dwsi minor oral surg

Department of Health/Facultyof General Dental Practice (UK)

Guidelines for the appointment of Dentists withSpecial Interests (DwSIs) in Minor Oral Surgery

Faculty of General Dental Practice (UK)The Royal College of Surgeons of England

DH INFORMATION READER BOX

Policy

HR/Workforce

Management

Planning

Clinical

Estates

Performance

IM&T

Finance

Partnership working

Document Purpose Best Practice Guidance

ROCR reference Gateway Reference: 5339

Title Guidance for the Appointment of Dentists withSpecial Interests (DwSIs) in Minor Oral Surgery

Author DH/Dental and Optical Services Division/FGDP (UK)

Publication date April 2006

Target audience PCT CEs, NHS Trust CEs, SHA CEs, Care TrustCEs, Foundation Trust CEs, Medical Directors,PCT PEC Chairs, NHS Trust Board Chairs,Directors of HR, GDPs, Salaried Dental Services,LDCs, Consultants in Dental Public Health,Dental Practice Advisors, Post Graduate DentalDeans

Circulation List Directors of PH, GPs, Communication Leads

Description Guidance to PCTs on the appointment of Dentistswith Special Interests in Minor Oral Surgeryincluding the competency framework for the scopeof treatment that can be undertaken

Cross Ref Implementing a Scheme for Dentists with SpecialInterests (DwSIs) DH/FGDP(UK) May 2004

Superseded Docs N/A

Action Required N/A

Timing N/A

Contact details Tony JennerDental and Optical Services DivisionSection 11/035, New Kings Beam House,22, Upper Ground, LONDON SE1 9BW020 7633 4143www.dh.gov.uk/cdo

For Recipient’s Use

Department of Health/Facultyof General Dental Practice (UK)

Guidelines for the appointment of Dentists withSpecial Interests (DwSIs) in Minor Oral Surgery

Contents

Introduction 2

• Definition of a DwSI in Minor Oral Surgery 2

• General Requirements 3

Competency Framework for a DwSI in Minor Oral Surgery 3

Evidence of Maintenance of Competencies 8

Accreditation of DwSIs in Minor Oral Surgery for Primary 9Care Trusts (PCTs)

• Contract Specification 9

• Appointment of DwSIs in Minor Oral Surgery with PCTs 9

• Monitoring of the Minor Oral Surgery Service 11

• Primary Care Trusts – needs assessment and delivery 12

System of assessment and evidence required to demonstrate competence 12

• Sources of Evidence 13

• Process 14

Appendices

Appendix 1 Recommended Procedures 15

Appendix 2 Suggested Assessment Standards 16

Appendix 3 Minor Oral Surgery Practice Requirements 19

1Department of Health/Faculty of General Dental Practice (UK)

Introduction

The Guidelines for the appointment of Dentists with Special Interests (DwSIs) inMinor Oral Surgery is one of a series of framework documents jointly developedby the Department of Health and the Faculty of General Dental Practice (UK).

The frameworks aim to provide guidance to Primary Care Trusts (PCTs) on thedevelopment of local DwSI services, and include the competencies for the scopeof treatment that can be undertaken by DwSIs.

The minor oral surgery guidance has been written in conjunction with the BritishAssociation of Oral and Maxillofacial Surgeons and the British Association of OralSurgeons, primary care dentists, specialists, consultants, university departments,dental faculties, PCT managers, Strategic Dental Health leads and patients.

The guidelines apply to England and should be read in conjunction withImplementing a Scheme for Dentists with Special Interests (DwSIs) May 2004, andA Step by Step Guide to Setting up a Dentist with a Special Interest (DwSI) Serviceavailable on the Chief Dental Officer’s section of the Department of Healthwebsite at www.dh.gov.uk/cdo and the FGDP(UK) website at www.fgdp.org.uk.

Definition of a DwSI in Minor Oral Surgery

1. A DwSI in Minor Oral Surgery is a primary care dentist who

• Is able to demonstrate a continuing level of competence in theirgeneralist activity;

• Is able to demonstrate an agreed level of competence in minor oralsurgery; and

• Is contracted to a PCT or PCTs, as a DwSI, to manage a numberof patients with specified dento-alveolar conditions/diseases.

2. Whilst not offering the same breadth of activity he/she will be required topractice to a standard consistent with that expected from the establishedspecialists who cover this area of clinical expertise.

