{"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":"2026-01-28T09:21:17","modified_gmt":"2026-01-28T09:21:17","slug":"oralsurgery","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/dentistryoralhealthservice\/oralsurgery\/","title":{"rendered":"Oral Surgery"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color\">All those suspected of having cancer must be referred to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/oralmaxillofacialsurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Maxillofacial Surgery<\/a> at St Johns. The <a href=\"https:\/\/www.rightdecisions.scot.nhs.uk\/scottish-referral-guidelines-for-suspected-cancer\/head-and-neck-and-thyroid-cancers\/\" target=\"_blank\" rel=\"noreferrer noopener\">head and neck section<\/a> of the Scottish Referral Guidelines for Suspected Cancer outlines that this includes anyone with 3 or more weeks of unexplained:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-b742fa7253ad4716122c9abbd0b5be6f\">Red or mixed red and white patches of the oral mucosa (not oral thrush)<\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-d392c7c26c824357a5fa414b211d75d4\">Ulceration or swelling\/induration of the oral mucosa<\/li>\n\n\n\n<li class=\"has-alert-red-color has-text-color has-link-color wp-elements-76a1fe2766d7332a0faf59e5964c681c\">Neck or parotid lump.<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color\">Red flag throat symptoms require referral to <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/entadult\/neck-lump-and-throat-cancer-risk-assessment\/\" target=\"_blank\" rel=\"noreferrer noopener\">ENT<\/a>.<\/p>\n\n\n\n<p class=\"has-alert-red-color has-text-color has-link-color wp-elements-08d0cc0acbf2487dd8392d8ce7bb23ad\"><strong>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. <u>They should not be referred to oral medicine or oral surgery<\/u>.<\/strong><\/p>\n\n\n\n<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.<\/p>\n\n\n\n<p>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><strong>Oral surgery is delivered on two sites in NHS Lothian:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Edinburgh, Mid- and East Lothian patients &#8211; Oral Surgery at the Edinburgh Dental Institute (see&nbsp;<a href=\"https:\/\/www.ed.ac.uk\/dentistry\" data-type=\"URL\" data-id=\"https:\/\/www.ed.ac.uk\/dentistry\" target=\"_blank\" rel=\"noreferrer noopener\">University of Edinburgh)<\/a>. On SCI Gateway access is via Lauriston (Oral Health).<\/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.<\/li>\n<\/ul>\n\n\n\n<p><strong>The following conditions are managed (5 onwards largely dental):<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Management of intra-oral benign and cystic lesions of the hard and soft tissues.<\/li>\n\n\n\n<li>Management of benign disease of the minor salivary glands eg mucoceole.<\/li>\n\n\n\n<li>Procedures involving soft \/ hard tissues where there is an increased risk of complications e.g. nerve damage, displacement of fragments into the maxillary antrum.<\/li>\n\n\n\n<li>Non-surgical management of temporomandibular joint (TMJ) disorders and craniofacial pain that have not responded to initial therapy.<\/li>\n\n\n\n<li>Surgical removal of third molars involving bone removal (according to national guidelines).<\/li>\n\n\n\n<li>Surgical removal of buried roots and fractured or residual root fragments.<\/li>\n\n\n\n<li>Management and surgical removal of ectopic teeth (including supernumerary teeth).<\/li>\n\n\n\n<li>Management and surgical exposure of teeth to include bonding of orthodontic bracket or chain.<\/li>\n\n\n\n<li>Surgical endodontics (apicectomy) \/ excision of jaw cysts.<\/li>\n\n\n\n<li>Surgical removal of tooth \/ teeth \/ root(s) that may involve access into the maxillary antrum.<\/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\n\n\n<li>Patients with significant anxiety or dental phobia requiring oral surgery.<\/li>\n\n\n\n<li>Patients with complex medical history requiring extractions.<br><br>The Oral Surgical team will manage patients whose care cannot reasonably be delivered in a General Dental Service (GDS) setting, such as patients who require a multidisciplinary approach between medical and dental teams to facilitate safe dental care.<\/li>\n<\/ol>\n\n\n\n<p><strong>Associated specialties are:<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralMedicine\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralMedicine\/\" target=\"_blank\" rel=\"noreferrer noopener\">ORAL MEDICINE\u00a0<\/a><\/strong>deals with the diagnosis and non-surgical management of patients with chronic \/ recurrent, benign conditions of the oral mucosa and facial pain. These conditions are often intractable and related to systemic disease requiring multi-disciplinary care.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralMaxillofacialSurgery\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralMaxillofacialSurgery\/\" target=\"_blank\" rel=\"noreferrer noopener\">ORAL &amp; MAXILLOFACIAL SURGERY (OMFS)<\/a><\/strong> &#8211; the diagnosis and management of benign and malignant diseases affecting the mouth, jaws, face and neck. The team at St John&#8217;s Hospital delivers the only&nbsp;OMFS service for NHS Lothian and does so for patients of all ages, including children.