Community Dental Service Remit

Summary

The requester asked for the definition of 'does not fit the remit' and related policies for the Isle of Man Community Dental Service. Manx Care responded by disclosing the service's objective to support vulnerable groups, detailing specific clinical criteria for access, and describing alternative pathways such as telephone advice for low-risk patients.

Key Facts

• The Community Dental Service targets priority groups including vulnerable adults, children, and those with complex medical or mental health conditions.
• Patients assessed as 'low risk' by dental practices are directed to general dental services for the full range of provision.
• 'High risk' patients receive telephone advice, antibiotics, or pain relief unless their condition is life-threatening.
• The service provides specialized facilities including a DIACO wheelchair ramp and bariatric wheelchairs for patients weighing over 135-159kg.
• Conscious sedation (inhalation and IV) and hypnosis are offered to manage severe dental phobia and behavioral problems.

Data Disclosed

• 16 July 2020
• 135-159kg
• 16 years old
• 44 pages
• 5 documents
• 2025-12-30
• 2026-02-06

Original Request

This request relates to the Community Dental Service, Primary Care. I would be grateful if you could provide the following information: The definition used by the Community Dental Team for the term 'does not fit the remit' when applied to referrals or access to the Community Dental Service. Any written policies, guidance documents, eligibility criteria, or referral protocols that explain the remit of the Community Dental Service. The clinical, administrative, or commissioning criteria used to determine when a patient is considered to fall outside the remit of the Community Dental Service. Details of any alternative services or pathways patients are signposted to when they are deemed not to fit the remit. If applicable, any standard wording or template letters used to inform patients or referrers that a case does not fit the service remit.

Data Tables (20)

Full Response Text

Community Dental Service The Community Dental Service offers high quality, preventative-focused dental care for patients who find it difficult to use general dental services. There are some differences that patients should be aware of with regard to accessing dental services and this information is available under the downloadable document ‘Guidance to Dentists on the Isle of Man – 16 July 2020’. Essentially any patient who is considered as ‘low risk’ following a risk assessment carried out by the dental practice will be able to access dental services for the whole range of dental provision. Patients who are considered ‘high risk’ will receive treatment via telephone advice, antibiotics or pain relief unless the dental condition the patient wishes to access services for is considered life-threatening. If patients have any queries or concerns they can contact a member of the Community Dental Service via email to SalariedDentalService@gov.im and a member of the team will be able to assist The objective of the Community Dental Service is to reduce inequalities in oral health and improve access to dental services to priority patient groups, vulnerable adults and children in the Isle of Man. Community dentists work in a variety of locations, for example, a patient’s own home, nursing homes and within one of the two community dental clinics (Douglas and Ramsey). The dentists work with a wider clinical team including other health professionals such as school nurses, health visitors and district nurses.
The Community Dental Service provides the children’s dental GA (General Anaesthetic) list at Nobles hospital. Children who are very anxious about dentistry are assessed in the community clinics and they can receive a full treatment plan which includes extractions, fillings and preventative treatment whilst under a general anaesthetic. This is one of the only community dental services in the UK that provides comprehensive care in this way. Our specialist skills and facilities enable us to see patients with complex needs who find it difficult to use general dental services such as: • Wheelchair users who are unable to transfer from their wheelchairs to the dental chair; we have access to a DIACO wheelchair ramp. This allows the patient to have their treatment carried out while remaining in their chair. We also have a bariatric wheelchair for patients who exceed the weight limits for our dental chairs (greater than 135-159kg). More information can be found on page 11 of the InTouch article about DIACO. • People who are genuinely house-bound living in their own home or residential care and unable to attend a dentist at a surgery, we can offer patient centred care in the patient’s own environment. • For patients with a severe dental phobia we can offer treatments under conscious sedation (both inhalation and intravenous techniques) for children and adults. Inhalation sedation is available to all age groups and patients with complex medical histories, whilst IV sedation is normally only available to patients who are fit and well and over 16 years old. Inhalation sedation also known as 'happy air' is a mixture of oxygen and nitrous oxide gases which are breathed through a small nose piece during the dental treatment. Patients stay awake but are slightly sedated. It is useful during dental treatment as it helps nervous patients relax. They can often become giggly or have tingles in their fingers and toes and can find treatment becomes a pleasant experience making it a successful way of managing anxiety in both children and adults. Intravenous conscious sedation relaxes you and makes you feel less anxious. Unlike general anaesthesia, you are still conscious but are so sleepy and relaxed that you are indifferent to the dental treatment. Your memory of treatment may be hazy and you may remember little or nothing about the treatment you have had. It is intended that over time, as your confidence grows, the eventual outcome will be that you will be able to cope with routine treatment without sedation. During intravenous conscious sedation the medication is delivered by injection in the back of the hand or arm. Once you are sufficiently relaxed and feel happy to proceed, the dentist will numb up the appropriate part of the mouth before dental treatment starts. We also have specialist training in hypnosis and behavioural management techniques. Service availability • Patients with complex medical / mental health conditions who need additional dental care. • Patients with moderate / severe learning difficulties and / or behavioural problems / dental phobia who find it difficult to cope with routine dentistry. • Patients with complex social needs / looked after children or those subject to child protection plans. • Patients with physical difficulties resulting in mobility problems which make it difficult or impossible to access care through general dental services. Access to this service We only accept written referrals from a health care professional such as: • Other dentists • Doctors • Other health professionals - health visitors, nurses, looked after children team, social workers • Carers of patients – residential / nursing homes • Community psychiatric team • Voluntary organisations A referral can be made to the service by completing the referral form above and sending it to; Community Dental Service Central Community Health Centre Community Dental Clinic Westmoreland Road Douglas IM1 4QA Email: Send Email All patients will be assessed on an individual basis and will fall into 1 of 3 categories:- 1. Not accepted - For those who do not meet the remit of the service. 2. Accepted for a course of treatment and then discharged back to the referrer, or signposted to continuing dental care 3. Accepted for continuing care if deemed appropriate by the dentist.
Discharge Criteria from the Community Dental Service The service will consider discharge planning as part of the initial assessment for all newly referred patients. • Patients with complex medical conditions can be discharged following treatment providing their medical condition is stable • Patients with learning difficulties, physical difficulties or mental health problems can be discharged following treatment with the support of their carers. For some patients, a decision may be made for them to be seen at a future date by the Community Dental Service • All dental phobic patients can be discharged, but can be referred again if appropriate • Patients who can be treated by a general dentist with input from the special care team • Patients who are unsuitable to be cared for by a general dentist will remain under the care of the Community Dental Service

