li>\n\n\n\n<li>Simple dental extractions in anxious patients. Please consider referral to the <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/adultdentalanxietymanagementservice\/\" target=\"_blank\" rel=\"noreferrer noopener\">Adult Anxiety Management Service<\/a> in the Public Dental Service.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Referrals should be made via SCI Gateway.<\/li>\n\n\n\n<li>Referrals must contain all relevant clinical information, in addition to the patient\u2019s medical and social history.<\/li>\n\n\n\n<li>Any referral relating to soft tissue lesions from General Dental Practitioners require a clinical photograph. Referrals from General Medical Practitioners should ideally have clinical photographs attached, as this allows us to safely and appropriately triage these patients to the correct pathway. <span style=\"text-decoration: underline\">The team\u2019s experience is that photos can help identify lesions where cancer needs excluding and those patients then urgently redirected to OMFS.<\/span> \u00a0They may be taken by the patient if there is no access to clinical photography. This allows us to safely and appropriately triage these patients to the correct pathway.<\/li>\n\n\n\n<li>Referrers\u00a0should include relevant\u00a0radiographs \/ charts \/ and clinical photographs in their referrals. These should be sent as an \u2018attachment\u2019 in SCI Gateway, appropriately labelled. If you have images exceeding the maximum file size or have relevant non digital images, please use an alternative option. The maximum file size is 2MB, sum of all attachments, 5MB. \u00a0Advice can be sought from our Pathways Team via <a href=\"mailto:loth.edireferrals@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.edireferrals@nhs.scot<\/a>.<\/li>\n\n\n\n<li>For sharing Cone Beam CT Scans (CBCT) please contact our Pathway Team (<a href=\"mailto:loth.edireferrals@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.edireferrals@nhs.scot<\/a>, 0131 536 1129). Imaging reports for CBCT should be attached to the referral. All imaging must be labelled appropriately, or it will be returned (demographics, date image taken).<\/li>\n\n\n\n<li>Where a practitioner works outwith the NHS then the referral should be sent via email to <a href=\"mailto:loth.edireferrals@nhs.scot\" target=\"_blank\" rel=\"noreferrer noopener\">loth.edireferrals@nhs.scot<\/a>.<\/li>\n\n\n\n<li>Once received, your referral will be triaged and directed to the appropriate part of the service with the appropriate prioritisation. Please note where incorrectly appropriated referrals are made this can result in a delay in the triage process.<\/li>\n\n\n\n<li>Where referral criteria for the service have been met, patients will be offered an appointment. Where referral criteria for the service have not been met, a letter will be sent to the referrer with an explanation. It is the responsibility of the referrer to ensure that the patient is informed of this returned or redirected referral, and the clinical responsibility remains with the referrer.<\/li>\n\n\n\n<li>Allocation of appointments will be dependent on individual referrals and assessment appointments may initially be offered face to face or remotely via telephone or video consultation using near me technology.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Referral destination \u2013 please refer via SCI Gateway:<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>There is a single point of entry for patients in Edinburgh, Mid- and East Lothian via Lauriston Oral Health Oral Surgery.<\/li>\n\n\n\n<li>West Lothian patients should be referred to St John\u2019s Oral Surgery via <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Charges<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Some Oral Surgery care is delivered under General Dental Service (GDS) terms and conditions with strict adherence to the Statement of Dental Remuneration (SDR)<\/li>\n\n\n\n<li>Therefore, NHS fees will apply to such treatment (unless the patient is entitled to free dental care)<\/li>\n\n\n\n<li>This applies to all postcodes<\/li>\n\n\n\n<li>If your referral relates to a previous failed extraction(s), please state clearly if you have already claimed for the attempted extraction(s).