The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care. NICE guidance is only officially for England only but some products and services are provided to Wales, Scotland and Northern Ireland. The decisions on how NICE guidance applies is made by the devolved administrations.
NICE was originally established in 1999 as the the National Institute for Clinical Excellence, a special health authority, to reduce variation in the availability and quality of NHS treatments and care. In 2005 it merged with the Health Development Agency and began developing public health guidance and its name changed to the National Institute for Health and Clinical Excellence.
In April 2013 NICE was established in primary legislation, becoming a Non Departmental Public Body (NDPB) providing a a solid statutory footing as set out in the Health and Social Care Act 2012. NICE then took on responsibility for developing guidance and quality standards in social care.
This CDO Letter to all dental practitioners highlights the launch of NICE guidance about about Antibiotic Prophylaxis Against Infective Endocarditits and reclassification of Midazolam as a controlled drug.
The 18 weeks Referral to Treatment (RTT) Standard is an integral element of the strategic objectives set by the Scottish Government, as outlined in Better Health, Better Care (2007).
The Dental Specialties Task and Finish Group was formed to help mitigate any risks to the achievement of the 18 Weeks Referral to Treatment Standard (RTT) in Dental Specialties.
The Scottish Intercollegiate Guidelines Network (SIGN) was formed in 1993. Its objective is to improve the quality of health care for patients in Scotland by reducing variation in practice and outcome, through the development and dissemination of national clinical guidelines containing recommendations for effective practice based on current evidence.
In January 2005 SIGN became part of NHS Quality Improvement Scotland (NHS QIS) and on 1st April 2011 part of Healthcare Improvement Scotland .
The General Dental Council (GDC) regulates the dental profession , setting standards, quality assuring education and by registering dental professionals. The GDC also takes action against those who work outside the law.
All dental professionals have a duty to keep their skills and knowledge up to date. CPD for dentists and DCPs is defined in law as activity which contributes to their professional development and is relevant to their practice or intended practice.
Guidance on CPD is available from the General Dental Council (GDC)
The new guidance summarises good practice on consent and takes account of several key legislative changes which impact on the safe delivery of health care, including:
The Adults with Incapacity (Scotland) Act 2000, and
The Mental Health (Care and Treatment) (Scotland) Act 2003.
The Scottish Dental Clinical Effectiveness Programme (SDCEP) is an initiative of the National Dental Advisory Committee (NDAC) in partnership with NHS Education for Scotland (NES). SDCEP is funded by the Scottish Government Health Directorates and contributes to NES’s role in implementing the Scottish Government’s Dental Action Plan.
SDCEP have produced a number of evidence-based guidance documents since they were established. This includes
Conscious Sedation
Decontamination – Cleaning of Dental Instruments
Decontamination – Sterilization of Dental Instruments
Dental Caries in Children
Drug Prescribing (Second Edition)
Emergency Dental Care
Management of Acute Dental Problems
Oral Health Assessment and Review
Oral Health Management of Patients Prescribed
Bisphosphonates
Practice Support Manual (10 topics)
Prevention and Treatment of Periodontal Diseases in Primary Care
The guidance recommends which healthcare professionals should be involved in treatment and care, and the types of hospital or cancer centre that are best suited to provide that healthcare.
The key recommendations are:
Cancer networks should decide which hospitals will diagnose, treat and care for patients
Multidisciplinary teams should be responsible for every patient
Clear systems should be in place for patients to be seen quickly by specialists
Support services should be available to all patients who need them
Local support teams should provide long-term support in the community
The guideline follows the patient’s journey of care from prevention and awareness through treatment to follow up and rehabilitation, making generic recommendations which hold for all head and neck cancers. The treatment sections focus specifically on cancers of the larynx, oral cavity, oropharynx and hypopharynx, as these are the tumour sites with the highest incidences. The guideline does not cover tumours of the nasopharynx, sinuses, salivary glands or thyroid.
This guideline will be of interest to all healthcare professionals working with patients with head and neck cancers, including ear, nose and throat specialists, oral and maxillofacial surgeons, plastic surgeons, general surgeons, clinical oncologists, nurses and allied health professionals.
Note:- This guideline is now more than 7 years old and should be used with caution .
Third molars generally erupt between the ages of 18 and 24 years, although there is wide variation in eruption dates. One or more third molars are absent in approximately 25% of adults but they may still be present in the elderly, otherwise edentulous, patient. The prevalence of unerupted third molars varies widely and is influenced by age, gender and ethnicity. The failure of eruption of third molars is a very common condition and the extraction of impacted third molar teeth is one of the most frequent surgical procedures carried out in the NHS. It has been reported that a significant proportion of those on oral and maxillofacial surgery waiting lists are awaiting third molar removal.
The guideline provides recommendations based on current evidence for best practice in dental interventions to prevent caries in children aged 0-18 years carried out by dental care teams within dental practices in Scotland.
Who is the guidance for?
This guideline will be of interest to healthcare professionals providing oral health advice to children in a one-to-one situation. It is intended for members of the dental care team. It may also be of interest to parents and carers, primary care and public health staff and others involved in children’s health, well-being and development.
Blockquote text: The objective of these guidelines is to provide healthcare professionals, including primary care dental practitioners, with clear guidance on the management of patients on oral anticoagulants requiring dental surgery. The guidance may not be appropriate in all cases and individual patient circumstances may dictate an alternative approach.
