Information for GMPs

Dentistry is concerned with the prevention and treatment of oral disease. It involves maintaining the health of the teeth, gums and the soft tissues of the oral cavity/oral mucosa.

The provision of NHS dental care is complex and differs depending on whether a patient is registered with an NHS general dental practitioner.

The majority of routine dental care is undertaken within the General Dental Services (ie. in a dental practice). To access such care a patient must be registered with a general dental practitioner. Patients who require routine dental care should be directed to register with a general dental practitioner. Patients who require specialist input can be referred into secondary care by their general dental practitioner or their general medical practitioner.

Patients may sometimes present to GMPs with oral problems, usually either because they don’t know how to access dental care, are not registered with a GDMP, feel unsure whether it is a medical or dental problem, or perceive the GMP to be more accessible.

The majority of dental care is undertaken within the General Dental Services (in a dental practice). Patients who do not require specialist input should be directed to contact their registered GDP or to register with a general dental practitioner.

The list of dental practices that are currently accepting new NHS dental patients may be found here.

GMPs can signpost patients directly to GDPs or refer directly where appropriate, through SCI Gateway to Oral Medicine, Oral Surgery, Oral Maxillofacial Surgery or the Public Dental Service.

Emergency and Urgent Dental Care

Patients registered with a dentist:

• In hours Monday to Friday 0830-1630 - should contact their own dentist for urgent dental care.
• Out of hours - advise patients to phone 111 (Out of Hours/weekends and the Christmas and New Year Public Holidays dental practices participate in the NHS Tayside Out of Hours service through NHS 24).

Unregistered patients
In hours Monday to Friday 0830-1630 - patients should call one of the following to arrange an emergency an appointment. Please note there is no walk-in service available:

• Dundee - Kings Cross Dental Centre 01382 596990
• Dundee - Dundee Dental Hospital 01382 401455
• Angus - Springfield Medical Centre Arbroath 01241 432481
• Perth - Broxden Dental Centre 01738 450550.

Out of hours phone 111.

The following conditions should be treated as an emergency. The patient should have contact with a dental clinician within 60 minutes and subsequent treatment within a timescale that is appropriate to the severity of the condition. During normal working hours contact the dental practice where the patient is registered or one of the emergency clinics named above.
Out-of-hours: evening or weekend – contact NHS24 for an appointment at the dental access clinic or Oral and Maxillofacial on-call staff:

• Trauma including facial/oral laceration and/or dentoalveolar injuries (e.g. avulsion of a permanent tooth)
• Oro-facial swelling that is significant and worsening
• Post-extraction bleeding that the patient is not able to control with local measures
• Dental infection that has resulted in acute systemic illness or raised temperature
• Severe trismus
• Oro-dental conditions that are likely to exacerbate systemic medical conditions

The following conditions should be referred directly to a GDP for first assessment:

• Dental Pain. 
  • If the patient is registered direct to GDP treatment / analgesia / antibiotics as required.
  • If patient is not registered, they must either register with a GDP or access emergency dental services (see above).
• Post-op pain/infection – patient should be advised to return to the team who undertook treatment/surgery.
• Suspected temporo-mandibular joint dysfunction/teeth grinding (see: Management of Temporomandibular Disorders (TMDs) Bulletin for GDPs)

Conditions GDPs should be dealing with/referring on directly:

• Any oral problems that require secondary care should be referred directly by GDPs to the appropriate dental specialty without involvement of the GMP.
• There is existing SDCEP guidance for GDPs covering the management of:
  • Patients who are anticoagulated
  • Patients at risk of Medication related osteonecrosis of the jaw
  • Patients who might require Antibiotic prophylaxis.

Patients with the above complicating issues should rarely need GMP involvement.

There may however be some more complex cases where dentists might require some advice/assistance from their medical counterparts.

If GDP thinks patient’s complaints are not of dental origin – e.g., Sinusitis – it would be reasonable for GDP to send to GMP who would either manage the problem or refer onwards to e.g. ENT.

Conditions GMPs should refer on directly to specialist if presenting to GMP first:

• Suspected oral cancer - Refer directly via to OMFS marked 'urgent suspected cancer'
• Soft tissue/oral mucosal lesions should be referred to Oral Surgery or Oral Medicine directly via SCI Gateway.
• Chronic facial pain of non-dental origin (e.g., Neuropathic pain or suspected trigeminal neuralgia) should be referred directly to Oral Medicine via SCI Gateway
• Unregistered patients with complex additional needs that seriously affect the provision of dental care may be referred to the Public Dental Service via SCI gateway.
  • Medically Compromised
  • Complex Learning Disabilities/Cognitive Impairment
  • Physical Disabilities/Mobility Problems
  • Mental Ill Health
  • Dental anxiety (including Inhalation and Intravenous sedation)
  • Care Homes
  • Domiciliary care
  • Bariatric