A tale of two tiers
As a dentist who works in both general practice and secondary care, I am frequently struck by the apparent confusion that exists between providers regarding what surgery treatments should be performed, where and by whom. Referrals can bounce between the two, with generalists unable to provide the treatment graded as suitable for practice. So what is actually expected of the general dental practitioner (GDP), and why the confusion?
General Dental Council guidance
Oral surgery is part of the undergraduate syllabus but variation exists between institutions regarding the scope and depth of experience provided.
Under GDC guidance, the practitioner must work within their knowledge, skills, professional competence and abilities (7.2). ‘So far, so straightforward’ you might suggest. ‘I cannot perform this treatment so it should be done in hospital.’ However, it is not as simple as that.
Oral and maxillofacial tiers
The NHS England Commissioning Framework requires that a general dentist should work at tier one level for oral and maxillofacial surgery. This includes extraction of teeth and erupted third molars, extraction of buried roots, basic management of oral mucosal disease, recognition and referral of malignant disease, management of dental trauma and haemorrhage, diagnosis and treatment of odontogenic infections and craniofacial pain (NHS England commissioning framework).
Some may feel surprised or even uncomfortable reading the above. I believe that with support and, if required, additional training the GDP can be not only competent, but ideally placed to provide basic surgical treatments.
Supporting GDPs in providing tier one treatments will benefit patients and professionals alike. Treatment pathways are streamlined, with appropriate therapies provided in a timely fashion and often at reduced cost. Conversely, when practitioners feel isolated or unsupported they are less able to determine and/or deliver the best possible care for their patient. Collaborative training and practice not only enhances patient treatment but improves job satisfaction and morale.
Student offers training days with support from brand leaders in dental equipment and materials to help develop the general practitioner. Each day combines practical and theoretical elements, and tailored to individual requirements. Themed days can be booked individually or as a complete five-day course, including surgical exodontia for the GDP; complications of exodontia; management of soft tissue pathology; and introductions to bone grafting and dental implants. Together they offer all of the essentials required to confidently deliver tier one treatments and provide a stepping stone to further specialist training.