The risk of significant bleeding in patients on oral anticoagulants and with a stable INR in the therapeutic range 2-4 (ie <4) is very small and the risk of thrombosis may be increased in patients in whom oral anticoagulants are temporarily discontinued. Oral anticoagulants should not be discontinued in the majority of patients requiring out-patient dental surgery including dental extraction (grade A level Ib)
For patients stably anticoagulated on warfarin (INR 2-4) and who are prescribed a single dose of antibiotics as prophylaxis against endocarditis, there is no necessity to alter their anticoagulant regimen (grade C, level IV)
The risk of bleeding in patients on oral anticoagulants undergoing dental surgery may be minimised by:
The use of oxidised cellulose (Surgicel) or collagen sponges and sutures (grade B, level IIb)
5% tranexamic acid mouthwashes used four times a day for two days (grade A, level Ib). Tranexamic acid is not readily available in most primary care dental practices.
For patients who are stably anti-coagulated on warfarin, a check INR is recommended 72 hours prior to dental surgery (grade A, level Ib)
Patients taking warfarin should not be prescribed non-selective NSAIDs and COX-2 inhibitors as analgesia following dental surgery (grade B, level III).
Scottish Intercollegiate Guidelines Network (SIGN) Guideline 83 addresses effective strategies for preventing and managing dental decay in the preschool child. The nature of dental decay and its diagnosis are discussed, along with the epidemiology of the disease.
The focus on this specific group followed widespread concern about the scale of the caries problem in Scottish teenagers, the uneven distribution of the disease in adolescents, and variations in clinical caries management. Effective targeted prevention of caries in the permanent dentition has great potential to achieve significant health gain, given that once an initial filling is placed a repetitive, costly, lifelong cycle of re-restoration occurs for many individuals. Prevention from age six is important if the first permanent molars are to be adequately protected and should build on preventive programmes for 0-5 year olds. Caries prevention in pre-school children is important but is outwith the remit of this guideline.
Introduction
1.1 Background: the need for a guideline
1.2 The Scottish Intercollegiate Guidelines Network
1.3 Remit of the guideline
1.4 Structure of the guideline
1.5 Who is the guideline for?
Primary prevention of dental caries
3.1 Risk factors for dental caries
3.2 Identifying children at high caries risk
3.3 Behaviour modification in children at high caries risk
3.4 Tooth protection in children at high caries risk>
Information for non-dental professionals
5.1 Dental caries development
5.2 Sugar consumption
5.3 Dry mouth
5.4 Sugar-free medicines
5.5 Children who do not attend a dentist regularly
5.6 Medically compromised
5.7 Orthodontic appliances/li>
Implementing the guideline
6.1 Local adaptation and implementation
6.2 Health service implications of implementation
6.3 Implementation issues for local discussion
“Prevention and Management of Dental Caries in Children” is designed to assist and support Primary Care practitioners and their teams in improving and maintaining the oral health of their child patients from birth up to the age of 16.
Based on information distilled from a range of sources, the guidance provides advice on:
the assessment of the child
the delivery of preventive care based on caries risk
choosing from the range of caries management options available
delivery of restorative care, including how to carry out individual treatments
recall and referral
providing additional support
management of suspected dental neglect.
The full guidance and support materials can be downloaded from the SDCEP website.
The NICE dental recall clinical guideline helps clinicians assign recall intervals between oral health reviews that are appropriate to the needs of individual patients.
The recommendations apply to patients of all ages (both dentate and edentulous) receiving primary care from NHS dental staff in England and Wales. The guideline takes into account the potential of the patient and the dental team to improve or maintain the patient’s quality of life and to reduce morbidity associated with oral and dental disease.
The recommendations take account of the impact of dental checks on: patients’ well-being, general health and preventive habits; caries incidence and avoiding restorations; periodontal health and avoiding tooth loss; and avoiding pain and anxiety.
This guideline does not cover:
recall intervals for scale and polish treatments
the prescription and timing of dental radiographs
intervals between examinations that are not routine dental recalls; that is, intervals between examinations relating to ongoing courses of treatment
emergency dental interventions or intervals between episodes of specialist care
Responsibility for undertaking a review of this guidance at the designated review date has passed to the National Clinical Guidelines Centre for Acute and Chronic Conditions (NCGCACC). The National Collaborating Centre for Acute Care is no longer active.
Impacted wisdom teeth that are free from disease (healthy) should not be operated on. There are two reasons for this:
There is no reliable research to suggest that this practice benefits patients
Patients who do have healthy wisdom teeth removed are being exposed to the risks of surgery. These can include, nerve damage, damage to other teeth, infection, bleeding, and, rarely, death. Also, after surgery to remove wisdom teeth, patients may have swelling, pain and be unable to open their mouth fully.
Patients who have impacted wisdom teeth that are not causing problems should visit their dentist for their usual check-ups.
Only patients who have diseased wisdom teeth, or other problems with their mouth, should have their wisdom teeth removed. Your dentist or oral surgeon will be aware of the sort of disease or condition which would require you to have surgery. Examples include untreatable tooth decay, abscesses, cysts or tumours, disease of the tissues around the tooth or where the tooth is in the way of other surgery.