Please send referrals to; Central Community Health Centre, Community Dental Clinic Westmoreland Road, Douglas,
Isle of Man IM1 4QA Tel; 01624 642785
Fax 642392
E-mail referrals to: specialcaredental@gov.im

Any fields marked with an asterix * must be completed or it will be returned to the referrer. Please can the referrer advise patients that they may be liable for NHS dental Charges.

Community Dental Service Referral Form

1. Referrer Details
   Name Work address Tel* (Work) Job title Email address

2. Patient General Dental Practitioner (GDP) Details
   Patient does not have a dentist ()

I am the referring dentist ()

Name*

Practice Address* (Practice stamp)

1.Patient Details
Title*

Referral date
Surname

Gender* () M

F

First name(s)*

Date of birth*

Address*

Postcode*

Nationality

Telephone*

Interpreter Req? Y/N
Language
Main Carer Details Full Name

Address

Telephone

Relationship to Patient

Radiographs Enclosed () Y

N Reason

Date Radiographs Taken

6.0 Referrers Signature

4.Dental Treatment (For GDP Referrals) What dental treatment does the patient need?*

What ways did you try to manage the patient?* Please tick which apply. Introduction with prevention only (tooth brushing instruction / fluoride varnish/ sealants)

Introduction to operative treatment with prophylaxis

Acclimatisation appointments

What Difficulties were encountered?*

1. Main Reason for referral*
   Disability ()

Medical ()

Mental Health ()

Dental Phobia ()

5.1 Disability Information Details Ability to Communicate? () Partially Impaired

Severely Impaired

Ability to leave the home? () Yes

No

Ability to transfer to the dental Chair () Yes

No

Has Capacity to consent? () Yes

No

Partially

5.2 Medical History Information* (All Referrals) Have you attached a medical history? () Y

N

Reason

5.3 Mental Health Information Please provide Mental Health Diagnosis

The Community Dental Service (CDS) accepts referrals from a wide range of health care professionals and those involved in the holistic care of vulnerable adults and children. This document outlines the criteria for an appropriate referral, how to submit a referral to the Special Care Dental Service and the Discharge Criteria from the Special Care Service.
Referrals into the service can be accepted via the following list of healthcare professionals:-

