Tag: oral

Public Dental Service

Scott McLaughlin

Who can we treat under the Public Dental Service?

The Public Dental Service’s treatment role is now focused on:

  • providing treatment to patients with special care requirements.
  • the provision of dental services that are not routinely available in general dental practice (such as dental treatment under general anesthetic for children and adults with special needs).
  • accepting referrals of patients (special care adults, vulnerable children and children with behavioural management problems) from independent contractor general dental practitioners and other Health Care Professionals.
  • accepting referrals of patients with complex medical needs that cannot be treated in general dental practice.
  • accepting referrals of anxious children and severely anxious adults for dental treatment under sedation.
  • the provision of care for socially excluded groups such as prisoners, and those who are unable to leave their home.

The other main roles for the Public Dental Service continue to be prevention, epidemiology and teaching.
While the vast majority of referrals are perfectly acceptable, the more information we can have about a patient before we see them, the better able we are to help them.

Patient Charges

The Public Dental Service has to charge patients for the dental treatment provided (unless the patient is exempt from charges) and work under the same rules and regulations as independent contractor general dental practitioners. Patient charges must be collected unless the patient is exempt.

Normal charging arrangements will apply when a PDS dentist provides general dental services. Patients are required to pay 80% of the cost of their NHS dental treatment up to a set maximum per course of treatment (currently £384), unless they are in one of the groups entitled to free NHS dental treatment or help with the cost of dental treatment.

Contact the Public Dental Service

The Dental Office,

Glendoe Building,

Coathill Hospital,

Hospital Street,

Coatbridge ML5 4DN

Telephone: 01236 707711

Lead Clinician: Michael Devine,
Director of Public Dental Services,
NHS Lanarkshire.
Review Date: January 2016

Public Dental Service (for GP use)

Scott McLaughlin

Who can we treat under the Public Dental Service?

The Public Dental Service’s treatment role is now focused on:

  • providing treatment to patients with special care requirements.
  • the provision of dental services that are not routinely available in general dental practice (such as dental treatment under general anesthetic for children and adults with special needs).
  • accepting referrals of patients (special care adults, vulnerable children and children with behavioural management problems) from independent contractor general dental practitioners andv other Health Care Professionals.
  • accepting referrals of patients with complex medical needs that cannot be treated in general dental practice.
  • accepting referrals of anxious children and severely anxious adults for dental treatment under sedation.
  • the provision of care for socially excluded groups such as prisoners, and those who are unable to leave their home.

The other main roles for the Public Dental Service continue to be prevention, epidemiology and teaching.
While the vast majority of referrals are perfectly acceptable, the more information we can have about a patient before we see them, the better able we are to help them.

Patient Charges

The Public Dental Service has to charge patients for the dental treatment provided (unless the patient is exempt from charges) and work under the same rules and regulations as independent contractor general dental practitioners. Patient charges must be collected unless the patient is exempt.

Normal charging arrangements will apply when a PDS dentist provides general dental services. Patients are required to pay 80% of the cost of their NHS dental treatment up to a set maximum per course of treatment (currently £384), unless they are in one of the groups entitled to free NHS dental treatment or help with the cost of dental treatment.

Contact the Public Dental Service

The Dental Office, Glendoe Building, Coathill Hospital, Hospital Street, Coatbridge ML5 4DN
Telephone: 01236 707711

Lead Clinician: Michael Devine,
Director of Public Dental Services,
NHS Lanarkshire.
Review Date: January 2016

Oral Maxillofacial Surgery Template

Scott McLaughlin

This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.

Presenting Complaint

Main presenting complaint:

  • Other lump / swelling
  • Other oral mucosal lesions
  • Oral / facial pain
  • Salivary gland problems
  • Temporo-mandibular joint problems
  • Oro-facial disproportion / deformity
  • Requiring minor oral surgery

Based upon the answer to the question above, please select the appropriate option from the questions below.
If ‘Oral/Facial pain’ is selected, no further information is required here.
If ‘Temporo-mandibular joint problems’ is selected, no further information is required here.

