Clinics

Secondary Care Clinics

Oral Surgery / Oral & Maxillofacial Surgery

Please send all referrals for Oral Surgery & Oral Medicine to: Div3.admin@dental.tcd.ie

Acceptance Criteria

The Oral Surgery Department does not accept patients who are having difficulty in accessing primary dental care services or have associated financial reasons or economic issues.

Primary Care (for undergraduate dental students only)

A) Extractions: Routine extractions and appropriate surgical extractions in patients without complex medical histories.

Secondary Care

B1) Oral cancer / salivary / skin lesions (All patients)

Patients with oral lesions suspicious for oral cancer – please call and write
Patients with neck lumps – please call and write
Patients with salivary disease – stones, lumps or bumps please call and write
Soft tissue lesions e.g. – mucocoele, fibro-epithelial polyps, labial frenulum and tuberosity reductions.
Patients with facial skin lesions, – suspicious lesions

Oral Cancer / Salivary / Neck Disease

These patients are treated in a Multidisciplinary Team in both the Dublin Dental School and the National Maxillofacial Unit.
Any patient with an ulcer or new lump within their mouth, neck or salivary glands for longer than 2 weeks needs to be seen urgently – please call and write
Any white or red patch of concern and it is not possible to identify a cause needs to be seen urgently – please call and write

B2) Jaw pathology (All patients)

Jaw cysts
Bony lesions of the jaws

B3) Dentoalveolar (Please see letter to GDPs for Patients requiring Dentoalveolar Surgery)

Please note due to extremely long waiting lists we are currently not accepting patients for routine third molar extractions. These patients can alternatively be referred to the Maxillofacial Department of St James’s Hospital. These referrals will be returned and patients will not be placed on any waiting list and patient will not be informed of same.

(Surgery is usually provided under local anaesthetic and sedation. Please do not discuss the option of GA with the patient. It is usually not necessary.)

Impacted and displaced teeth. Wisdom teeth, Canines etc. These patients will be assessed for surgical exposure, removal or possibly no treatment
Retained roots requiring surgical removal
Surgical removal of ankylosed teeth / teeth with hypercementosis (evident on radiograph)
Patients on intravenous bisphosphonate therapy for advice and possible treatment
Peri-radicular surgery providing that an adequate root filling is present
Oro-facial infections / Dento-alveolar trauma (Please see documentation for patients on oral bisphosphonates.)

B4) Bone grafting / Implants

Jaw bone grafting / implantology. Treatment will be undertaken in conjunction with Prosthodontics and Periodontology

B5) Jaw deformities

Facial deformity secondary to congenital, trauma, neoplastic conditions / diseases. Treatment will be undertaken in conjunction with Orthodontics / Maxillofacial Laboratory.

B6) Temporomandibular joint / Facial pain

Please note we are only accepting patients who have received a bite raising appliance and have tried conservative measures for a period of no less than 6 months. Any patient who does not meet these criteria will be returned to the referrer for same.

Patients with pain AND severe limitation to movement should be referred urgently.

TMJ problems, – limited mouth opening, – closed lock, – dislocation, – deformity
TMJ reconstruction

Waiting Times:
All letters are appointed by the consultant involved upon receipt and stratified into very urgent, urgent, soon and routine.

Capacity for New Patients:
There are two consultants and three specialists in this area. The current capacity is for 90 – 100 new patients per week.

Information Required at Referral:

Oral & Maxillifacial Surgery proforma letter

Letter to GDPs for Patients requiring Dentoalveolar Surgery

Surgical Management of the Primary Care Dental Patient on Warfarin Final

Guidelines for treating patients taking bisphosphonates prior to dental extractions

The dental patient with a congenital bleeding disorder

Medical emergencies in dental practice

IV access in dental practice

Epilepsy in dental practice

Renal disease and chronic renal failure in dental practice

Oral Medicine

Acceptance Criteria

Persistent or recurrent oral ulceration including oral ulceration lasting >2 weeks, following primary care treatment of possible causes
White or red oral mucosal lesions
Pigmented lesions
Non-odontogenic pain, i.e. pain where a dental cause has been excluded
Oral dysaesthesias
Xerostomia
Granulomatous disease
Cheilitis/stomatitis/glossitis
Oral mucosal infection
Oral manifestations of systemic disease

Information Required at Referral:

Oral Medicine proforma letter

Waiting Times:

All letters are stratified by the consultants into urgent (to be seen in less than ten working days, usually through the Accident and Emergency Department), priority (to be seen in less than six weeks) and routine (to be seen in less than one year).