3. The proposed activity will have been identified and agreed by the PCT inconsultation with all relevant care agencies.


General Requirements

4. In order that PCTs might satisfactorily contract with a primary care dentistto carry out an agreed area of special interest work the PCT should, firstand foremost, ensure that the primary care dentist is a competent andexperienced generalist.

5. In addition it is recommended that a PCT satisfies itself that a primary caredentist wishing to be contracted as a DwSI in Minor Oral Surgery is able tosatisfactorily demonstrate that he/she:

a. Is able to manage patients with specified common dento-alveolarconditions/diseases to an agreed high standard.

b. Recognise his/her limitations of knowledge and competence and beaware of the appropriate time to refer on for treatment.

c. Has knowledge and skills, reflecting an approved period ofpostgraduate experience.

Competency Framework for aDwSI in Minor Oral Surgery

6. Many of the competencies will already have been assessed either at anundergraduate or postgraduate level, but it will be required thatconfirmation of competence be obtained.

7. Because the work a DwSI in Minor Oral Surgery may be required toundertake will depend upon the needs of the local community and bespecified by the PCT, there may be no requirement for the practitioner tohave developed competence in all the procedures listed in Appendix 1.

8. It is recognised that for the majority of appointments sedation skills maynot be required and there would therefore be no requirement for candidatesto be able to demonstrate competency in sedation techniques. For thoseappointments where sedation skills are a requirement, the necessarycompetencies have been included within the framework.

9. It will, however, be required that he/she be able to demonstrate competencein all fields relevant to the activity undertaken.



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Directobservationand/or casereviews

Communication – oraland written

Ability to present to the patient(and relatives where appropriate)the findings of the history andexamination such that the patient(and relatives) can understand.


KnowledgeSelf-awareness/insightCommunication – oraland written

Accurate judgement in relationto when NOT to intervene in aclinical situation and recognisewhen help is required.


KnowledgeReasoning/logical thought

Ability, using all the informationavailable to establish a diagnosisand formulate an appropriatetreatment plan.

TreatmentPlanning& PatientManagement

Clinical


KnowledgeSelf-awareness/insightCommunication – oraland written

Ability to recognise thata diagnosis is outwith thecompetence of the DwSIand describe the appropriatereferral procedures.


KnowledgeAbility to manage bleedingdisorders and use ofanticoagulants.


KnowledgeReasoning

Assess the influence of systemicdiseases (and associatedtreatment) on oral health anddelivery of treatment


KnowledgeClinical/manual dexterity

Ability to perform a clinicalassessment of a patient toenable identification of clinicalfeatures of oral mucosaldiseases and in particular theearly diagnosis of cancer.


KnowledgeRecognise the need forrelevant clinical laboratoryand diagnostic tests whenappropriate


Record KeepingAbility to satisfactorily maintainlegible and contemporaneouspatient records.


KnowledgeReasoning

Ability, using a comprehensivehistory, examination andconsidering investigations, togenerate and rank a differentialdiagnosis using all relevantinformation.

Examinationand Diagnosis

Clinical




Case reviewsKnowledgeCommunication – oral

Knowledge of behaviouraltechniques for the relief of fearand anxiety.

Case reviewsKnowledgeCommunication – oral& written

Ability to select and prescribeappropriate drugs for pain relief.


KnowledgeClinical skillsCommunication – oral

Ability to administer relativeanalgesia and to describe theclinical situations when it isrelevant.

Case reviewsKnowledgeClinical skillsCommunication – oral

Ability to describe inappropriate detail theprevention, recognition andmanagement of complicationsrelating to the use of localanaesthetic drugs.

Anaesthesia,Pain andAnxietyControl

Clinical

Case reviewsKnowledgeAbility to demonstrate anappropriate knowledge ofcommon drug interactions.


KnowledgeCommunication – oralClinical skills

Ability to diagnose and instituteeffective management for allcommon medical/dentalemergencies including thoseresulting from treatmentcomplications.

Medical/DentalEmergencies

Clinical


KnowledgeAbility to recognise whenfollow-up is required.


Communication – oralCommunication – written

Ability to obtain appropriateconsents from patients/relatives/guardians for the proposedtreatment.


Communication – oralKnowledge

Ability to discuss with the patient(and relatives where appropriate)possible complications ofproposed treatments.


Communication – oralKnowledge

Ability to discuss with the patient(and relatives where appropriate)alternative options to thepreferred treatment plan.


