Special Care Dentistry Pathway - Acceptance Criteria
Special Care Dentistry is concerned with:
“the improvement of oral health of individuals and groups in society, who have a physical,
sensory, intellectual, mental, 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)
The Special Care and Specialist Dental Service is complimentary to and not in competition with the
General Dental Practitioner (GDP) on the high street. One of the guiding principals therefore is that we
do not provide care for clients who could be treated by these dental practitioners.
Acceptance for treatment will be subject to defined acceptance criteria as outlined below. Patients will
usually be seen for an episode of care and then discharged. Patients with more complex special
needs may continue to receive care with the team on an ongoing and regular basis.
Referrals are to be made on the referral forms provided and returned to the appropriate clinic. Verbal
and email requests for patient care will not be accepted. Some specialist services can only be
provided in one location, necessitating patients to be cared for at the appropriate clinic.
Referrals will be rejected:
- if incomplete or insufficient information i.e. “see and treat”
- for routine care
- if sent for financial / economic reasons
- for co-operative children requiring orthodontic extractions with LA alone
- for common medical history problems that are manageable by a GDP e.g. Warfarinised patients,
If it is not possible to determine whether or not a patient fulfils the acceptance criteria from the referral
information, an appointment will be given for an assessment to enable a decision to be made. Please
ensure the person you are referring (and / or their carer) understand this.
Adults and children initially accepted into the Special Care service will be assessed and should their
treatment needs be deemed manageable within a General Dental Practice they will be returned with
appropriate advice.
Treatment will be carried out under the NHS Charges Regulations. For those claiming exemption proof
will be required at the first assessment appointment. For adults in residential care the responsibility of
establishing exemption status remains with the referrer – this must be done before the first visit.
Who can refer?
Treatment will only be offered following an assessment initiated by the receipt of a completed referral
form. Referrals are accepted from a range of healthcare professionals and those involved with the
holistic care of vulnerable adults and children including:
-
General Dental Practitioners
General Medical Practitioners
Medical and Dental consultants
School Nurses
Specialist Nurses
Health Visitors
Looked After Children Team
Social Workers
Community Mental Health Team
Learning Disabilities Team
Residential and Nursing Home Managers
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Adults & Children requiring special care – an outline of criteria leading to acceptance
Criteria
Complex medical history where
medical condition or medication
compromises oral health or
necessitates special care
Management problems /
challenging behaviour
Examples of cases which might fulfil the
criteria

Poorly controlled epilepsy

Poorly controlled diabetes,

Haemophiliacs

Patients who have undergone
radiotherapy of head/neck

Leukaemia

Cystic fibrosis

Lupus

Oncology patients

Patients on immunosuppressants

Palliative care

Autistic spectrum, ADHD

Significant Mental health problems

Learning disability

Neuro-disability requiring special
care

Children who have demonstrated
uncooperative behaviour requiring
more than “tell-show-do” and other
basic
behaviour
management
techniques

Adults who have severe dental
phobia who may need RA or IV
sedation to facilitate co-operation


Complex social needs
Physical difficulties resulting in
mobility problems which make it
difficult / impossible for the
individual to access care
Learning
Disabilities
which
make it difficult/impossible for
the individual to access GDS
care





Complex dental problems
Examples of case that may not fulfil the
criteria

Controlled epilepsy

Controlled diabetes,

Hep B, Hep C or HIV +ve (unless fulfils
other referral criteria)

HIV/Hep –ve despite past or current risk
behaviour

Anticoagulant therapy (ie routine care
for warfarinised patients)




Patients requiring translation services
Patients with history of mental health
problems but no current symptoms or
challenging behaviour
Orthodontic extractions under GA
Children - just because they are young

Complex oral surgery extractions must
be referred to the Oral Surgery Clinical
Network
Child at risk, child protection register
Looked after Children in foster care /
residential schools
Vulnerable adults (see note below *)
Housebound patients
Wheelchair bound patients who
cannot transfer easily requiring
hoist/ramp
Challenging behaviour, +/- complex
medical history.

Poor attenders

Patients who could access practices
with ground floor surgeries

Mild Learning Disabilities with no
challenging behaviour or complex
medical history.
Severe
enamel
hypoplasia,
hypodontia, supernumeries – all
should be referred to Consultant in
Restorative Dentistry, in first instance
for a consultant opinion. May be seen
in our service following this if patient
has additional needs.