Capacity for New Patients:

There are two consultants in this area. The current capacity is for 42 priority or routine new patients per week.

Paediatric Dentistry

Only patients suitable for Undergraduate clinics are accepted at present. All other paediatric dentistry waiting lists are closed until further notice.

Acceptance Criteria

Suitable for undergraduate students: co-operative child with routine paediatric treatment needs for prevention and management under LA. Treatment plan capable of being completed in one academic year. Patient must be able to attend on student schedule. Orthodontic treatment will not be provided. Inappropriate referrals will be returned to the primary care dentist eg. treatments that are too complex, too extensive, or patient management is beyond the scope of UG clinics.
Non-Consultant Hospital Dentists/ Postgraduate trainees: Must meet educational needs of students and patients must be motivated, able to commit to proposed treatment and assume any costs involved. Complex care will be provided under supervision.
Consultant: Patient has paediatric needs requiring secondary/tertiary or /interdisciplinary care, that cannot be provided elsewhere due to complexity. Patients will be also accepted for assessment of rare or unusual conditions.

Information Required at Referral:

Paediatric Dentistry Proforma letter

Capacity for new patients:

Capacity determined by educational needs.

One consultant in this area. General anaesthesia is not provided in DDUH.

Orthodontics

Acceptance Criteria

The majority of patients treated in the Postgraduate Orthodontic Clinic are referred from the HSE Regional Orthodontic Clinic in St James’s Hospital. Patients /parents are advised treatment is carried out by undergraduate or postgraduate students under the supervision of a Consultant/Specialist Orthodontist.

Patients are selected on the basis that they are suitable “teaching cases” for postgraduate students.

To be accepted for orthodontic treatment patients should have:

Good oral hygiene.
Regular dental attendance at a HSE clinic or General Dental Practitioner
No previous history of orthodontic treatment.
Understand that they are attending a teaching clinic and that appointment times are limited (patients are required to attend on a Wednesday AM or PM on a long-term basis).

Suitable Patients for Treatment in Undergraduate Orthodontic Clinics

Children presenting with a Class II division 1 malocclusion with well aligned arches are accepted for treatment if they would benefit from functional appliance treatment.
Patients with an anterior or buccal crossbite of dental origin who would benefit from simple appliance therapy.
Patients requiring treatment adjunctive to restorative treatment being carried out in the Dublin dental School and Hospital where the supervising orthodontist accepts the case is suitable for an undergraduate student.

Suitable Patients for Treatment in Postgraduate Orthodontic Clinics

Postgraduate students treat patients assigned to them from the joint restorative / orthodontic clinic, the orthognathic clinic and other DDSH clinics where patients require multidisciplinary care.

Suitable Patients for Treatment in Consultant Orthodontic Clinics

Patients are allocated from the joint restorative / orthodontic clinic, the orthognathic clinic and other DDSH clinics where patients require complex multidisciplinary care.

Capacity for New Patients:

There are two consultant in this area. Patient intake depends primarily teaching demand.

Restorative Dentistry /Prosthodontics

General Dental Practitioners, Specialists, Health Board Dentists can refer patients directly to the departments of Restorative Dentistry and Periodontology for restorative / prosthodontic treatment.

Information Required at Referral:

Link to proforma letter (attached)

Waiting Times:

There is a pre-assessment referral screening by a consultant and may be assigned to:

An undergraduate dental clinic
A postgraduate prosthodontic clinic
A consultant assessment clinic

Acceptance Criteria

Suitable for undergraduate dental students: routine restorative treatment under local anaesthetic. The agreed treatment plan must be capable of being completed in one academic year. Patient must be able to attend on student schedule and commit to any costs involved. The waiting lists are stratified by undergraduate dental year.
Patients unsuitable for undergraduate dental students include: treatments that are too complex, too extensive, or patient management is beyond the scope of undergraduate dental clinics.
Postgraduate prosthodontic: waiting time must be less than 1 year. Must meet educational needs of students, be motivated, able to commit to extensive treatment and assume any costs involved.
Non Consultant Hospital Dentists: Treatment can be completed within a short period (6 visits or fewer). Includes acrylic night splints or certain prostheses. A staff member must be available to provide treatment.
Consultant: Patient has prosthodontic needs requiring secondary/interdisciplinary care, that cannot be provided by postgraduates, or other staff due to complexity.

Capacity for New Patients

The current capacity is for 19 new patients per week.

