Doctors dealing with dental emergencies

At certain times of the year, such as school holidays, MDDUS sees an increase in the number of calls from doctors requesting advice on how to deal with patients attending for dental problems.

Basic Considerations

Such dilemmas often start at the front door with medical receptionists put in the difficult position of dealing with a patient requesting an appointment for an oral problem or symptoms, such as a dental abscess. The easy response is to say “our doctors don’t see patients with dental problems" and then direct the patient to their regular dentist. However, a dental abscess can potentially lead to a systemic infection and hospital admission. It is important to ensure such appointment requests are properly considered and safety netted.

Reception staff should not routinely turn patients away because they have a dental problem – particularly if the patient has been unable to get a dental appointment and need pain relief, emergency treatment or advice. There is always the possibility of an associated medical problem, and a doctor should undertake reasonable enquiries to ascertain the nature of the patient’s condition. Once it is clear the issue is dental and not something a doctor can assist with, advice can then be given on how to access local emergency dental services.

In coming to a decision on how to handle such cases it is essential to remember that:

• Dental treatment as such is not covered as part of the GP contract.
• All patients should be able to access emergency dental appointments locally, and referring the patient to these is likely to be appropriate.
• Patients cannot always be relied on to provide an accurate history of their dental treatment and this, along with a lack of knowledge or expertise, may mean a doctor is not able to offer a diagnosis or understand fully the complications which could arise from treatment. This could lead to a doctor straying outside their area of competence.
• GMC prescribing guidance states that in providing clinical care: "you must propose, provide or prescribe drugs or treatment (including repeat prescriptions), only when you have adequate knowledge of the patient’s health and are satisfied that the drugs or treatment will meet their needs".
• Should a doctor decide that it is reasonable in the circumstances to offer treatment in a dental case – perhaps with analgesia or antibiotics – they are responsible for the outcome of that decision and any follow-up required.
• GMC consent guidance further states: "If a patient asks for treatment or care that you don’t think would be in their clinical interests, you should explore their reasons for requesting it, their understanding of what it would involve, and their expectations about the likely outcome. This discussion will help you take account of factors that are significant to the patient and assess whether providing the treatment or care could serve the patient’s needs. If after discussion you still consider that the treatment or care would not serve the patient’s needs, then you should not provide it. But you should explain your reasons to the patient and explore other options that might be available, including their right to seek a second opinion.”
• In all circumstances the patient must be informed that dental advice should be sought as soon as possible, and this advice should be clearly documented within the patient’s medical record.

Common Pitfalls

• Failing to assess a request for treatment/appointment in what may appear to be a dental matter but proves to be symptomatic of a medical condition.
• Agreeing to treat or prescribe for a dental condition that falls outside a doctor’s area of competence.
• Failure to offer appropriate advice, including safety netting, on where a patient can obtain emergency dental assistance in cases where you are unable to offer treatment.

Key points

• Always act within your area of competence and refer patients to the appropriate local dental services.
• Ensure that the patient is not suffering from a medical condition which requires assessment and treatment.

Further guidance

• GMC. Good practice in proposing, prescribing, providing and managing medicines and devices
• GMC. Decision making and consent
• BMA. Patients presenting with dental problems

MDDUS Training & CPD resources

Doctors dealing with dental emergencies