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Introduction

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Introduction

The clinical services provided for patients with acute dental problems can be variable.1-3 Factors such as whether a patient is already under the regular care of a dentist, the availability of local emergency dental services and whether the care is required in or out of usual working hours contribute to this variation. A significant proportion of patients only seek dental care when they suffer an acute episode and may initially present to other providers of care (e.g. general medical practitioners, emergency departments, pharmacies), a situation which may be exacerbated by challenges in accessing dental care.4

There may also be variation in the care provided. In some cases patients attending for unscheduled care with pain or infection that requires a clinical intervention may be prescribed antibiotics inappropriately, contrary to the principles of antimicrobial stewardship and contributing to the risk of antimicrobial resistance.5-7 For less frequently encountered problems, such as dental trauma and certain medical conditions, there might be more uncertainty about the care that should or can be provided.8

Recognising the diverse manner in which patients requiring unscheduled clinical care are managed, the Scottish Dental Clinical Effectiveness Programme (SDCEP) convened a multidisciplinary guidance development group to support the delivery of safe and effective patient care and promote a consistent approach, by providing clinical guidance on best practice for the management of acute dental problems. The first edition of the guidance built on SDCEP’s Emergency Dental Care guidance,9 the experience of managing dental calls within NHS 24 and evidence relating to treatment of the wide range of conditions that may present. This second edition of Management of Acute Dental Problems provides an update of the guidance following a full review of the 2013 first edition. 

Further information about development of this guidance is provided in Methodology

The main changes in this edition of the guidance are:

  • amendments to the categories of care to differentiate between medical and dental emergencies and to acknowledge the practicalities of implementation (see Timescales for treatment)
  • provision of additional information about contacting providers of dental care in the UK (see Providers of care)
  • inclusion of information on sepsis (see Sepsis)
  • explanation of how the guidance relates to Realistic Medicine (see Realistic medicine)
  • amendments to the decision support flowcharts for patients with pain, swelling, bleeding, trauma or ulceration
  • updates to the advice on specific oral conditions to reflect current sources of evidence and expert opinion (see Management of oral conditions)
  • updating of information on paracetamol overdose (see Analgesia) 

The guidance aims to:

  • encourage a consistent approach to the management of acute dental problems to reduce unwarranted variation in practice
  • improve the quality of unscheduled clinical care for patients with acute dental problems
  • provide a standard for the initial management of presenting symptoms for patients with acute dental problems
  • ensure patients receive appropriate advice about subsequent care and/or referral to appropriate treatment providers, if applicable

The guidance focuses on initial management and subsequent care to address the presenting problem. Longer term care planning is beyond the scope of this guidance. The guidance is based on guidelines, systematic reviews and other published literature and the opinion of experts and experienced practitioners.

The guidance is applicable to patients of all ages in all population groups, irrespective of the healthcare setting or whether or not they are regular attenders for routine dental care.

This guidance is intended for use by staff within the range of services directly involved in provision of care for patients with acute dental problems, including general dental practice, community and public dental services, out-of-hours services, general medical services, hospital dental services, emergency departments, pharmacies, and the Ambulance Service. The guidance is also of relevance to those involved in quality improvement within the NHS, health care education and undergraduate training. In addition, the guidance might inform commissioning of services and can be adapted for use by those organising services at both local and national levels.

Depending on their current knowledge, users with different professional backgrounds are likely to differ in the way they use the guidance. Some might use the decision support pathways as a means of accessing the appropriate advice on specific conditions. Others might go directly to the advice on specific conditions.

This guidance has resulted from careful consideration of the available evidence, other resources and expert opinion where evidence is lacking. The recommendations should be taken into account when managing patients with acute dental problems. As guidance, the information presented does not override the healthcare professional’s right, and duty, to make decisions appropriate to each patient, with the patient’s valid consent. However, it is advised that significant departures from this guidance, and the reasons for this, are fully documented and that this documentation is included in the record of advice given to patients who present with acute dental problems.