Referral criteria mos

Referral Criteria for Extractions

• Unsuccessful attempt at extraction by referring • Any tooth root filled or not, with sufficient crown or roots to apply either forceps or luxators • Severely abnormal root morphology likely to • Single rooted teeth and multi rooted teeth whether root filled or not that do not need division that • Multi rooted teeth that need division prior to extraction could be elevated and removed with root forceps. • Wisdom teeth meeting NICE criteria that are impacted • Root fragments situated wholly in soft tissue so will need a flap procedure and bone removal and • Upper 8s fully erupted with good vision and • Teeth with significant cystic/ periapical areas that • Lower 8s with favourable roots that are fully • Teeth with areas of unexplained root resorption • Single simple extractions on patients on Warfarin • Patients on warfarin with unstable INR or INR >4 or with a stable INR < 4( an extraction appointment should be arranged 24hrs after pt has attended • Patients requiring treatment under sedation/GA • Patients on bisphosphonates (only when in line with • Patients who are medically compromised NHS Hampshire Minor Oral Surgery Referral Criteria Referral Criteria for Apicectomies

Within primary care, conventional root canal treatment should be the first treatment option for cases of periapical pathology. If
unsuccessful, non surgical re-treatment should be the preferred option for endodontic failure. Apicectomies cannot be performed
without an adequate orthograde root filling.

• Unsuccessful conventional endodontic treatment on incisor, canine or premolar tooth where there is evidence of re-root • Where the root canal therapy is inadequately treatment, and an adequate coronal seal. The roots should
obturated and there is access to the root canal show successful and complete obturation .
• Unsuccessful conventional root canal treatment due to • Where patients have unstable and active periodontal disease or uncontrolled dental caries • Where the tooth has inadequate coronal tooth Considered
tissue to support a conventional crown and the tooth has not previously been restored or in the • Where the peri-radicular radiolucency is greater than 1cm and • Teeth with a post crown where the post is • Where the post fits the root canal well and is of an appropriate • Teeth which have post crowns where the post length (normally 10mm+) and there is no history of cementation does not fit the canal, or the post has been re- failure and where the coronal seal is adequate but there is apical • Teeth with post crown but no evidence • Where the root canal is not considered negotiable from the orthograde root filling and no evidence of radiograph through its entire length and there is pathology • Where the tooth is a crucial abutment for a bridge and there is an adequate coronal seal with no subgingival decay • Patients who are medically compromised and • Teeth with post crown but no evidence of orthograde root filling and are appropriate for primary care or meet CDS • Teeth with iatrogenic or traumatic damage, or resorption where surgery offers the opportunity to retain the tooth NHS Hampshire Minor Oral Surgery Referral Criteria Referral Criteria for Medically Compromised Patients Requiring Non-Mandatory Services
(ie not those covered under a primary care dental contract)

Most patients with cardiovascular, respiratory disease, diabetes and epilepsy are well controlled
on their medication and can be treated within the primary care setting. Steroid therapy
maintained at <10mg may not need steroid cover. Patients on antiplatelet drugs such as aspirin,
clopidogrel are not at risk of excessive bleeding and therefore can be treated under a primary
care course of treatment (not necessarily one appointment) without cessation of their therapy.
Patients on warfarin can be treated by a GDP if their INR is < 4. Ideally extraction appointments
will be arranged the day after a visit to the INR clinic when a reading can be obtained and
brought by the patient to the appointment.
Accepted criteria for oral surgery treatment within a hospital setting would include:

• Respiratory function decreased to the extent the patient has to have home oxygen • Any medical condition such as liver/ kidney disease that requires additional investigations • Patients with coagulation disorders such as Haemophilia, Von Willebrands • Patients on Warfarin whose therapeutic INR >4, or whose INR is unstable or requires • Patients who have had radiotherapy to the head and neck • Steroid medication >10mg of prednisolone or equivalent dose of other steroid, as per • IV Bisphosphonate therapy or oral bisphosphonates and an additional comorbidity such as diabetes, steroid or other immunosuppressive therapy. For patients on oral bisphosphonates only please see referral protocol. • Patients who have severe immune dysfunction
For patients with learning disabilities, unstable mental health problems or dementia that are
untreatable within the dental chair and would benefit from the provision of not only extractions
but also full oral examination, radiographs and conservation under General Anaesthetic, please
continue to refer directly to the Special Care Dentistry Department.

NHS Hampshire Minor Oral Surgery Referral Criteria


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