 Dentists employed by the Community Dental Service
 General Dental Practitioners
 General Medical Practitioners
 School Nurses Team
 Health Visitors Team
 Looked after Children Team
 Social Workers  Community Psychiatric Team
 Residential and Nursing Home Managers
 DAT
 Any professionals covered in the list above can submit a referral letter to the Community Dental Service for patients who meet the following criteria:- Criteria Examples of cases which might fulfil the criteria Examples of case that may not fulfil the criteria Complex medical history where medical condition or medication compromises oral health or necessitates special care  Poorly controlled epilepsy  Poorly controlled diabetes  Haemophiliacs
 Patients who have undergone radiotherapy of head/neck  Leukaemia  Cystic fibrosis  Controlled epilepsy  Controlled diabetes  Hep B, Hep C or HIV +ve (unless fulfils other referral criteria)  HIV/Hep –ve despite past or current risk behaviour  Anticoagulant therapy (i.e. Community Dental Service Referral Process to the Community Dental Service

 Lupus  Oncology patients  Patients on immunosuppressants  Palliative care routine care for Warfarinised patients) Management problems / challenging behaviour  Autistic spectrum, ADHD  Significant Mental health problems  Learning disability  Neuro-disability requiring special care  Children who have demonstrated uncooperative behaviour requiring more than “tell-show-do” and other basic behaviour management techniques  Adults who have severe dental phobia who may need Relative Analgesia or Intra-venous sedation to facilitate co-operation  Patients requiring translation services  Patients with history of mental health problems but no current symptoms or challenging behaviour  Orthodontic extractions under GA  Children - just because they are young

 Complex oral surgery extractions must be referred to the Oral Surgery Department

Complex social needs  Child at risk, child protection register  Looked after Children in foster care
 Vulnerable adults

 Poor attenders Physical difficulties resulting in mobility problems which make it difficult / impossible for the individual to access care  Housebound patients  Wheelchair bound patients who cannot transfer easily or require hoist/ramp  Patients who could access practices with ground floor surgeries

Learning Disabilities which make it difficult/impossible for the individual to access GDS care  Challenging behaviour, +/- complex medical history.  Mild Learning Disabilities with no challenging behaviour or complex medical history. Complex dental problems  Severe enamel hypoplasia, hypodontia, supernumeries – all should be referred to Consultant in Restorative Dentistry, in first instance for a consultant opinion. May be seen in our service following this if patient has additional needs.
 High treatment need if no other management problems.  Pulpotomies, orthodontic extractions, RCT and other routine care on co-operative children.
 Complex treatment plans for anxious patients. Procedure Referrals:  All referrals to the Community Dental Service should be made using the special care referral form. Typed and not handwritten where possible ( See Appendix 1 at the end of this document)  Referrals or contact can be made via the e-mail address specialcaredental@gov.im
 The Community Dental Service clinical team are responsible for the daily management of all correspondence to the Special Care inbox. This includes triaging, accepting and booking of appointments where appropriate or replying to correspondence.
Patients will either be -  Not accepted if they fail to meet the remit or if the referral is incomplete.  Accepted for a course of treatment and then discharged back to the referrer (or signposted to continuing dental care).  Accepted for continuing care if it deemed appropriate by the clinician.

Discharge Criteria from the Community Dental Service:

Discharge planning will be started at assessment for all newly referred patients and not left to completion of treatment. The offer of service will be explained to the patient and the treatment plan will include a decision on discharge and arrangements for the provision of continuing care.
People with learning disability, physical disability, and mental health problems are by definition vulnerable

adult groups. They may be discharged following treatment, with the support of their carers providing their condition does not present insurmountable difficulties accessing a GDP. For those with severe disability it is usually the exception that they can be managed in General Dental practice and they should offered continuing care by the special care dental team. Patients with a complex medical history will be discharged following treatment providing their medical condition is stable. People with social exclusion (i.e. the consequence of a series of problems affecting an individual such as unemployment, discrimination, poor skills, low income, poor housing, high crime, ill health, and family breakdown) should be discharged following treatment completion. There will be continual assessment for all patients as to their need for recall within the Community Dental Service. If deemed appropriate patients may be signposted back to General Dental practice.

Discharge

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