GGC - Oral Health
Management of complex acute dental trauma. Please note acute dental trauma requiring emergency management should be referred via telephone on 07870806319 providing all relevant referrer, patient, and injury information.
Advice on complex pain diagnosis, or extensive apical pathology noted radiographically (this may be provided via attend anywhere and/or communication with referring dentist). An assessment of odontogenic pain should have been carried out in practice, prior to referral, to include TMJ/myofascial source, dentinal hypersensitivity, and periodontal assessment. In addition, all active caries should have been treated, teeth/roots of poor prognosis extracted, and all heavily restored teeth should have pulp tests and periapical radiographs (to be submitted with the referral) This includes referrals redirected to us by Oral Medicine.
Pathological root resorption which is thought to be rapidly progressing
Perforation repair in anterior teeth (incisor/canine) deemed amenable to repair in one visit by vetting consultant (up-to-date radiograph and clinical diagram showing site of perforation essential)
Endodontics Referral Guidance
Warning
Priority list of conditions that we will accept and those which at the present time we will not accept for treatment.
Please note for all teeth referred for endodontics questionable coronal restorations and caries should be completely removed to allow assessment of restorability, including identification of cracks. Teeth of questionable-poor prognosis will not be accepted for treatment.
Teeth should be restored with well sealed, hard wearing provisional restoration (usually GIC), prior to referral.
For any re-RCT, attempt must be recent, by referring GDP. Unless significant complexity, GP removal should have been performed by referring GDP prior to referral.
Peri-apical radiograph of tooth in its current condition (post any attempted access) must be provided.
- Location of root canal with evidence of canal obliteration radiographically, where GDP access attempt has failed (access must have been attempted recently by referrer)
- Complex root canal morphology, such as: apical bifurcation, canal curvature >30 degrees, ‘S’ shape, ‘C’ shape, dens invaginatus, open apex.
- Periradicular surgery where chance of success is high as assessed by the endodontic team
- Removal of separated instrument, silver point or fractured post where chance of treatment success is high (as assessed by the endodontic/restorative specialist)
- Post removal, where there has been a meaningful attempt and provisional coronal restoration provided
- Patients unwilling to meet financial costs out with GDH. Direct referral to the BDS undergraduate clinics could be considered as an alternative if straightforward primary care. https://www.gla.ac.uk/schools/medicine/dental/practitionerreferrals/
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Endodontic treatment for teeth of dubious prognosis such that extraction and prosthetic replacement would be a more predictable treatment option
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Failure of local anaesthetic (advice only at vetting stage)
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Limited mouth opening
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Assessment of restorability
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Whitening of discoloured teeth
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Treatment of 7’s and 8’s. 7's will be considered if only functional molar remaining in that quadrant or prosthetic abutment. (Must also meet other endodontic acceptance criteria)'
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Post removal, if no meaningful attempt has been made in practice
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Endodontic retreatment where multiple attempts at re-RCT have been made and a further attempt is unlikely to be successful
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Treatment to avoid extraction due to medical conditions that does not meet the endodontic acceptance criteria
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Treatment under sedation or general anaesthetic
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Iatrogenic damage including perforation in a posterior tooth (premolar/molar), or an anterior tooth which could not be predictably repaired
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Management of combined periodontal/endodontic lesion unresponsive to primary endodontic treatment in the primary care setting that does NOT also fulfil current periodontal criteria
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Patients with uncontrolled periodontal disease or primary carious lesions