Minor Oral Surgery Service Referral Guidelines for Lancashire



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Table 1





Anticipated procedure type


Sub-type

Suggested appropriate service

 


GROUP 1

Primary care dental practitioner



GROUP 2

Tier 2 Oral Surgery Service



GROUP 3

Secondary care Oral and Maxillofacial Surgery Service



 Surgical exposure of tooth

 

 



Buccal/labial approach




y




Buccal/labial approach to include bonding of orthodontic bracket







y

Palatal approach







y

Drainage of abscess of alveolus of tooth

 


Intra-oral approach required

y







Extra-oral approach required







y

Other specified operations on gingiva

Simple gingivectomy




y




Complex periodontal surgery







Cases to be referred to NHS Central Manchester Foundation Trust

Removal of apparent simple mucocele

In areas other than floor of mouth




y




Lesion in floor of mouth







y

Excision of non-suspicious lesion of oral soft tissues

E.g. apparent denture induced hyperplasia

Apparent fibro-epithelial polyp

Lesion of palatal mucosa



Lesion size less than 10mm





y




Lesion size more than 10mm







y

Initial management of temporomandibular joint dysfunction syndrome (TMJDS)




y







Management of TMJDS which has not responded to simple interventions (for example, exercise regime, simple splint therapy) in primary care










y

Minor oral surgical procedure considered by referrer to be beyond the competence of any performer working under the provider’s contract







As appropriate

As appropriate


Modifying factors


For each referral, the allocations relating to procedure sub-type shown above may be modified for one or more of the following reasons. These relate to the referred patient’s medical status, anxiety relating to the planned procedure, or other complications.


Allocation criteria relating to medical status


Patients assessed at grades ASA I and ASA II (using the American Society of Anaesthesiologists physical status classification system (ASA)) requiring interventions in Group 1 (Table 1) will be expected to receive treatment in primary care settings, to include provision by NHS Dental Providers.

Patients assessed at grades ASA I and ASA II requiring Group 2 (Table 1) procedures will be allocated to the Tier 2 Oral Surgery Service.

Patients assessed at grades ASA III, who in the opinion of the referring dentist present a potential higher risk of complications and require Group 1 (Table 1) or Group 2 (Table 1) interventions should be referred for management in secondary care.

Patients assessed at grades above ASA III requiring any minor oral surgical procedure should be referred for management in secondary care.


Allocation criteria relating to anxiety levels and physical conditions requiring treatment under sedation


Patients who require Group 1 procedures carried out under sedation because of a demonstrable severe psychological state affecting their ability to receive treatment will be allocated to the hospital dental system.

Such patients would be characterised by:



  1. Considerable difficulty in co-operation

  2. Limited examination only possible

  3. Considerable interruption which disrupts provision of treatment due to anxiety

  4. Patient has received two or more behaviour modification/acclimatization visits without success

In addition patients who require Group 1 procedures who have a physical condition, such as a severe gag reflex, who need to be treated under sedation will be managed in the hospital dental system



Patients who require Group 2 procedures with difficulties relating to co-operation or the afore mentioned physical conditions will be allocated to secondary care.

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