Communication – oralAbility to present to the patient(and relatives where appropriate)an appropriate sequencedtreatment plan.




Directobservation

Clinical skillsAbility to effectively exposeteeth.

Directobservation

Clinical skillsAbility to effectively removeimpacted/ectopic/supernumaryteeth.

Directobservation

Clinical skillsAbility to effectively removeburied roots and fractured orresidual root fragments.

Directobservation

Clinical skillsAbility to perform routineextractions of single and multi-rooted erupted teeth.

SurgerySpecificprocedures

Clinical


KnowledgeKnowledge of materials for usewithin the oral cavity, whichincludes suture materials.

Directobservation

KnowledgeClinical skills

Ability to design and raise amucoperiosteal flap, removebone where required andperform effective suturingwithin the oral cavity.

Directobservation

KnowledgeAbility to maintain an aseptictechnique during a surgicalprocedure.

Directobservation

Manual dexterityCareful and appropriatehandling of tissues

Directobservation

KnowledgeManual dexterity

Which instruments to usein different surgical situations,understanding of how eachinstrument should be usedand demonstration ofmanual dexterity.

Surgery(Basic surgicalprinciples)

Clinical

Certificationof satisfactorycompletion ofan approvedsedationcourse.

KnowledgeClinical skillsCommunication – oral

Ability to use sedation and todescribe the clinical situationswhen it is appropriate.

Certificationof satisfactorycompletion ofan approvedsedationcourse.

KnowledgeAbility to describe inappropriate detail the prevention,recognition and managementof complications relating to theuse of single agent sedation(intravenous or inhalational).

SedationClinical





KnowledgeCommunication – oral& written

Ability to understand the needfor and to prescribe correctlypharmacotherapeutic agents.



Ability to investigate, diagnoseand effectively manage localisedoral infections including dentalabscesses and pericoronitis.

Non-SurgicalManagementof Hard andSoft Tissues

Clinical

Directobservation


Ability to perform effectivesurgical endodontics.

Case ReviewsKnowledgeAbility to recognise the needfor surgical endodontics


KnowledgeClinical skill

Ability to recognise and treatpost-operative complications,which include pain,haemorrhage, infection.

Directobservation


Ability to manage minor dentaltrauma including reimplantationof avulsed teeth.



Ability to recognise when atuberosity has fractured; whenand what treatment might beeffective and appropriate; orwhether the condition requiresa referral to a specialist.


KnowledgeClinical skillsCommunication – oral& written

Ability to recognise when anoro-antral communication hasbeen created or a root elementhas been displaced into theantrum; when treatment isappropriate immediately orreferral is required.



Ability to recognise and treatintra-operative complications.

Directobservation

Clinical skillsAbility to perform minor pre-prosthetic surgical procedures.

Directobservation

Clinical skillsConsider giving examples

Ability to perform correctlyminor soft tissue surgery. (Biopsyshould be excluded if eithera malignant tumour or anysalivary tumour is suspected.)




Groupdiscussion

KnowledgeUp-to-date knowledge of crossinfection control procedures andtheir implementation within asurgical practice.

Groupdiscussion

KnowledgeAppropriate understanding ofhealth and safety issues relatingto his/her practice.

Ethics/Legislation

Profess-ionalism

Directobservation

Communication – oral& writtenSelf-awareness

Ability to communicateeffectively with referrers anda willingness to seek advicewhen necessary.

Directobservation

Communication – oral& written

Ability to communicateknowledge effectively to peersand other professionals bothverbally and in writing.

With ClinicalTeam, Peersand otherprofessionals


KnowledgeCommunication – oral& written

Ability to explain situations topatients and/or their relativesand carers in a sensitive mannersuch that they understandwithout undue anxiety.

With Patientsand Relatives

Communi-cation

Case reviewsKnowledgeAn understanding of the originsof cranio-facial pain, appropriatetreatment and when to refer.

Evidence of Maintenanceof Competencies

10. The DwSI will be expected to maintain his/her competencies throughcontinuing professional development (CPD) and education. It isrecommended that he/she undertakes CPD relevant to his/her specialinterest area as part of the general and verifiable CPD requirementslaid down by the GDC.

Accreditation of DwSIs inMinor Oral Surgery for PCTs

Contract Specification

11. The contract for a service provided by a DwSI should specify asappropriate:

11.1 The core activities and the competencies required (see CompetencyFramework for a DwSI in Minor Oral Surgery and Appendices 1 & 2respectively).

