Clinical Care Pathway
At your first clinical examination appointment (Not on emergency appointments) we aim to:
- Give you a diagnosis. That is to identify the specific problem if there is one.
- Do a needs assessment. That is to inform you of what can be done to resolve the identified problem/ problems.
- Prevention. Our dental care will aim to adopt a preventative outlook in line with current treatment modalities. These preventative measures may not all be available on the NHS and as such may incur further charges. This includes lifestyle advice such as smoking cessation, oral health advice, oral cancer screening etc.
- We will discuss care options available to you either on the NHS or privately.
- Oral healthcare provided, i.e, actual treatment consented to by you.
- Agree a regular review interval with you at the completion of your course of treatment to ensure you sustain the attained oral health. We have adopted the National Institute for Clinical Excellence (NICE) guidelines at setting your recall interval.
- For those presenting for the relief of symptoms or other problems.
- Regular examinations for those patients wishing to enter into a continuing relationship with the practice at intervals determined by their risk of developing disease, following NICE guidelines.
- Regular monitoring for those at risk of developing disease
- Children to be seen at specific age milestones in their dental development at the ages of 3,6,9 and 12 years.
- Radiographs will be taken in accordance with the current Faculty of General Dental Practice (UK) guidelines.
- We do not encourage taking radiographs for non-clinical reasons. If you request it we will charge private fee
- We aim to ensure your participation in your oral health care. As such we will inform you of measures you can implement to improve your oral health. If you fail to comply it may redefine our continued relationship with you.
- We do not have a contract to provide preventive programmes under the NHS at the moment but can provide one for individuals/ families privately. For example demonstration of tooth brushing techniques using disclosing tablets etc.
Periodontal care (gum care)
- Periodontal care will be provided under the NHS contract in accordance with current guidelines for the management of disease rather than for cosmetic reasons. These services will be provided by the dentist.
- The specialist services of a hygienist/ therapist will be charged privately.
- The use of periodontal treatment adjuncts such as perio chips etc will be charged privately as these are not available under the NHS.
- Patients with BPE Score of 4 or * will be refered to specialist practitioners privately or to the appropriate department at the Dental Hospital.
Fillings and endodontic care
- Fillings will be provided under the NHS. We have adopted the latest guidelines for a minimal intervention.
- Cosmetic restorations will be charged privately.
- White fillings on back teeth are provided privately.
- Root fillings will be available under the NHS using manual hand files. Rotary root canal instrumentation will be charged for privately in view of the higher costs of these instruments. Rotary instrumentation is more efficient at performing root fillings.
Treatments involving laboratory work
(such as veneers, inlays, crowns and bridge abutments)
- Treatments involving laboratory work will only be provided where the condition of the whole mouth justifies it and there is no other clinically acceptable form of treatment.
- The condition and health of the tooth or teeth concerned must indicate a reasonable prognosis. There should be no significant mobility.
- An appropriate radiograph will be taken to show the periapical condition, with bone support usually not less than 50% (per cent) of root length and the adequacy of any root filling present.
Crowns and inlays
The guidelines as to the conditions of the mouth necessary for advanced treatments must be met. A crown or inlay will be provided under the NHS if:
- The tooth is in immediate need of attention and there is so much missing tooth material or serious marginal discrepancy that the tooth cannot be restored by other means:
- For an incisor (front tooth) at least one-third of the biting edge is missing
- For a premolar at least one cusp is missing
- For a molar tooth more than one cusp is missing
- No other restoration will achieve oral health.
- An existing crown has failed and renewal is the only treatment that will conserve the tooth.
The following conditions as to types of crown and material used apply to NHS crowns:
- Full metal crowns will be constructed in precious or non-precious alloy.
- Bonded crowns will only be placed anterior to the first molar.
If these conditions are not met the treatment may be provided privately. All Metal free crowns are provided privately.
A veneer on an upper tooth anterior to the first premolar will be provided under the NHS or privately for the following reasons:
- Masking gross discoloration of teeth
- Restoration of fractured teeth as an alternative to a jacket crown
- Improvement of morphology of teeth that have not developed normally
- Where an existing veneer has failed.
Where these conditions are not met, a veneer may be provided privately only.
Dentures under the NHS contract
- Dentures will be provided under the NHS if the dentist considers that the gap needs restoring.
- Cases that present difficulties may be referred where care might be better provided by a dentist with a special interest in prosthetics.
- Acrylic dentures will usually be provided.
- Chrome dentures will be provided under the NHS if:
- Three months have lapsed since extractions
- It is unlikely that further extractions will be necessary
- There is low caries incidence
- There is a low incidence of periodontal disease
- Where an acrylic denture has fractured on more than one occasion.
- Otherwise chrome dentures may be provided privately.
Those patients wearing any partial denture will be considered at high risk of periodontal disease.
Bridges under the NHS contract
Bridges will only be provided under the NHS where the condition of the whole mouth justifies it, and there is no other clinically acceptable form of treatment and if the following conditions are met:
- Patients should be aged 17 years or over.
- Bridges should be provided at least six months after extractions.
- There should be satisfactory periapical and periodontal condition and a reasonable prognosis for all other teeth in the mouth.
- Proposed abutment teeth should show no significant mobility, have bone support of not less than 50 per cent of root length and an adequate root filling if present.
- There should be no other clinically acceptable form of treatment and the provision of a denture previously has proved unsatisfactory.
- There should be either;
- A single anterior space of not more than two units in an otherwise healthy and intact arch of not fewer than ten units OR
- A single posterior space of not more than two units where the replacement of the missing unit is necessary for the stability of the occlusion.
- Bridges should have an adequate retainer to pontic ratio:
- Not more than one pontic per retainer in cantilever bridges
- Two pontics per retainer in fixed movable bridges
- No more than one bridge in the same jaw should be provided.
- The replacement of a failed bridge must fulfil the conditions above.
If these criteria are not met in full a bridge may be provided privately.
Extractions and oral surgery under the NHS contract
- Non-surgical extractions and associated postoperative care will be provided under the NHS.
- Oral surgery including surgical extractions, periodontal and endodontic surgery may be provided under the NHS or referred appropriately where it is beyond the competence of the dentist.
General anaesthesia and sedation under the NHS contract
- General anaesthetics and sedation will not be provided under the NHS in our practice.
- Patients requiring sedation or general anaesthesia will be referred appropriately.