Adult dental anxiety services

Adult Dental Anxiety Service

The Adult Dental Anxiety Service provides behavioural, psychological and pharmacological approaches to managing dental anxiety / phobia for patients resident within NHS Borders.

Referrals are accepted for a single course of treatment. Patients will be returned to their General Dental Practitioner(GDP) /signposted to registration when they are considered suitable for ongoing ‘continuing care’.

The service offers a range of treatment modalities:

Behavioural management techniques
Inhalation sedation
Access to intravenous sedation (dentist / anaesthetist led depending on ASA Classification)
Access to general anaesthesia

Please note that patients should not be referred for a specific treatment modality. The patient assessment will determine the treatment modality most suited for the patient.

Treatment is provided under General Dental Service (GDS) terms and conditions with strict adherence to the Statement of Dental Remuneration (SDR).

NHS fees apply to all unless the patient is entitled to free dental treatment

Who to refer, who not to refer, how to refer

Patients Not Accepted

Referrals not accepted for the following:

Patients requiring / requesting:

Private treatment options (Treatment only within the remit of the SDR)
Implants
Cosmetic dentistry
Premolar/Molar endodontics or fixed prosthodontics under conscious sedation (Anterior endodontic treatment may be considered on an individual basis but will not be considered as a routine)
Hygiene therapy in isolation under conscious sedation or general anaesthesia
Conscious sedation solely to facilitate denture construction in those with a severe gag reflex.
Unregistered patients requiring routine dentistry (i.e with no presentation/history of acute dental problems). These patients should be signposted for dental registration.
Patients resident out with the boundaries of the health board.

Required information to be included in referrals:

Reason for referral – why the procedure cannot be managed in the routine practice setting
Details of any oro-dental pathology
History of presenting complaint including any pain, swelling
Full medical history including medication, allergies (a scanned up to date form is entirely acceptable)
Previous sedation history (previous successfully completed treatment, which modality – IHS / IVS / GA)
What treatment has been attempted in GDS (and what modalities used) including details of emergency care provided if patient in pain/other symptoms
Summary of oral hygiene level, BPE score, any proactive preventative measures undertaken
Stability of dentition
What is the GDP asking for, both dental treatment and anxiety management?
What are the expectations of the patient? Level of motivation?

How to refer:

Referrals to the Adult Dental Anxiety Service are only accepted from General Dental Practitioners (GDP).

GDPs providing NHS dentistry must refer via SCI Gateway. Any other route of referral will be rejected.
If you are a primary / secondary care health or social care professional without access to SCI Gateway, please email pdsreferrals@borders.scot.nhs.uk. or refer to:

Public Dental Service Department,

Borders General Hospital,

Melrose,

TD6 9BS

If a referral is urgent in addition to the above, please contact the Oral/Dental/Orthodontic Secretary on 01896 826201

Please note that the secure transmission of emails containing patient information is the referrer’s responsibility

For other primary and secondary health and social care providers wishing to refer to the services, please advise the patient to register with a GDP in the first instance. Information on how to register with a dentist can be obtained via the NHSB Dental Enquiry Line 0300 7900 710 or dental.enquiry@borders.scot.nhs.uk Referrals should be completed as fully as possible, with poorly completed forms rejected.

When referring please ensure the following:

A clear treatment plan is included.
Recent and relevant radiographs are attached. Please upload with the patient’s name and date taken.
If a treatment plan and radiographs are not included, then a reason provided for this.
Optimum oral hygiene achieved prior to referral.

Relevant radiographs / images should be included in your referral. These can be sent as an ‘attachment’ in SCI Gateway (maximum file size of 2MB, with a total attachment capacity of 5MB). If you are not registered with SCI Gateway, please provide the images in an alternative accessible format.

Please note that:

It remains the responsibility of the referring GDP to provide or secure any necessary treatment or advice (including emergency / urgent care).
The GDP will remain the first point of contact for all emergency / urgent care.
All patients should have their oral hygiene and diet optimised under the care of their GDP prior to referral. Patients with poor plaque control or non-compliant with good oral hygiene regimens could have their treatment options greatly limited and are unlikely to be considered suitable for Sedation/General Anaesthesia.
Patients identified as having an outstanding financial balance with our service will not be accepted.

Discharge criteria:

Patients will be discharged from the care of the service for the following reasons:

Their care can be reasonably delivered in a GDS setting.
They have completed a course of treatment.
They fail to attend or repeatedly cancel their appointments at short notice. The referrer will be duly informed. For patients still wishing to be treated by the service a new referral will be necessary.

Primary care management

Patient should have received preventative advice and be encouraged to maintain oral hygiene to the highest standard they are able. Any treatment the patient is able to cope with in GDS should be completed prior to referral