11.2 The types of patients suitable to be referred to the service, includinginclusion and exclusion criteria.

11.3 The minimum/maximum caseload. (normally equivalent to an averageminimum and maximum of 1 to 2 days per week respectively).

11.4 The facilities, including the staffing, that must be present to deliverthe service (see Appendix 3).

11.5 The clinical governance, accountability and monitoringarrangements, including links with other relevant surgical disciplines(Oral and Maxillofacial Surgery, Oral Surgery and Surgical Dentistry)working in primary care, at PCT level and in Acute Trusts.

11.6 The agreed arrangements with the secondary care sector to facilitatethe management of complications not able to be dealt with in theprimary care setting.

11.7 Remuneration at an appropriate level.

Appointment of DwSIs in Minor Oral Surgery with PCTs

12. In appointing a primary care dentist with a special interest in minor oralsurgery, the PCT should consider:

12.1 The development of a managed local clinical network appropriate forthe delivery of the necessary services and need for surgical care.


12.2 The views of key people in delivering the surgical services locally,including clinicians and managers in other relevant Acute andPrimary Care Trusts, and local dental practitioners. It is importantthat the primary care dentist with a special interest in minor oralsurgery commands the support and respect of others involved indelivering surgical services and of potential service users.

12.3 Evidence of generalist primary dental care competencies. The DwSIwill be able to demonstrate a continuing level of competence in his/hergeneralist skills. Evidence of training and experience in generalist skillsshould be provided through a portfolio approach and shoulddemonstrate competence in the following areas:

Clinical Record Keeping

Infection Control

Legislation and Good Practice Guidelines

Medical Emergencies

Radiography

Risk Management and Communication

Team Training

The FGDP(UK)’s Key Skills in Primary Dental Care is one means bywhich generalist skills can be demonstrated and independently assessed.The Key Skills assessment is part of the MFGDP(UK) courseworkmodule which provides a portfolio approach to the validation ofgeneral fitness to practice. The case and audit requirement of theMFGDP(UK) coursework module can be met through the overallrequirements for the assessment of special interest competencies.

12.4 Evidence of successful acquisition of the defined special interestcompetencies. It is important that the service provided meets localneeds and that the skills and competencies are appropriate to the servicerequirements. Applicants will be able to offer a range of evidence, asconfirmation of competency, which will include both formalqualifications and/or experiential evidence. (See paragraphs 19-21)

12.5 Before the service can be delivered, the following should be in place:

• Support of the local population, primary care dentists andspecialist dental practitioners, PCTs and acute trusts.

• Induction, support and continuing professional developmentarrangements for the DwSI and team.


• Facilities and staffing to allow satisfactory delivery of surgicalcare (see Appendix 4). Where sedation is not a requirement ofthe appointment those facilities specifically relating to the useof sedation may be omitted.

• Local guidelines on the use of the service having been developedby the PCT in consultation with the clinical network.

• Monitoring and clinical audit arrangements.

• Appropriate indemnity cover. If the primary care dentistis employed directly by the PCT or Acute Trust, he/she willbe covered by the Clinical Negligence Scheme for Trusts run bythe NHS Litigation Authority. The PCT should notify or discussits proposed scheme with the NHS Litigation Authority and itsown legal advisors. If the primary care dentist is an independentcontractor, he/she will normally be covered by his/her professionalindemnity provider. However, in all circumstances the primarycare dentist should notify his/her defence organisation.

Monitoring of the Minor Oral Surgery Service

13. In reviewing the service and the DwSI’s work (through clinical governance,annual appraisal, annual review of the contract and future revalidationrequirements), the following should be sought:

13.1 Evidence that the guidelines for use of the service are being followed.

13.2 Evidence that the caseload is appropriate.

13.3 Evidence of relevant CPD in general and special interest area, clinicalaudit, exploration of the views of patients, carers and other healthprofessionals, peer observation and compliance with futurerevalidation requirements.

13.4 Evidence of involvement in appropriate clinical governancearrangements, including when appropriate in the local Acute Trust(s).

13.5 Evidence of satisfactory process and outcomes of care.

13.6 Evidence that the individual’s generalist service is not being adverselyaffected.

13.7 Dentists who are appropriately registered in EU countries and whoapply for DwSI posts or contracts will need to demonstrate thecompetencies through equivalence.


