Dental specialties

Providing specialist dental care and training

Dental directorate departments

  • Oral surgery

    The department is able to undertake treatment for a large number of patients requiring routine surgical treatment suitable for undergraduate training. More complex surgical cases may be managed under sedation or general anaesthesia, as appropriate:

    • simple extractions of erupted teeth and roots, including orthodontic extractions
    • uncomplicated buried roots
    • simple impacted teeth
    • MDT jaw necrosis clinic 
    • the following conditions are accepted for referral to consultant clinics for diagnosis, management advice and treatment:

      • impacted and ectopic teeth
      • apical surgery (see surgical endodontics in the restorative dentistry section for acceptance criteria)
      • dental and jaw cysts
      • soft and hard tissue swellings of the mouth, jaws, neck and salivary glands
      • oral mucosal ulceration, white and red patches of the mucosa
      • any suspected malignancy of the mouth, jaws and salivary glands
      • salivary gland disorders (lumps, obstructive salivary disease, chronic salivary disease, mucoceles, swellings of unknown origin)
      • facial and jaw trauma including fractures and soft tissue injuries
      • craniofacial and jaw deformities
      • facial and dental pain

    Patients requiring oral and facial implant rehabilitation (see restorative referral protocols).

  • Orthodontic extractions under general anaesthesia

    Orthodontic extraction of permanent teeth should normally be performed using local anaesthesia unless there are clear indications for the use of general anaesthesia. Common indications for general anaesthesia would be:

    • Extraction of first molars in patients under 12 years of age.
    • Surgical removal or uncovering of teeth.
    • Patients with special needs resulting in all treatment requiring the use of general anaesthesia. Extractions of both deciduous and permanent teeth should follow the guidelines associated with the use of local and general anaesthesia. In the first instance all patients should be counselled to accept local anaesthesia. If, however, after extensive discussion they feel unable to do so, then they should be offered the opportunity of receiving general anaesthesia. This is the accepted guidance from the Royal College of Anaesthetists and the General Dental Council.
  • Orthodontics

    The orthodontic department will see any referral for diagnosis and treatment planning. Patients will only be accepted for treatment if they fall within grades 4 or 5 of the Index of Orthodontic Treatment Need (IOTN).

    A very limited number of more simple cases will be accepted for diagnosis and treatment by dental undergraduates working under supervision. The acceptance criteria by IOTN grade are as follows:

    IOTN Grade 4 - Great treatment need

    • Increased overjet greater than 6mm but less than or equal to 9mm.
    • Reverse overjet greater than 3.5mm with no masticatory or speech difficulties.
    • Severe displacements of teeth greater than 4mm.
    • Extreme lateral or anterior openbites greater than 4mm.
    • Increased and complete overbite with gingival or palatal trauma.
    • Less extensive hypodontia requiring pre-restorative orthodontics or orthodontic space closure.
    • Posterior lingual crossbite with no functional occlusal contact in one or both buccal segments.
    • Reverse overjet greater than 1mm but less than 5mm with recorded masticatory and speech difficulties.
    • Partially erupted teeth, tipped and impacted against other teeth.

    IOTN Grade 5 - Very great treatment need

    • Increased overjet greater than 9mm.
    • Extensive hypodontia with restorative implications.
    • Impeded eruption of teeth due to crowding, displacement, the presence of supernumerary teeth, retained deciduous teeth and any pathological cause.
    • Reverse overjet greater than 5mm with reported masticatory and speech difficulties.
    • Defects of cleft lip and palate.
    • Submerged deciduous teeth.
  • Restorative dentistry

    General categories

    • Oncology patients - intraoral cancer resections, obturators and post-radiotherapy management.
    • Developmental defects - cleft lip and palate, hypodontia, joint orthognathic and/or orthodontic cases and amelogenesis/dentinogenesis imperfecta cases.
    • Trauma - severe trauma involving the dentoalveolar complex.
    • Medically compromised - e.g. haemophilia, immunocompromised, organ transplant, infective endocarditis and those requiring intravenous antibiotic cover. (We do not provide care for those patients requiring routine oral antibiotic cover).

    Please note that a patient currently taking Warfarin does not require dental treatment in hospital unless their INR exceeds 4.0

    Restorative dentistry

    A comprehensive treatment planning consultation advisory service is available. A limited treatment service is available for patients in list covered in general categories.

    Periodontology

    Patients with the following conditions are accepted for care.

    Conditions of acceptance for specialist periodontal treatment:

    • The referring practitioner will manage all other treatment required
    • Patients cannot be accepted simply because they will not pay NHS charges in the General Dental Service, or private charges if applicable

    Priority patients:

    High susceptibility to periodontitis based on

    • Age of onset
    • Age at diagnosis
    • Disease severity
    • Disease extent

    Medical complications or drug interactions affecting periodontal disease or its treatment

    Patients with complex problems such as:

    • Severe localized gingival recession
    • Lack of attached gingival attachment leading to complication
    • Gingival overgrowth

    Requests for advice

    Consultant opinions and advice on treatment planning will be offered for

    patients referred with the following documentation:

    • Full medical history
    • Comprehensive periodontal charting
    • Appropriate diagnostic radiographs.

    Acceptance of other patients for treatment

    If patients referred for opinions have problems which require consultant-led management, or if there are sufficient facilities for treating them on teaching clinics, they may be offered treatment in the department. Practitioners should

    advise at referral whether they would like this option if available, subject to resources.

    Prosthetic dentistry

    Patients are seen for diagnosis and advice. They are only accepted for treatment if they fall within categories listed under general categories or have had several previous unsuccessful attempts to construct dentures.