\u00a0<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<ul class=\"wp-block-list\">\n<li><a href=\"http:\/\/www.healthcareimprovementscotland.org\/our_work\/cancer_care_improvement\/programme_resources\/scottish_referral_guidelines.aspx\" target=\"_blank\" rel=\"noreferrer noopener\">Scottish referral guidelines for suspected cancer (Healthcare Improvement Scotland)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/medication-related-osteonecrosis-of-the-jaw\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Health Management of Patients at Risk of Medication-related Osteonecrosis of the Jaw (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/anticoagulants-and-antiplatelets\/\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Dental Patients taking Anticoagulants or Antiplatelet Drugs (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/antibiotic-prophylaxis\/\" target=\"_blank\" rel=\"noreferrer noopener\">Antibiotic Prophylaxis (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.baoms.org.uk\/#MainForm\" target=\"_blank\" rel=\"noopener\">British Association of Oral and Maxillofacial Surgeons<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.baos.org.uk\/\" target=\"_blank\" rel=\"noopener\">British Association of Oral Surgeons<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.bsom.org.uk\/home\/\" target=\"_blank\" rel=\"noreferrer noopener\">The British Society for Oral Medicine (BSOM)<\/a>: this website has produced patient information leaflets for a number of oral conditions.<\/li>\n\n\n\n<li><a href=\"http:\/\/www.bad.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">British Association of Dermatologists<\/a>: patient information leaflets available.<\/li>\n\n\n\n<li><a>International Association for the Study of Pain: <\/a><a href=\"https:\/\/www.iasp-pain.org\/resources\/\" target=\"_blank\" rel=\"noopener\">patient resources available<\/a>.<\/li>\n\n\n\n<li><a href=\"https:\/\/www.england.nhs.uk\/commissioning\/wp-content\/uploads\/sites\/12\/2015\/09\/guid-comms-oral.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Guide for Commissioning Oral Surgery and Oral Medicine (NHS England)<\/a><br><br><strong>Primarily for dentists:<\/strong><\/li>\n\n\n\n<li><a href=\"https:\/\/www.rcseng.ac.uk\/dental-faculties\/fds\/publications-guidelines\/clinical-guidelines\/\" target=\"_blank\" rel=\"noreferrer noopener\">Guidelines for Selecting Appropriate Patients to Receive Treatment with Dental Implants: Priorities for the NHS (Royal College of Surgeons)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/sedation\/\" target=\"_blank\" rel=\"noreferrer noopener\">Conscious Sedation in Dentistry (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.baos.org.uk\/\" target=\"_blank\" rel=\"noreferrer noopener\">British Association of Oral Surgeons (BAOS)<\/a><\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/management-of-acute-dental-problems-madp\/\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Acute Dental Problems (SDCEP)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.england.nhs.uk\/commissioning\/wp-content\/uploads\/sites\/12\/2015\/09\/guid-comms-oral.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">Guide for Commissioning Oral Surgery and Oral Medicine (NHS England)<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.bsperio.org.uk\/news\/dementia-friendly-dentistry-good-practice-guidelines\" target=\"_blank\" rel=\"noopener\">Dementia friendly dentistry: good practice guidelines<\/a>.<\/li>\n\n\n\n<li><a href=\"http:\/\/www.sdcep.org.uk\/published-guidance\/management-of-acute-dental-problems-madp\/\" target=\"_blank\" rel=\"noreferrer noopener\">Management of Acute Dental Problems (SDCEP)<\/a><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>The specialty of Oral Surgery deals with the diagnosis and management of pathology of the mouth and jaws that&nbsp;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<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3839,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[84],"class_list":["post-4216","page","type-page","status-publish","hentry","category-oral-surgery"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/dentistry-oral-health-service\/oral-surgery\/\" rel=\"tag\">Oral Surgery<\/a>","rttpg_excerpt":"The specialty of Oral Surgery deals with the diagnosis and management of pathology of the mouth and jaws that&nbsp;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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4216","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4216"}],"version-history":[{"count":1,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4216\/revisions"}],"predecessor-version":[{"id":30378,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4216\/revisions\/30378"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3839"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}