2 Clinical Standards

2.1 Introduction
In compiling clinical standards, we were acutely aware that every clinical contact sets a different set of circumstances for the clinician to deal with. Not only is every patient different, but every tooth and every contact present variable factors that make standardising dentistry an extremely challenging task. We based our standardisation on key elements of every patient contact, namely:

  • Assessment
  • Diagnosis
  • Valid consent
  • Control of active disease
  • Careful consideration of prognostic indicators for teeth

While the intricacies of standards for individual disciplines can be accessed via the various specialist bodies (some of which are listed in the appendix) we were acutely aware that complex as dentistry is, the fundamentals to optimal patient care can be based on these key principles. These principles stand firm whether placing a single surface restoration or undertaking full mouth rehabilitation. While we aspire to these standards, the grading system of aspirational, basic and conditional (ABC) recognises the importance of patient factors which are often beyond our control as clinicians. For example, despite our best efforts, we may not be able to significantly improve the patient’s oral hygiene or systemic risk factors that make control of periodontal disease extremely challenging. This element of compromise is something clinicians face on a daily basis, and the standards are designed to reflect this.

2.2 Consultation and diagnosis 

Aspirational Basic Conditional

- Radiographs appropriate for diagnosis and risk have been selected, justified, taken to excellent standard (rating 1)1 and reported on.

- Appropriate photographs taken.

- Consideration given to all systemic risk factors and evidence that advice has been given to address these.

- Full consideration given to all prognostic indicators (endodontic, periodontic and restorative).

- Written diagnosis, rationale for treatment plan and aim of treatment provided to patient.
 

 

 

 

 

 

 

 

 

 

 

- Valid consent.

- Medical and socio-behavioural history checked in accordance with current recommendations.2

- Appropriate health screening.

- Oral mucosa screened.

- BPE recorded as appropriate.

- Appropriate indices recorded following initial screening with BPE (6PPC, plaque, bleeding).

- Radiographs appropriate for diagnosis and risk have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)1 and reported on.

- Extent and severity of disease documented and patient advised.

- Consideration given to most significant prognostic indicators (endodontic, periodontic and restorative).

- Written recording of all relevant information.

Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3

- Oral health and hygiene advice.

- Recalls in accordance with risk status and recommended guidelines.4
 

- Hard tissue charting.

- Appropriate written diagnosis and treatment plan provided for hygienist/therapist if patient on referral.

- Appropriate onward referral.

- Appropriate behavioural management techniques utilised on journey to achieve oral health.

- Alcohol identification and brief advice given in accordance with guidelines.3,5

- Written treatment plan including diagnosis provided.

- Diagnosis and appropriate management of diagnosed conditions.

- Written consent obtained.

 

 

 

 

 

 

1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.

2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016

3. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.

4. NICE. Clinical guideline [CG19]: Dental checks: intervals between oral health reviews. London: NICE; 2004

5. NICE. Public health guideline [PH24]: Alcohol-use disorders: Prevention. London: NICE; 2010.

 

2.3 Making and receiving referrals 

Aspirational

Basic

Conditional

General principles:

- Indicate if referral is NHS or private.

 

Personal information recorded:

- Occupation.

- Signature for verification.

 

Factors affecting appointment recorded: 

- Timing.

- Mobility.

- Travel considerations.  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

General principles:

- Summary of relevant dental and medical history. 
- Clear indication of the condition/reason for referral.
- All information disclosed with patient’s consent.
- Options discussed and patient’s preferences noted.
- Indication of the level of urgency.
- Contact details of referring practitioner.
- Referral letter dated and copy kept in patient’s notes.
- Upon completion of treatment the receiving dentist

should send a written report to the referring dentist

confirming what has been undertaken and any

arrangements for follow-up.

 

Personal information recorded:

- Name. 

- Address. 

- Date of birth. 

- Telephone numbers. 

- Preferred contact method. 

- [For children] parental contact details.

