Warwickshire Special Care Dental Service
Guidelines for Provision of Treatment under General Anaesthesia
These guidelines are based on guidelines originally developed by Philip Jenkins,
Consultant in Dental Public Health in 2000 and updated as required.
ACCEPTANCE CRITERIA
Indications

Failure with Alternative Methods
Failure to achieve adequate pain control with alternative methods such as local
anaesthesia or sedation may be an indication for general anaesthesia but will
only be provided if the treatment is essential, as defined in the following
paragraph.

Essential Treatment
The dental treatment required must be essential to the well being of the patient
and part of a long term treatment plan. It is likely to include the alleviation of
severe dental pain or the eradication of gross sepsis, if no alternative care is
feasible. Examples would be:
-
Extraction of multiple deciduous teeth where there have been more
than one episode of significant pain or sepsis.
-
Extraction of first permanent molars which have poor prognosis in the
mixed dentition.
Contra-Indications

Age
General anaesthesia normally should not be provided for very young children
or adults, particularly the very old unless it is absolutely unavoidable.

Alternative Methods
Where the use of alternative methods of pain control have not been fully
explored and excluded, general anaesthesia will not be considered.

Medical Conditions
Referring dental practitioners are required to provide a full medical history.
The presence of a medical condition placing the individual at risk from the
intended procedure may preclude general anaesthesia. This includes such
things as the presence of acute respiratory tract infections at the time of the
anaesthetic, patients who are excessively overweight or who have congenital
heart defects. Where there is any doubt over the suitability of a patient for
general anaesthesia, the final decision will rest with the anaesthetist.

Specific Treatments
In general the following would not be considered for treatment under general
anaesthesia unless the individual has a significant special need and the
treatment is considered essential to long term health and well-being.

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
Conservative treatment of deciduous teeth.
A single tooth extraction.
Simple orthodontic extractions.
CLINICAL FACILITIES
Treatment under general anaesthesia is provided at three sites in Warwickshire.
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Warwick Hospital – Tuesday a.m.
UHCW Coventry – Friday p.m. alternate weeks
George Eliot Hospital – 1st, 3rd and 5th of the month.
Tuesday a.m. adult only (predominantly complex cases requiring restorations,
periodontal treatment and exodontia.)
REFERRAL PROCEDURES
Referrals are accepted from General Dental Practitioners using a standard proforma
referral letter. This includes:
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
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Patient Details.
Indicated treatment prescription (adequate periapical 0PG radiographs must be
provided for the extraction of permanent teeth).
Clear justification for the use of General Anaesthetic.
Referring GDP’s details.
GMP’s details.
NHS Number.
Signature of referring dentist.
TRIAGE AND TREATMENT
Referrals are triaged as Urgent and the patient or parent or guardian of the patient
invited to ‘opt in’ to the service.
When they ‘opt in’ an appointment is given for them to attend an assessment
appointment at a time/clinic of their choice.

At the assessment appointment, options for pain control and associated risks
will be discussed
 If a general anaesthetic is considered the most appropriate pain control
mechanism for treatment1. Paediatric cases will be offered an appointment at the next available date at
UHCW and Warwick and parent/guardian can choose which they prefer.
2. Adults requiring treatment under general anaesthesia will be put on a waiting
list and contacted on an individual basis.

Following treatment, patients will either be discharged back to the referring
dentist or kept within a recall system for our service. Referring clinicians
will be advised by letter.