Special Care Dentistry Pathway – Acceptance Criteria
Adults & Children requiring specialist & 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
/
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 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

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.

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.
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

Poor attenders

Patients who could access practices
with ground floor surgeries

Mild Learning Disabilities
challenging behaviour or
medical history.

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.


* 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)
Side 1 of 2
with no
complex
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.

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



Other pathways available


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
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.
September 2011
Side 2 of 2