Periodontology

General Dental Practitioners & Specialists, Health Board Dentists, General Medical Practitioners and Consultants can refer patients directly to the Department of Restorative Dentistry and Periodontology for advice regarding periodontal therapy.

Acceptance Criteria

Patients with all aspects of periodontal care are accepted for assessment.
The number of patients accepted for treatment will depend on teaching need. This will also dictate the disease categories accepted for treatment – gingivitis, periodontitis of varying severity and mucogingival defects.
Following assessment, a letter will be sent to the referring clinician with details of planned treatment. The patient will either be placed on a hospital treatment list or referred back to the general dental practitioner for provision of care.

Information Required at Referral:

In order to formulate a suitable treatment plan tailored to the patients’ individual requirements adequate information must be supplied by the referrer. A good letter of referral is vital for:

Successful treatment planning.
Ongoing communication between the dentist, the periodontist and the patient during the maintenance phase.
Efficient allocation of appointments and reduced waiting period.

When referring patients for periodontal treatment please use the pro forma check list below, developed as a guide to referring practitioners.
Link to proforma letter (attached)

Waiting Times:

Waiting times will depend on the number of referrals received. All referral letters are screened by a senior staff member in Periodontics and assigned for assessment to:

Undergraduate clinic – three assessments clinics yearly
Postgraduate clinic – one assessment clinic monthly
Consultant clinic – one assessment clinic monthly

Capacity for New Patients:

All patient assessment and treatment planning is under the supervision of senior staff members.
The patients referred to the undergraduate clinics are usually accepted by the student for treatment. Approximately 120 new patients are examined each year.
The monthly postgraduate and consultant clinics assess 10 to 12 patients. Patients are assigned for treatment to undergraduates (dental and dental hygiene), postgraduates, NCHD or staff dental hygienist. If not suitable for treatment in the Dublin Dental School & Hospital, the individual is referred back to the referring clinician with a suggested treatment plan.
All patients will be referred back to their own general dental practitioner following treatment.

Endodontic Clinic

Acceptance Criteria

Primary Care (for undergraduate dental students only)

Non-surgical root canal treatment (RCT) cases for single and multi-rooted teeth.
- There is a particular shortage of single rooted teeth requiring root canal treatment, a skill essential in undergraduate training.
- Generally root canal retreatment is not suitable for undergraduate care.

Secondary Care (for Senior and Junior Staff)

Non-surgical de novo RCT cases only if compelling medical/other reason for specialist/staff treatment
- advanced sclerosis
- tooth anomalies (e.g. dens en dente)
- medical/other reason
Non-surgical endodontic retreatment and other cases including perforation repair, instrument or post removal.
Surgical root canal treatment including de novo, surgical retreatment and curettage.
Other endodontic surgical including root resection/amputation/ perforation repair/ root resorption.
Immature apex apexification, apexogenesis and root end closure
Vital pulp treatment pulpotomy, partial pulpotomy and revitalization

Notes:

If the patient has complex prosthodontic needs that require secondary or interdisciplinary care; at present we are limited in capacity to accept these patients.
All patients will be referred back to their own general dental practitioner following treatment for restoration

Tertiary Care (Senior Staff)

Trauma
Other Advanced resorption, selected endodontic surgery (as part of joint procedure with Paediatric Dentistry or Periodontology).
Combined cases with Implantology/Oral Surgery

Information Required at Referral:

Proforma Letter

Waiting Times:

All letters are appointed by the consultant involved upon receipt.

Capacity for New Patients:

There is one consultant and one specialist in this area. The current capacity is up to 10 new patients per week (350-400 new patients per year).

Special Care Dentistry

Acceptance Criteria

People with a disability where:

Communication and/or co-operation is insufficient to allow routine dental care (i.e. examination/operative/surgical procedures with/without LA).
Appropriate facilities are not available from the referral source at present.
People with physical disability whose impairment does not permit the safe delivery of dental care in the conventional way.
People with a disability including unstable organic disease whose consultant physician requires them to be treated in a hospital (2° or 3°care) setting.
People with a disability including organic disease in whom routine management of their impairment puts them at risk from dental procedures (e.g. need for complex ABC, steroid cover, INR management)
People with a general and dental impairment that requires interdisciplinary care (e.g. person with ectodermal dysplasia, cleft palate and mild learning disability).

Information Required at Referral:

Link to proforma letter.

In your referral letter please include the following details:
Name
Date of birth
Address where appointment should be sent
Family contact (if known) if patient is in residential care
Summary of medical history / drugs
Dental problem(s)
Reasons for request for secondary / tertiary care

Capacity for New Patients:

There are two consultants in this area. The current capacity is for 18 new patients per month.