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"has-alert-red-color has-text-color\"><\/p>\n\n\n\n<p><strong>Dental Charges<\/strong><strong>.<\/strong><strong>&nbsp;<\/strong><\/p>\n\n\n\n<p>Please note that some of the care provided is delivered under General Dental Service (GDS) terms and conditions with strict adherence to the Statement of Dental Remuneration (SDR).&nbsp;&nbsp;&nbsp; Accordingly, NHS fees will apply to dental treatment in some locations unless the patient is&nbsp;<a rel=\"noreferrer noopener\" href=\"https:\/\/www.nhsinform.scot\/care-support-and-rights\/health-rights\/access\/help-with-health-costs\" target=\"_blank\">entitled to free dental treatment<\/a>.<\/p>\n\n\n\n<p><strong>If your referral relates to a previous failed extraction(s), please state clearly if you have already claimed for the attempted extraction(s).&nbsp;<\/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\">Who to refer:<\/h4>\n\n\n\n<p>Please see details of <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralSurgeryUrgentDentalIndications\/\" data-type=\"URL\" data-id=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/OralSurgeryUrgentDentalIndications\/\" target=\"_blank\" rel=\"noreferrer noopener\">indications for urgent Oral Surgery referrals<\/a>, and above for details of conditions managed by the service.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who not to refer:<\/h4>\n\n\n\n<p>Anyone suspected of having oral cancer should be referred to&nbsp;<a href=\"\/refhelp\/guidelines\/OralMaxillofacialSurgery\" target=\"_blank\" rel=\"noreferrer noopener\">Oral and Maxillofacial Surgery<\/a>&nbsp;at St John&#8217;s, Livingston.<\/p>\n\n\n\n<p>The Oral Surgery service will not accept referrals for:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Temporomandibular joint (TMJ) dysfunction&nbsp;where conservative management has not been provided.<\/li>\n\n\n\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 (see SDCEP guidance on Oral Health Management of Patients at Risk of Medication- related Osteonecrosis of the Jaw)<\/li>\n\n\n\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\n\n\n<li>Patients with dental problems that require restorative treatment.&nbsp; Ref Help guidance for &#8216;Oral Health Service: Restorative Dentistry&#8217;&nbsp;(link will be available soon).<\/li>\n\n\n\n<li>Patients for whom a purely radiographic opinion is requested.<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p>Dentists&nbsp;should include relevant&nbsp;radiographs \/ periodontal charts \/ images in their referrals. These can be sent as an &#8216;attachment&#8217; in SCI Gateway (maximum file size of 2MB, with a total attachment capacity of 5MB).&nbsp; If you, have images exceeding the file size or have relevant non digital images, please use an alternative option for the&nbsp;<a href=\"\/files\/sites\/2\/Quick-reference-guide-for-Transfer-of-Images-to-the-Oral-Health-Service.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">transfer of images<\/a>.<\/p>\n\n\n\n<p>SCI Gateway referrals from dentists cannot be accepted unless these are included (that rule does not apply to GPs).<\/p>\n\n\n\n<p>Urgent Suspicion of Cancer.<br><br>All such referrals should be directed to Oral &amp; Maxillofacial Surgery at St John&#8217;s Hospital via SCI Gateway.<br><br>Routine or Urgent Referrals&nbsp;&nbsp;via Sci Gateway:<\/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&#8217;s Oral Surgery.<\/li>\n<\/ul>\n\n\n\n<p>Emergency referrals<\/p>\n\n\n\n<p>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><a href=\"\/refhelp\/guidelines\/OralSurgeryUrgentDentalIndications\" target=\"_blank\" rel=\"noreferrer noopener\">Oral Surgery Urgent Dental Indications.aspx<\/a>&nbsp;&#8211; Edinburgh Dental Institute &#8211; 0131 536 2221. Calls will be accepted Monday to Friday (9:30 &#8211; 12:00 and 1:30 &#8211; 16:00)<\/li>\n\n\n\n<li>Oral and Maxillofacial Surgery &#8211; via St John&#8217;s Hospital switchboard.<\/li>\n<\/ul>\n\n\n\n<p><em>These details are not for use by patients who should contact their dentist or GP if they need help.<\/em><\/p>\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\">British Association of Oral and Maxillofacial Surgeons<\/a><\/li>\n\n\n\n<li><a href=\"https:\/\/www.baos.org.uk\/\">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\/\">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\">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>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 flag throat symptoms require referral to ENT. Patients with lesions in their mouth<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":3839,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"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":"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 flag throat symptoms require referral to ENT. Patients with lesions in their mouth","_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":17,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4216\/revisions"}],"predecessor-version":[{"id":26326,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4216\/revisions\/26326"}],"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}]}}