Primary Care Trusts – needs assessment and delivery

14. Primary Care Trusts should identify their priorities in the context of keynational policies (e.g. NHS Plan, National Service Frameworks) local needsand local service delivery. In order to meet a priority, a service may requireconfiguration. PCTs in an area should work together or singly to consider theoptions for service development. These options will include the appointmentof a primary care dentist with a special interest. In deciding how to developthe service the PCT may also wish to consider the views of other trusts andof the current surgical service providers. Dental public health colleagues mayprovide an assessment of needs and demands to determine if the service isa priority for development.

15. If it is decided to appoint a primary care dentist with a special interest inminor oral surgery as part or all of a service development, then the PrimaryCare Trust (acting singly or as a lead PCT for local PCTs) should make anappointment after due process in line with this guidance and in collaborationwith relevant stakeholders including clinicians and providers.

16. In the circumstance where there are no appropriately skilled candidates thePCT (acting singly or as a lead PCT for local PCTs) could consider sponsoringa suitably motivated local primary care dentist on an appropriate programmeto acquire the necessary competencies.

17. As in all commissioning decisions, the PCT should review the appointmentregularly. In the case where the PCT is both commissioner and provider,there is a special responsibility to review service quality rigorously. In doingso, it will wish to take into account the views of the local health communityand service users, clinical governance and audit data, and the outcomesfrom appraisal. It will need to be satisfied that the post continues to meeta local priority.

System of assessmentand evidence required todemonstrate competence

18. Evidence of successful acquisition of the competencies is required. It isimportant that the service provided meets local needs and that the skills andcompetencies are appropriate to the service requirements. Applicants will beable to offer a range of evidence, as confirmation of competency, which willinclude both formal qualifications and/or experiential evidence.


Sources of evidence

19. In the absence of an appropriate supporting testimonial, from a consultantoral and maxillofacial/oral surgeon with whom the applicant has worked,there will be an assessment of the applicant’s relevant ability andcompetence by a consultant oral and maxillofacial/oral surgeon working inthe secondary care sector.

In addition to:

19.1 Formal qualification

19.1.1 Any formal qualification (FDS, MSc etc.) must be relevantto the competencies required, and must be accompanied byappropriate experiential evidence if the qualification wasobtained more than three years prior to the application.

19.1.2 Experiential evidence must be collected in a professionalportfolio demonstrating evidence of continuing experience.

and/or

19.2 Experience-based

19.2.1 Working under direct supervision with a consultant Oraland Maxillofacial Surgeon or Oral Surgeon in secondarycare (minimum of one session per week for one year) orthe equivalent.

19.2.2 Working under direct supervision with a Specialist SurgicalDentist in primary care (minimum of one session per weekfor one year) or the equivalent.

19.2.3 Experiential evidence offered, by way of clinical attachmentsetc. must be presented in a professional portfolio andaccompanied by an appropriate reference from thesupervising consultant/specialist.

19.2.4 Experience gained post attachment, or its equivalent, mustalso be presented in the professional portfolio.

Plus

20. Continuing Professional Development

Documented evidence of attendance at relevant courses must be includedwithin the professional portfolio.


Plus

21. Audit

Documented evidence of relevant audit either carried out personally or inassociation with others must be included in the professional portfolio.

Process

22. The process will usually be an evaluation of the evidence presented inthe applicant’s professional portfolio together with the clinical assessment(see 19 above).

23. The evaluation should be carried out by a local accreditation panel,which would normally include a consultant/specialist in the clinical area,an FGDP(UK) representative, representing primary care dentistry, a LocalDental Committee representative and a PCT representative.

24. PCTs may consider it appropriate to interview potential candidates foraccreditation as DwSIs.

References

Competency Document – OMFS/SHO Working Group – Dr Linda Prescott,June 2001


Appendix 1Recommended proceduressuitable to be carried out by aDwSI in Minor Oral Surgery

1. Routine extraction of single and multi-rooted erupted teeth.

2. Removal of buried roots and fractured or residual root fragments.

3. Removal of simple impacted/ectopic/supernumerary teeth.

4. Exposure of teeth.

5. Minor soft tissue surgery:

5.1 Removal of simple fibro-epithelial polyps.

5.2 Removal of simple mucocoele.

5.3 Removal of uncomplicated denture induced mucosal hyperplasia.

6. Management of minor dental trauma including the re-implantation ofavulsed teeth.

7. Surgical endodontics on single rooted anterior teeth.

8. Management of cranio-facial pain.



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Appendix 3Minor Oral Surgery PracticeRequirements

Primary Care Trusts that place a contract for services with a dentist with a specialinterest in minor oral surgery need to ensure that the service they commission is,in all its aspects, fit for purpose – the commissioner, in the event of any untowardincident, having a vicarious liability. This includes ensuring that the standards offacilities and support staff available for a particular service at each site meetcontemporary standards.