If ‘Other lump/swelling’:

  • Oral
  • Facial
  • Neck

If ‘Other oral mucosal lesions’:

  • Long-term mucosal pigmented lesion
  • Other mucosal abnormality
  • Mucosal bullous lesion
  • ROAU

If ‘Salivary gland problems’:

  • Major gland
  • Minor gland
  • Salivary calculus
  • Dry mouth

If ‘Oro-facial disproportion / deformity’:

  • Skeletal growth abnormalities
  • Cleft lip palate
  • Post traumatic abnormalities

If ‘Requiring minor oral surgery’:

  • Third molar/impacted tooth
  • Other tooth/root
  • Peri-radicular
  • Pre-prosthetic
  • Pre orthodontic

Reason for Referral: [Text]

Priority:

  • Routine
  • Urgent
  • Urgent – Suspicion of cancer

Date of Onset: [Date]

Priority Reason: [Text – 98 character maximum]

 

Head and Neck, Suspicion of Cancer Referral

Scott McLaughlin

Head and Neck Cancers

The incidence of head and neck cancer is increasing and around 1,200 people are diagnosed with a head and neck cancer each year in Scotland, of which around 240 are thyroid cancers. The incidence of oropharyngeal cancer is increasing in the younger population, and appears to be associated with human papilloma virus (HPV) infection.

Risk factors for head and neck cancers (excluding thyroid) include: smoking, HPV, alcohol, poor diet, social deprivation, tobacco chewing habits (including Betel, Gutkha and Pan) and older age. The risk of developing nasopharyngeal cancer is higher in patients of Chinese origin and a higher index of suspicion should be used in these patients.

All patients with features suspicious of malignancy should be referred to a team specialising in the management of head, neck or thyroid cancers, depending on local arrangements

With the changing pattern of disease, age, non-smoking or non-drinking status should not be a barrier to referral.

Emergency Referral

Stridor

Urgent suspicion of cancer referral

Head and Neck Cancer
  • Persistent unexplained head and neck lumps for >3 weeks.
  • Ulceration or unexplained swelling of the oral mucosa persisting for >3 weeks.
  • All red or mixed red and white patches of the oral mucosa persisting for >3 weeks.
  • Persistent hoarseness lasting for >3 weeks (request a chest x-ray at the same time).
  • Dysphagia or odynophagia (pain on swallowing) lasting for >3 weeks.
  • Persistent pain in the throat lasting for >3 weeks.
Thyroid Cancer
  • Solitary nodule increasing in size.
  • Thyroid swelling in a pre-pubertal patient.
  • Thyroid swelling with one or more of the following risk factors:
    • neck irradiation
    • family history of endocrine tumour
    • unexplained hoarseness
    • cervical lymphadenopathy.

Reference:
Scottish Referral Guidelines for Suspected Cancer. Scottish Government, August 2014
SIGN Guideline 90 – Diagnosis and Management of Head and Neck Cancer
Clinical Lead Mr Andrew Carton, Head and Neck Surgeon, Monklands DGH
Review Date March 2017

ENT Cancer Referral

Scott McLaughlin

Consider referral to ENT when the patient presents with any of the following signs or symptoms:

  • Hoarseness persisting for more than 3 weeks
  • High dysphagia persisting for more than 3 weeks
  • Unresolved neck masses for more than 3 weeks
    • (** Also refer to Monklands or Hairmyres Hospital for ultrasound and or FNA **)
  • Persistent unilateral unexplained throat pain
  • Unilateral nasal obstruction particularly when associated with purlent discharge
  • Unexplained ear pain particularly with any of the above

Stridor should be referred as an emergency

Consider referral to Maxillofacial when the patient presents with any of the following signs or symptoms:

  • Ulceration of oral mucosa persisting for more than 3 weeks
  • Oral swellings persisting for more than 3 weeks
  • All red or red and white patches of the oral mucosa
  • Unexplained tooth mobility not associated with peridontal disease

Consider referral to Ophthalmology when the patient presents with any of the following signs or symptoms

  • Orbital masses

Consider referral to General Medicine when the patient presents with any of the following signs or symptoms

  • Cranial neuropathies

CCI Guidelines

The CCI Referral Guidelines can be found at ENT Referral Pathways.