    Crowns and bridges

    A full diagnostic and advisory service is available. We are unable to accept patients for rectification of problems with crown and bridgework that has been carried out outside GKT Dental Institute. We are pleased to advise as to appropriate methods of removal and management of fixed restorations. Patients in general categories list are accepted for treatment.

    Endodontics

    Patients with the following conditions are accepted for care, subject to availability of facilities:

    • apical periodontitis in teeth that have already been endodontically treated
    • apical periodontitis in teeth with technical difficulties including calcified canals, severely curved canals and internal resorptions
    • endodontic disease caused by dental trauma.

    Conditions of acceptance for specialist endodontic treatment:

    1. the referring practitioner will manage all other treatment required
    2. patients cannot be accepted simply because they will not pay NHS charges in the GDS or private charges if applicable.

    Surgical endodontics

    Patients fulfilling the protocols may be referred either to restorative dentistry or to oral and maxillofacial surgery.

    Apicectomy is only indicated when endodontic treatment has been impossible to complete because of:

    • continuing extra-radicular infection
    • calcification
    • a post which cannot be removed
    • non-negotiability of root canals
    • management of perforations.
    • biopsy of a suspicious periapical lesion

    Implant dentistry

    The following factors need to be taken into account when considering patients for implant treatment:

    • Partially dentate patients should have otherwise healthy intact dentitions, i.e., good oral hygiene, periodontally healthy, minimal restorations and good long term prognosis.
    • Patients losing teeth through periodontitis, endodontic failure, and bridge failure are not usually considered for implant treatment.
    • Replacement of posterior teeth is considered a low priority and not usually accepted.
    • The mere fact that a patient would like to have their existing denture replaced by an implant retained prosthesis or dislikes the thought of wearing dentures does not justify the use of limited NHS funding unless the patient falls into one of the priority categories.

    Patients in general categories list are normally accepted if they are in the following categories:

    Edentulous in one or both jaws

    • Severe denture intolerance
    • Physical due to severe gagging
    • Physical due to severe ridge resorption with unacceptable stability or pain
    • Prevention of severe alveolar bone loss
    • Moderate ridge resorption in patients under the age of 45
    • Moderate resorption in one jaw opposed by natural teeth with a good prognosis

    Partially dentate

    Preservation of remaining healthy intact teeth when the patient has missing teeth due to:

    • Developmental disorders (oligodontia/anodontia or cleft lip/palate)
    • Trauma
    • Complete unilateral loss of teeth in one jaw where dentures are not tolerated or an edentulous span considered too difficult to manage by other means

    Maxillofacial and craniofacial defects

    • Intraoral implants. This group of patients have missing significant amounts of hard and soft tissues in addition to loss of teeth. They result from developmental disorders, trauma and the treatment of tumours.

    Extraoral implants

    • Ears - congenital, traumatic or surgical loss of pinna
    • Eyes - loss of globe with exenteration of orbit due to trauma or resection
    • Nose - loss due to trauma or surgical resection
    • Compound facial defects - usually due to resection for malignant disease

      Please note that the provision of implant therapy is subject to local Primary Care Trust protocols.

  • Sedation and special care dentistry

    Only patients with conditions that preclude treatment in general dental practice or the community dental service are accepted for treatment. These conditions comprise:

    • Complex medical problems.
    • History of infective endocarditis (also included in restorative protocols).
    • Hepatitis and/or HIV related medical and oral conditions (also included in Hospital and Community care protocols). All patients in this category will be seen for mucosal lesions but routine dental care is not offered.
    • Severe bleeding disorders.
    • Psychological problems that preclude treatment in general dental practice e.g. severe autistic spectrum disorders, profound learning disability, uncontrolled mental illness.
    • Confirmed allergy to more than one local anaesthetic agent.
    • Confirmed latex allergy.
    • Profound immunosupression. eg recent transplant, anticancer therapy, autoimmune disease (also included in restorative and CDS protocols).
    • Severe dental phobia (including persistent gagging).

    Patients are normally accepted for only one course of treatment. Long-term care is not provided. The department does not provide advanced restorative care or testing for those suspected of having allergy to local anaesthetic agents or latex.

  • Specialist clinics for blood borne viruses

    This specialist service is provided both in the hospitals (HDS) and in the community dental service (CDS). The service is restricted to patients living in Lambeth, Southwark and Lewisham. Patients are only accepted by referral from their dental or medical practitioners or from their HIV physician. The following is a list of the eligibility criteria:

    • If a patient is HIV positive and unwell. A patient is deemed unwell if the following are present - Oral manifestations fof HIV (hairy leukoplakia, candidiasis, Kaposi's sarcoma, ulcerative, gingival and periodontal conditions).
    • If a patient is terminally ill or housebound and needs domiciliary care (CDS).
    • If a patient is HIV positive and in addition has other complex medical conditions such as profound immunosupression.

    If a patient is HIV positive and well and is dentally stable after one or more six-monthly check-ups, he or she will be referred to a GDP. If a patient's health deteriorates at any time and the GDP is in need of reassurance the patient may be referred to the CDS or HDS for review. There will be a number of patients who will be unable to find routine dental care in the GDS. For these patients the CDS will act as a safety net. The referring physician should indicate in their letter that the patient has found difficulty in obtaining care in the GDS.

    It is important to ensure that in referring people with blood borne viruses that you have specific permission to share this information. If so, please highlight this under 'other', providing the relevant information, otherwise refer to the appropriate specialty for the care required.

  • Team care dentistry

    Referrals to team care dentistry should follow the same protocols as for restorative dentistry.

    A limited number of patients requiring integrated restorative dental care of the type that could be undertaken in an average general dental practice are accepted for undergraduate treatment. Patients requiring periodontal treatment only are not accepted.