Patients presenting with dental problems

The number of patients seeking dental advice from their GP is increasing. This guidance informs GPs of their obligations to patients who request emergency dental treatment, or ask for an NHS prescription for drugs.
Location: UK
Audience: GPs Practice managers
Updated: Thursday 16 January 2020
GP practice article illustration

A recent study found that a typical GP practice can expect to see 30-48 patients with dental problems a year, possibly due to the charge for dental services.

GPs and practice teams should be aware of dental services available locally to manage emergency dental conditions, including:

Local arrangements vary; this information should be available from local commissioning bodies.

 

Emergency dental services

  • GPs are not responsible for treating dental problems.
  • GPs should not attempt to manage a condition requiring dental skills unless they have appropriate training.
  • Both the civil courts and the GMC require doctors to have appropriate skills for any treatment they offer.
  • Patients should be advised to contact local emergency dental services or the emergency department.
  • General dental practitioners have an ethical responsibility to provide access to advice and emergency treatment for patients, including those under a private contract.
  • General dental practitioners have an ethical responsibility to provide access to emergency treatment outside normal hours.
  • NHS commissioning bodies are responsible for out-of-hours dental care.
  • Most provide emergency out-of-hours dental treatment, and they may also buy in-hours open access urgent sessions from dental practices.

 

Legal and contractual obligations

  • Before refusing to treat a patient asking for emergency dental treatment, the GP must ascertain that the condition requires only dental treatment.
  • Primary care teams must judge the nature of the patient’s condition by undertaking reasonable enquiries and, where appropriate, a clinical assessment.
  • Having established an apparent dental problem, GPs or practice teams should direct the patient to a dentist or local emergency service, or refer them to secondary care.
  • Everyone in the practice team must do their best to ensure the patient doesn’t need the attention of a GP when signposting.
  • If the patient has no usual dentist or there is no response from the usual dentist, the patient should contact NHS 111 (England), NHS 24 (Scotland), NHS Direct or local dental helplines (Wales) or the Health and Social Care Board (Northern Ireland).
  • Patients presenting with signs of spreading infection or systemic involvement of a dental infection should be referred immediately to secondary care for appropriate surgical management.
  • The GP’s obligation to refer is set out in the GMS  and PMS regulations.

 

Acute dental conditions

Clinical guidelines recommend that the first-line treatment for acute dental conditions should be an operative intervention, such as extraction or root canal treatment.

Acute dental abscesses respond well to local surgical treatment. For patients presenting with bleeding and trauma, early diagnosis and referral to a dentist is advised.

Antibiotics should only be prescribed in patients exhibiting signs of local or systemic spread or for those who are moderately or severely immunocompromised.

 

Oral cancer / pathology

Patients may present oral pathologies including suspected oral cancers to their GP. GP surgeries must be aware of the local arrangements in place for the urgent referral pathway for suspected oral cancer cases.

A patient with a non-suspicious oral pathology should be advised to see a dentist for a full examination as soon as possible.

 

Prescribing

This guidance applies to patients seeking an NHS prescription following the issue of a private prescription or recommendation of a drug by a dentist.

  • Dentists are obliged to issue NHS prescriptions to NHS patients where required.
  • Dentists have a duty of care to issue private prescriptions to private patients.
  • If, after seeing a dentist, a patient asks their GP for an NHS prescription, the GP should investigate the patient’s condition and accept sole responsibility for that prescribing decision before issuing an NHS prescription.
  • If a legitimate need for an NHS prescription cannot be established, it should not be provided.
  • GPs should be cautious about accepting a patient’s understanding of dental advice and should be satisfied that what they prescribe is appropriate to the patient’s condition.

 

Local arrangements

LMCs (local medical committees) and LDCs (local dental committees) should establish a working partnership to enable GPs to raise local problems with their LMC. The LMC should then liaise with the LDC to manage the problems.

If good LMC-LDC relations are established, the LDC can be told of any difficulties with emergency arrangements.