Dietetics Service Referral

Scott McLaughlin

NHS Lanarkshire Dietetics Service

Adult Nutritional Support – Only patients who are at risk of malnutrition should be referred to this service. These will be patients with a MUST score of 2 and above (see below for detailed explanation).

Paediatric Dietetics – should be used for all paediatric referrals

Adult Dietetics – All other adult dietetic referrals should be completed here

Guidelines for Adult Oral Nutrition Support Referrals

The Community Dietetic Service will accept referrals which conform to our referral criteria.
For proposed referrals which do not fit these referral criteria please use the links to our First Line Advice Documentation provided.

Medical or Dietary Condition Referral Criteria
Adult Obesity BMI of 35kg/m² or greater ,
BMI 30kg/m² or greater with co-morbidities or requiring advice to support use of anti obesity medication e.g. Orlistat

Patients who do not fit these criteria can receive advice from the following websites:

British Dietetic Association Weight Wise
British Dietetic Association Food Fact Sheets

For patients with a BMI of 25 or higher, who do not fufill the referral criteria, a self referral can also be made to the Weigh To Go weight management/lifestyle initiative run in North and South Lanarkshire leisure venues :

Weigh To Go
Hyperlipidaemia Total Cholesterol of 6.0mmol/l or greater and/or Serum Triglycerides > 2.0mmol/l will be accepted in the community

Patients who do not fufill these criteria can receive advice using these websites:

British Heart Foundation Publication Search
British Dietetic Association Food Fact Sheets
Hyperlipidaemia
Food Allergy/Intolerance 		Single Adult Food Allergy/Intolerance can be seen in the community setting following a confirmed medical diagnosis from a specialist in allergy medicine.

Adult Multiple Food Allergy can be seen by community dietetics following a confirmed allergy specialist diagnosis.

Paediatric Single or Multiple Food Allergy/Intolerance should be referred via the SCI Gateway Paediatric Referral page.
Coeliac Disease Patients will have received a confirmed diagnosis of Coeliac Disease following blood anti body tests and small bowel biopsy and/or a diagnosis of Dermatitis Hepetiformis

In addition patients should be directed to: Coeliac UK website
Gastrointestinal Diseases
Irritable Bowel Syndrome
Diverticular Disease 		Referrals will be accepted for patients who have been unsuccessful in improving or settling their IBS symptoms following use of first line advice provided on the British Dietetic Association Food Fact Sheets website

Referrals will be accepted for patients with a confirmed diagnosis of Crohn's Disease, Ulcerative Colitis and Diverticular Disease
Therapeutic Diets

Low Iron Levels
Low Vitamin B12 Levels
Low Vitamin D levels
Low Calcium Levels
Constipation 		Please use first line advice information located on the British Dietetic Association Food Fact Sheets website

Please only refer to the service if first line advice has proved unsuccessful
Texture Modification Referrals should be made in conjunction with a referral to a Speech and Language Therapist for confirmation of the required texture before dietary advice can be provided.

Additional Information

All patients will be seen in an outpatient clinic setting in a health centre within or near their home locality.

Domicilliary Visits will only be accepted by the service for patients who are permanently confined to their home and meet the referral criteria laid out above.

The department will aim to see urgent referrals from receipt of the referral within 1 month and routine referrals within 9 weeks.

Guidelines for Paediatric Dietetic Referral

Please consider whether it is appropriate to refer to dietetics in the first instance from the guidance provided below:

Medical paediatric referrals

The following conditions require initial referral to a Paediatrician who will then make onward referral to dietetics where appropriate:

Allergy – unconfirmed multiple and/ or severe including anaphylaxis
Cystic Fibrosis
Diabetes
Endocrine
Enteral feeding
Gastroenterology – suspected Crohns/ colitis/ IBS/ liver disorders
Neonatology – feeding difficulties, poor growth
Neurodisability
Renal

Child and Adolescent Mental Health Service (CAMHS) referrals

If a child or young person is suspected of having an eating disorder they should be referred directly to the local CAMHS team:

 

Airdrie/Cumbernauld Child and Family Clinic,

Glendoe Building,

Coathill Hospital,

Hospital St,

Coatbridge,

ML5 4DN

01236 707774

 