High treatment need if no other
management problems.
Pulpotomies, orthodontic extractions,
RCT and other routine care on co
operative children.
Complex treatment plans for anxious
patients.


Adults & Children requiring special care – an outline of treatment limitations.

Intravenous Sedation – This will only be offered to patients over 16 years of
age and who are deemed to be appropriate for this treatment modality after a
full assessment by appropriate staff.
 The range of treatment available under IV sedation is limited to basic
conservative care; routine extractions will be carried out as
appropriate.
 Root canal therapy of teeth will not be undertaken except in cases in
which anterior teeth (incisors, canines) have been involved in trauma.
Nerve extirpation only may be undertaken in these circumstances.
 Advanced restorative treatment (including crowns and bridges) will
not be provided under IV sedation.

Inhalation Sedation – This mode of anxiety control is normally offered to
anxious child patients for the delivery of routine dental care especially the
extraction of sound premolar teeth necessary as part of an orthodontic
treatment plan. In certain circumstances this may also be offered to adult
patients.
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
Domiciliary Care – This will only be offered on a limited basis and is likely to
be for an examination only. In order to ensure patient safety all attempts will
be made to arrange to transport patients to one of our community clinics for
any treatment required. This includes provision of dentures.
Information to be included on the referral form:
Please complete all sections of the referral form – this will help to ensure efficient and effective onward
care for your patient / client. Information to be included in the free text boxes:
-
-
-
-
Presenting complaint
Indication of urgency - for example:

pain or swelling

Oncology patients

Patients’ requiring a dental opinion / treatment prior to medical
intervention (e.g. cardiac patients)
Indication of patients level of anxiety
Justification for referral – multiple extractions in more than one quadrant
If referral is from a General Dental Practitioner:
 any treatment attempted and reason for failure,
 dental charting
 evidence of discussion relating to options for treatment including
risks of GA discussed with parent
 relevant recent radiographs
Any other relevant information that may facilitate enhanced individual care for
example:
 The best time for appointments in relation to cooperation /
medication
 Triggers to avoid e.g. touching patient
 Specific patient worries e.g. waiting in communal area
Details of relevant medical or dental consultants or social workers involved with
patient care
Enclosures to be included with the referral form:
-
For Dental referrers
 Relevant radiographs
 Correspondence from other Dental or Medical professionals e.g.
Orthodontic Treatment plan
-
For Other Referrers



Print out of GMP notes. Please note if the patient is unable to fill
in their own medical history, it must be completed and signed by
a senior and accountable staff member
Mobility questionnaire if relevant (Patients in residential care or
with specific mobility requirements)
Copy of consent for Children Looked After and contact details for
the authority that are able to authorise further interventions if
required
On receipt of your referral:
-
It will be categorised and logged
If accepted the patient will be entered on the appropriate waiting list
An assessment appointment will be sent to the patient when they are nearing the top of the
waiting list
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Prior to the first appointment:
-
-
The patients that are under the care of the referring GDP will need to contact you in case of a
dental emergency
Should the patient fail their assessment consultation, no further appointments will be sent out
and the referrer will be advised. A new referral will be necessary before a further assessment
appointment can be made
If your referral is not accepted you will be informed in writing.
First appointment:
-
This will be for an assessment; normally no treatment will be carried out
Compilation of a provisional treatment plan to include sedation or GA where appropriate
Discussion and consent process with patient and/or carer
Arrangement of further appointment(s)
Contents of referral pack
Acceptance criteria guidance
Referral forms
Mobility questionnaires
Clinic contact details (leaflets)
Other pathways available

Minor Oral Surgery - All referrals should continue through the oral surgery
network using the appropriate referral form.

Orthodontic Opinions and Treatment - All referrals should continue through
the orthodontic network using the appropriate referral form.
* Vulnerable adults
The Law Commission defines the term vulnerable adult as “a person of 18 years or over whom is or
may be in need of community care services by reason of mental or other disability, age or illness; and
who is or may be unable to take care of him or herself or unable to protect him or herself against
significant harm or exploitation”. The Department of Health guidelines state that harm is a violation of
and individual’s human or civil rights by a person or persons – the ill treatment can be physical,
sexual, psychological, financial, neglect or discrimination. (“No Secrets” – DoH)
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