Many of these standards will have been checked and met via the local generaldental practice inspection system, but additional requirements for the practice ofa DwSI in Minor Oral Surgery would also need to be defined and monitored onan annual basis. It is suggested that this could be the responsibility of the localConsultant in Dental Public Health and general dental practice advisor workingclosely in conjunction with the person who leads the local Minor Oral Surgerynetwork (if set up) within which the DwSI would operate.

The Criteria/Quality Standards

(i) The number, level of training and expertise of clinical and support staff willbe assessed locally. The assessment of sedation standards will be carried outby a consultant anaesthetist based on the SAAD protocol – Clinical Auditof Conscious Sedation Techniques in Dentistry by Peer Review. See Annex Afor details.

(ii) The facilities offered for both surgery and sedation will be assessed by theGeneral Dental Practice Advisor, as will other non-clinical aspects, againstpre-determined criteria. Such assessments will be carried out as part of arolling programme. Details are given in Annex B.

(iii) The extent of care/responsibilities of the contracted dentist are as follows:

(a) The dentist who is contracted to carry out the surgery should bepersonally available to deal with emergencies involving their oralsurgery patients on the same basis as required within the GDS locally,or should make arrangements with another dentist approved by thelocal commissioner to carry out minor oral surgery, to provide suchemergency cover.


(b) The practice must identify itself to the emergency services to ensurethat in an emergency the ambulance crew is aware of the location ofthe practice and the routes in and out of the premises.

(c) A clear pathway of referral must be established with local consultantoral and maxillofacial surgeons for referral into hospital in the eventof a complication occurring, which cannot be treated in a primarycare setting.

Annex ACriteria to be applied for sedation standards

This is a synopsis of the criteria to be applied for intravenous sedation. Fulldetails for both intravenous and inhalation sedation are contained in ClinicalAudit of Conscious Sedation Techniques in Dentistry by Peer Review (Society for theAdvancement of Anaesthesia in Dentistry (SAAD) – available from the SAADwebsite at www.saaduk.org/evaluation.htm) or approved publication detailingcurrent contemporary standard.

Guidelines for intravenous sedation

Definition

Intravenous sedation (IVS) may be achieved by the use of one drug or acombination of drugs to an end point remote from anaesthesia. Where more thanone drug is used equipment must be available for, and staff and dentist trained in,advanced life support skills.

Operator/sedationist

Where IVS is employed, a suitably experienced practitioner may assume theresponsibility of sedating the patient as well as operating, provided that as aminimum requirement a second appropriate person is present throughout theprocedure. Such an appropriate person might be a suitably trained dental nurse ordental auxiliary, whose experience and training enables that person to be anefficient member of the dental team and who is capable of monitoring the clinicalcondition of the patient. Should the occasion arise, they must also be capable ofassisting the dentist in case of emergency.

Auxiliary personnel

Chair side support staff must be adequately trained and records kept of trainingundertaken.


Premises and equipment

Premises, practitioners and auxiliary personnel must be satisfactorily assessedas per the SAAD protocol Clinical Audit of Conscious Sedation Techniques inDentistry by Peer Review.

IV agents should be administered by an indwelling needle or cannula, which isnot removed until the patient is fully recovered.

Appropriate equipment for monitoring the patient

Pulse oximeter with audible alarms.

Pre-operative assessment of weight and blood pressure.

Additional equipment to provide advanced life support

Manual or semi-automatic defibrillator ECG.

Recovery and aftercare

Recovery is generally uneventful but supervision is required. All patients treatedwith IV sedative techniques must be accompanied by a responsible person.

Documentation

It is essential that written consent is obtained on each occasion prior to the use ofsedation and comprehensive written pre and post-operative treatment instructionsand advice should be provided.

Equipment and drugs

Every dental practice must be equipped to enable resuscitation to be performed.