Bellshill/ Coatbridge Child and Family Clinic,

Coatbridge Health Centre,

1 Centre Park,

Coatbridge

ML5 3AP

01236 438402

 

Clydesdale, East Kilbride and Hamilton Child and Family Clinic,

194 Quarry Street,

Hamilton,

ML3 6QR

01698 426753

 

Motherwell/Wishaw Child & Family Clinic,

49/59 Airbles Rd,

Motherwell,

ML1 2TJ

01698 269651

 

First Line Advice

Please use first line advice for simple conditions as listed below. Public health nurses and Integrated Children’s Services may also be able to offer support. If the situation has not improved within 2 to 3 months then a referral can be made to dietetics.

Constipation
Fussy eating
Healthy eating (including vegetarian)
Infant feeding
Iron deficiency anaemia
Low Vitamin D
Weaning

The first line advice is available via two routes:

Email – Public Folders/ Paediatric dietary help sheets
Firstport/ Intranet – Clinical services/ Child health/ General paediatrics/ dietetic advice for children

Dietetic Referrals:

  • Referrals can be made for the following conditions:
  • Allergy – single foods (including milk allergy and reflux), confirmed multiple allergies
  • Autism – for dietary manipulation and or associated faltering growth
  • Chronic respiratory conditions – where there are concerns about nutrition and growth
  • Dietary assessment – where there are concerns over nutrient quality, adequacy and growth (after first line advice has been given)
  • Gastroenterology – coeliac disease
  • Growth – faltering, undernutrition, weight management
  • The dietitians will triage them to seen in the acute or community settings as per ‘Dietetic Guidelines for referrers FEB 2012’

Guidelines for Adult Oral Nutrition Support Referrals

Screening

Only patients referred with a MUST score of 2 or more will be accepted into the service.

The “Malnutrition Universal Screening Tool”, (MUST), has been designed to help identify adults who are underweight and at risk of malnutrition and is supported by the British Dietetic Association, The Royal College of Nursing, the Registered Nursing Home Association and the Royal College of Physicians.

MUST has been designed to help you to identify adults in your practice who are underweight and at risk of malnutrition and who may benefit from dietetic involvement.

“Using MUST Malnutrition risk has been identified in 18% to 30% of patients attending outpatients clinics and GP surgeries”, Elia, M. Screening for malnutrition: a multidisciplinary responsibility. Development and use of the “Malnutrition Universal Screening Tool” – (MUST) for Adults. MAG, a standing committee of BAPEN, 2003

“Greater use of healthcare and costs associated with malnutrition mean: 65% more GP visits; 82% more hospital admissions; 30% longer hospital stay”, www.mindthehungergap.com

Key MUST links:

The MUST Itself
Introducing MUST

The “Malnutrition Universal Screening Tool” (MUST) has been evaluated in hospital wards, outpatient clinics, general practice, the community and in care homes. Using the MUST to categorise patients for their risk of malnutrition was found to be easy, rapid, reproducible, and internally consistent.

The Department of Nutrition and Dietetics aims to provide an efficient, equitable service to patients and to assist in this, the provision of a MUST score is highly desirable.

MUST Calculator

Patients with a MUST score of 1 or less will not be seen by the service and should be provided with first line nutritional advice which can be found on Firstport.

Dietetics Firstport page

These include: –

  • Get More In!
  • Get More In! for Diabetics
  • Get More in Drinks!
  • Get More in Drinks! for diabetics
  • Snacks to Supplement your Diet

Triage

Referrals will be prioritised and triaged based on their MUST score. (This will be vetted by the dietitians)

Patients with a MUST score of 4 and above will be prioritised as URGENT .

Additional Considerations

  • Only patients that are house bound and unable to attend a clinic will be offered a domiciliary visit.
  • Patients with alcohol or drug misuse who are not currently being supported by another appropriate service (such as addiction services, CPNs etc) will not be seen.
  • Patients referred only due to low albumin, will not be seen as this alone is not an indicator of nutritional status.
  • Patients at the end of life are likely to be an inappropriate referral. Please seek guidance from the Management of Patients in Late Palliative Care.
  • Care pathway link to Long Term Conditions document – Guidance for the nutritional management of patients in late palliative care