Thorough examination of patient, comprehensive dental screening and diagnosis (initial, definite) with the use of additional measures: mouth rest, light source, plastic mirror.

Treatment planning and patient management, including the use of hoist, bariatric chair, etc.

Provision of advice on oral hygiene and peri-operative care and personal care associated with dental procedures.

Provision of lifestyle behaviour change, brief interventions and support (e.g. smoking cessation)

Detailed radiographic assessment, including BW and PA radiographs, OPG, lateral oblique radiographs if patient not compliant

Decision about some invasive dental interventions (extractions) may require a consultant second opinion based on the referral provided

Periodontal therapy and management of soft tissue to maintain dentition and prevent oral health deterioration. Patients may not tolerate ultrasonic scalers due to sensitivity, fear or impaired swallowing function (water)

Treatment of oral mucosa lesions: ulcerations, sel-inflicted injuries

Supplemental use of saliva substitutes (“artifical saliva”) in case of xerostomic problems (dry mouth)

Routine exodontia and/or simple surgical exodontia. May require the use of ‘safe’ local anaesthetics without vasoconstrictors, eg. 3% mepivacaine LA (Scandonest plain, Mepivastesin)

Management of the developing dentition in children with special needs, eg. provision of fissure sealants

Management of acute/chronic dental trauma

Restoration and replacement of teeth. The use of fluoride releasing dental materials (glass-ionomers) in case of eg. multiple root caries lesions

To consider Cr-Co dentures in case of poor cooperation and risk of fracture of acrylic dentures in case eg. poorly controlled epilepsy

Special combined denture-obturator for patients with oral malformations

Root canal treatment provided for the teeth with a good long-term prognosis

Liaison within a pathway for conscious sedation and general anaesthetic procedures so that these can be provided where required.

Dental procedures ‘delegation’ to specialist if more complex and/or require specialist skills (eg. surgical extractions of wisdom teeth for medically compromised patient)

Fluoride preventative measures

Prescription of highly concentrated fluoride toothpaste (Duraphat 2800ppm or 5000pm) for high risk group of individuals, special needs patients, patients with dry mouth, patients wearing fixed ortho appliances, patients with root caries, etc.

Soft occlusal guards in case of severe tooth wear

Proceeding with GA referrals

Second opinion from specialists, GP’s, consultants