Drugs

Glyceryl trinitrate (GTN) spray (400micrograms / dose)Salbutamol aerosol inhaler (100micrograms / actuation)Adrenaline injection (1:1000, 1mg/ml)Aspirin dispersable (300mg)Glucagon injection 1mgOral glucose solution / tablets / gel / powderMidazolam 5mg/ml or 10mg/ml (buccal or intranasal)Oxygen

For full details of recommendations issued by the Resuscitation Council (UK),please see: http://www.resus.org.uk/pages/MEdental.pdf

Airway maintenance

Suction apparatus independently powered and portableSimple airway adjunct e.g. Laerdal pocket maskCricothyroid puncture needle

Oxygen and artificial ventilation

Portable oxygen with appropriate valves, metering and delivery systemSelf inflating bag, valve and mask with oxygen enhancement facilitySuction tubing and Yankauer sucker x 1Suction catheters sizes 6FG and 10FG x 2 of eachOropharyngeal airways sizes 1,2,3 x 1 of each

Maintenance of circulation

Disposable syringes 2,5 and10ml x 5 of eachDisposable needles 21G and 23G x 10 of eachDisposable IV cannulae 16G and 22G x 5 of eachDisposable IV infusion sets x 2Scissors x 2Tourniquet, sphygmomanometer, stethoscopeInjection swabs


Annex BCriteria to be applied forthe assessment of general andsurgical facilities for generaldental practices

The following are statutory minimum requirements for all general dental practicesand must be met by all practices tendering for minor oral surgery contracts.

• Employers Liability Insurance

• Electricity at Work Regulations (Portable Appliance Testing)

• Transportable Steam Autoclave and Pressure Vessel Regulations

• Ionising Radiation Protection Regulations

• Hazardous Substances Risk Assessment and COSHH Assessment

• RIDDOR

• Compliance with Water Bylaws

• Compliance with Poswillo Recommendations with reference to:

– Emergency drugs including portable oxygen supply

– Portable self powered suction

– Airway adjuncts

– Monitoring equipment (as appropriate)

– Arrangements for storage and disposal of clinical waste andsharps

– current cross-infection control guidelines


The commissioning PCT would wish to see the following as the minimumadditional requirements for those practices wishing to contract with the PCTto provide minor oral surgery services from their practices:

(i) Surgical equipment and instruments

2 surgical kits, comprising the following (substitutions acceptable):

Warwick James (L, R and Straight)

Couplands (1,2 and 3)

Cryers (L and R)

Upper read forceps

Lower root forceps

Scalpel

Periosteal elevator

Retractor

Toothed dissecting forceps

Needle holder

Scissors

Mirror probe and tweezers

Cheek retractor

Aspirating syringe

Straight handpiece

Surgical burs

Artery forceps

Oral surgery drill unit with sterile irrigant system (Physio 7000 or similar)

(ii) Disposable items

Local anaesthetic cartridges and needles

Appropriate sutures

Paper towels

Gloves and masks

surgical suction tips

Gauze squares/swabs


(iii) Equipment

Chair

Operating light

High volume aspiration

Pulse oximeter

(iv) Recovery area

Should be large enough to accommodate two patients and should have thefollowing equipment:

Oxygen – ideally piped and if not then permanently sited

High volume suction

Adequate lighting

Recovery chair/couch x 2 (as a minimum)

(v) Reception and waiting room

Should provide adequate and comfortable accommodation not only forthe patient but for the patient’s escort who may have a lengthy (30 to 60minute) wait.

(vi) Staffing levels

a. Reception should be autonomous.

b. Two dental nurses in the surgery, one as a “scrub nurse” and one as arunner and available to attend recovery room if summoned.

c. The dental nurses must be suitably trained and experienced in thefollowing areas:

• assisting the surgeon undertaking minor oral surgery

• assisting in the care of the sedated patient

• basic life support skills

(Whilst the above skills may not necessarily have been tested by a formalexamination, the PCT may request sight of curriculum vitae for assistingstaff.)


(vii) Car parking or pick up facilities

The practice should have its own car park or at the very least a facilityto park a car safely outside the surgery whilst the patient is escorted intothe vehicle.

(viii) Pre- and post-operative instructions and consent, and medicalhistory forms

Copies must be submitted and they must comply with current guidelines.A consent form must be completed for each patient. Additional specificconsent must be given for treatment under sedation.


dwsi minor oral surg

Documents

minor oral surgery guidance

minor oral surgeryincluding

minor oral surgery service

appointment of dwsis

britishassociation of

dental practice advisors

dental faculties

primary care dentists