Tertiary Care Clinics

Dysplasia Clinic

Acceptance Criteria

Referral to this clinic is made directly, only by the consultants in Oral Medicine and Oral and Maxillo-facial Surgery. Following initial assessment and biopsy, where applicable, of potentially malignant oral lesions, patients are reviewed on this clinic. This clinic also follows up on patients who have had treatment for oral cancer.

Capacity for New Patients:

This clinic runs twice per month.

Joint Complex Oral Medicine Clinic

Acceptance Criteria

Referral to this clinic is made directly, only by Oral Medicine Consultants, following initial assessment of patients, where the treatment plan is complex. This includes, for example, patients who require systemic immunosuppressive therapy.

Capacity for New Patients: This clinic runs once a fortnight

Joint Oral and Maxillo-facial Surgery /Prosthodontic Clinic

Acceptance Criteria

Referral to this clinic is made directly by Consultants in oral and maxillo-facial surgery and prosthodontics.

Waiting Times:

All letters are stratified by the consultants into urgent (to be seen in less than one week), priority (to be seen in less than six weeks) and routine (to be seen in less than one year).

Capacity for New Patients:

This clinic runs once a fortnight. The current capacity is for 8 new patients per clinic.

Joint Orthodontic-Restorative Clinic

Acceptance Criteria

Referrals are accepted from all sources for patients who require treatment planning and advice where multi-disciplinary care involving orthodontic and restorative dentistry /prosthodontics is required.

Information Required at Referral:

Link to proforma letter

Waiting Times:

All letters are appointed by the consultants involved upon receipt.

Capacity for New Patients:

This clinic runs once a month. The current capacity is for eight new patients per clinic. Priority is given to patients with developmental dental anomalies.

Orthognathic Clinic

Acceptance Criteria

Referral to this clinic is made directly by Consultants in orthodontics or maxillo-facial surgery.

Information Required at Referral:

Not applicable

Waiting Times:

All letters are stratified by the consultants into urgent (to be seen in less than one week), priority (to be seen in less than six weeks) and routine (to be seen in less than one year).

Capacity for New Patients:

This clinic runs once a month. The current capacity is for 6 new patients per clinic.

Sleep Apnoea Clinic

Acceptance Criteria

Patients must be referred by a medical consultant in a Sleep Disorders Clinic. No referrals from dentists or doctors are accepted. The patient will normally need to have completed an overnight sleep study.

Information Required at Referral:

Link to proforma letter

Waiting Times:

Patients are allocated directly by the two consultants involved.

Capacity for New Patients:

There are two consultants in this area. The current capacity is for four new patients per week.

Oncology and Restorative Dentistry

A dental assessment is considered to be an aspect of “best practice” in preparation for radiation treatment for the treatment of cancer in the head and neck area.
Referrals are accepted for head and neck cancer patients both before and after their radiation treatment.
The referral will usually be from the maxillo-facial / ENT surgeon or the radiation / clinical oncologist. Referrals are also sent by general dental and medical practitioners.

Acceptance Criteria

Ideally, individuals diagnosed with head & neck cancer will be referred before radiation treatment for a dental assessment and necessary treatment.
If the referral is following their radiation treatment, dental treatment decisions will be based on the recent cancer treatment received including field and dose of radiation treatment.

Information Required at Referral

In order to formulate a suitable treatment plan tailored to the patient’s individual requirements, adequate information must be given by the referrer (see attached form).

Patient name, address, date of birth, contact number.
Referring physician/surgeon, address, contact number.
If the patient is an in-patient, contact details of hospital/ward.
Urgency of referral.
Special requirements – radiation stent.
Relevant medical history, including medications.
Cancer diagnosis, site and stage.
Treatment planned – surgery, chemotherapy and radiotherapy.
In relation to the radiotherapy – field, dose and fractions planned.

See Pro-forma referral (attached)

Waiting Times

All letters are screened by the Consultant.
An appointment is arranged as soon as possible, ideally within two weeks, for pre-radiotherapy patients.
An appointment is arranged for the post-radiotherapy patient as soon as possible, depending upon the urgency.

Capacity for New Patients

There is one dedicated consultant session per week. The current capacity is for 3 new patients per week.
Pre- and post-radiotherapy patients are assessed and a treatment plan developed.
Emergency treatment and advice are provided in the DDSH.
The referring medical, surgical consultants, General Dental Practitioner and patient will be informed of the planned treatment.
Long-term dental care is provided in partnership with the General Dental Practitioner.