Dental Care

Overview

Guidance on providing dental care

The BMA advises that general practice is not the appropriate place for the management of dental issues.  Specific guidance can be found below: 

• Patients presenting with dental problems (bma.org.uk)

Bristol Dental Hospital

Bristol Dental Hospital is no longer accepting referrals for – or carrying out - urgent adult dental care.

Urgent dental care is available from a range of local primary dental care providers via 111.  Patients who go to the hospital needing urgent treatment will be redirected to 111 unless their condition is considered an emergency under current NHS guidelines.

Bristol Dental Hospital remains open for other existing services, including emergency dental care for children, specialist dental services and appropriate secondary and tertiary referrals. More information and referral forms can be obtained  from the website.

Dental Referrals

It is advised that referrals to the dental hospital should come from a general dental practitioner and not from a GP. We suggest the patient sees their dentist for assessment and referral if indicated (this is recommended for all oral surgery referrals and also referrals for atypical facial pain). All Dentistry Referral forms are available from this link.

If a patient is not currently registered with a dentist and needs more urgent dental care then they can ring NHS111 to find out about local dental services.

Referrals

Emergency Dental Service - Patients who are registered with a Dentist

To access this service, patients must phone 111. This service is provided to any patient, NHS or private, who requires out of hours dental treatment or if they are visiting the area. Triage will determine the patient's need and an appointment will be given if appropriate. Referral is not needed by a dentist.

The cost of treatment for all services and clinics is the same as at any other NHS dental practice and is payable at the time of treatment.

Urgent Dental Care 

• From Friday 21 July 2023, urgent dental care will no longer be carried out at the Bristol Dental Hospital.
• Urgent dental care is still available from a range of local Primary Care providers and from September 2023, provision will be available from a new site in Bristol city centre, at Temple Quay, when the new University of Bristol Dental School opens.
• Patients will no longer access urgent dental care by contacting the Bristol Dental Hospital directly. They will continue to be advised to contact NHS 111 to access urgent dental care.
• There is no walk-in service. 

Bristol Dental Hospital remains open for all other existing services, including emergency dental care for children, emergency dental care by professional referral, appropriate secondary and tertiary referrals, and specialist dental care. Doctors and dentists should continue to refer to Bristol Dental Hospital for all services other than urgent dental care.

Emergency Dental Service for Children (aged 0-16 years)

The Department of Child Dental Health is a Specialist Unit and only provides emergency care for children with:

• complex dental trauma
• facial swelling associated with dental infection
• uncontrolled bleeding following dental extractions or dental trauma

Attend at Bristol Dental Hospital between 9am and 4.30pm, Monday to Friday. Emergencies of this nature outside of these hours should attend the Bristol Royal Hospital for Children's A&E department.

All children attending as an emergency will be triaged. If they do not meet the criteria above, they will be asked to return to their own dentist or directed to phone 111 for out of hour's services.

For any other dental problems, children who are registered with their own dentist should contact their dentist in the first instance.

If outside normal dentist opening hours, they should phone 111 for information regarding out of hour's dental services in their area.

If the child is not registered with a dentist, the carer should phone 111 for advice regarding dentists who are accepting NHS patients for registration, and for information regarding out of hour's dental services, and access to the Primary Care Dental Service.

Primary Care Dental Service (PCDS)

If the patient has special needs or disabilities and cannot access a GDP then they can be referred to the UHB primary care dental service which is available via direct referral using their proforma (also available as an EMIS template). This service provides comprehensive dental care for adults and children who cannot access routine dental care in regular dental practices due to their additional health or social needs.  There are clinics in Southmead, Charlotte Keel, Easton, Yate, Bath and Weston-Super-Mare.  For further information about the acceptance criteria for referrals please click here.

Dental Student Service

Bristol Dental School is moving to 1 Trinity Quay, Avon Street, Bristol, BS2 0PT in Summer 2023. They are no longer accepting volunteer patients for student-led restorative treatment at Bristol Dental Hospital. More information will be available on how to volunteer for assessment for suitability at the new site on Bristol Dental School's website in Spring 2023.

Access Dental - Dental Helpline Service

‘Access Dental’ is delivering a new dental helpline service to patients living in BNSSG from April 2nd 2019. Access Dental is run by DevonDocs and is open 8am-10pm, 7 days a week 365 days per year. It is an advice and triage service that

• Provides information about NHS dental services in the area
• Provides appropriate advice and signposting of non urgent dental enquiries
• Provides urgent care advice where appropriate
• Can book patients into dedicated urgent care slots provided by General Dental Practitioners (weekdays) across the area, or out of hours providers, following triage and assessment.

Patients access the new service by dialling NHS111 and selecting option 2 (for dental problems). When Access Dental is open, patients who select option 2 will be diverted directly to Access Dental and will therefore not come through to NHS111 for pathways assessment, or to the Clinical Assessment Service (CAS). When Access Dental is closed, dental cases will come through to NHS111 for pathways assessment and may be passed through to the CAS for clinician input.

Guidance for clinicians managing patients with dental symptoms/ problems:

If you speak to a patient with a dental problem between 10pm and 8am when Access Dental is closed, please advise the patient to call back to NHS111 and select option 2 (for dental problems) after 8am the following day.

In the interim period, the NICE Clinical Knowledge Summary provides helpful guidance about the diagnosis and management of dental problems in primary care. It outlines the features of serious illness or complications warranting immediate treatment. In the absence of these features, the guidance outlines that our main role in primary care is to provide advice about and/ or prescription(s) for analgesia. Patients should also be advised to seek advice/ assessment from a dentist as soon as possible.

We should therefore not routinely provide antibiotics for otherwise healthy patients at low risk of complications, when there are no signs of spreading infection. In the absence of immediate attention by a dentist, only prescribe an antibiotic if the patient

• is systemically unwell
• has signs of severe infection (eg fever, lymphadenopathy, cellulitis, diffuse swelling)
• is at high risk of complications (eg immunocompromised or diabetes).

Anticoagulation treatment and dental procedures

Please see the guidelines for anticoagulation treatment and dental procedures.

Latest News Articles Update to dental guidance on anticoagulants (bda.org)

Prescribing for oral and dental problems

Please see the Oropharynx page of the BNSSG formulary for advice on prescribing for oral and dental problems.

Advice on Dental Infections (1)

GPs should not be involved in dental treatment. Patients presenting to non-dental primary care services with dental problems should be directed to their regular dentist or if this is not possible to NHS 111 who will be able to provide details of how to access emergency dental care.

Antibiotics do not cure toothache. First line treatment is with paracetamol and/or ibuprofen.Codeine is not effective for toothache.

Current recommended dental prescribing information can be found online: Antimicrobial prescribing in dentistry – College of General Dentistry

(1) BNSSG Primary Care Antimicrobial Guidelines

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.