- Emergency contact. 

- General medical practitioner.

 

Medical history recorded:

- New form completed or updated. 

 - Dated and signed by patient and clinician. 

 

 

 

 

 

 

 

 

General principles

- Write ‘cancer suspected’ if applicable.
- Follow up on all urgent referrals to confirm

action has been taken.
- Copies of relevant test results, including

radiographs and photographs, provided.

 

Personal information recorded:
- Patient dependent on someone.
- Email.
- Relevant specialist practitioner.
- NHS identification number.

 

Socio-behavioural history recorded:
- Smoking.
- Alcohol consumption.
- Eating habits.
- Dietary information.
- Contact sports.
- Musical instruments.

Previous dental history recorded:
-Chewing unrestricted.
- Restorative procedures.
- Orthodontic care.
- Endodontic care.
- Oral surgery procedures.
- Oral hygiene routine.
- Anxiety.

Factors affecting appointment recorded:
- Carer to be present.
- Physical and mental impairments. 
- Need for domiciliary care or special

equipment/facilities.

More detailed information, including details of what, when, and how to refer are available in: Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.

2.4 Paediatric dentistry

Aspirational

Basic

Conditional

  • Advise first visit by age 1. 
  • Primary prevention including dietary
    advice, oral hygiene instruction and
    fluoride advice starting from first dental
    visit.
  • Radiographs appropriate to management
    have been selected and taken to excellent
    standard (rating 1).
  • Appropriate photographs taken.
  • Consideration given to all systemic risk
    factors and evidence that advice has been
    given to address these.
  • Written diagnosis, rationale for treatment
    plan and aim of treatment provided to
    parent/guardian. 
  • Valid consent (parent/guardian).
  • Medical and socio-behavioural history
    checked in accordance with current
    recommendations.2
  • Extent and severity of disease documented
    and 
    patient/guardian advised.
  • Radiographs appropriate to management have
    been selected, justified, taken to an acceptable
    standard (>70% rating 1, <20% rating 2; < 10%
    rating 3)1 and reported on. 
  • Consideration given to preventable disease risk
    indicators and appropriate preventative advice
    given in accordance with the prevailing guidelines.
  • Recalls in accordance with risk status
    and
     recommended guidelines.4
  • Appropriate onward referral.
  • Appropriate behavioural management
    techniques utilised on journey to achieve oral
    health.
  • Consideration of safeguarding issues where
    there are grounds for suspicion. 
  • Written consent obtained

     

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.
  4. NICE. Clinical guideline [CG19]: Dental checks: intervals between oral health reviews. London: NICE; 2004

 2.5 Orthodontics

Aspirational

Basic

Conditional

  • Radiographs appropriate to the orthodontic management have been selected, justified, taken to excellent standard (rating 1)1 and reported on. 
  • Appropriate photographs taken.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Primary preventative advice.
  • Patient, parent/guardian understands reason for orthodontic assessment.
  • Medical and socio-behavioural history checked in accordance with current recommendations.2 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3 
  • Radiographs appropriate to orthodontic management have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)1 and reported on. 
  • Appropriate orthodontic assessment and referral as necessary.4

Deciduous dentition:

  • Individuals with cleft lip and/or palate, or other craniofacial anomalies.
  • Severe maxillary/mandibular disproportion (but only if parents are concerned, otherwise wait until the mixed dentition stage).

Occlusal problems in the mixed dentition:

  • Anterior or posterior crossbites with associated mandibular displacements.
  • Class III in the mixed dentition.
  • Class II/I malocclusion where there is an underlying skeletal II pattern.
  • Asymmetry in the pattern of tooth eruption. 
  • Lack of palpable canine bulges buccally at 10-12 years. 
  • Hypodontia. 
  • Supernumerary teeth. 
  • Submerged deciduous molars. 
  • Impacted first permanent molars. 
  • Periodontal problems caused by severely ectopic tooth position 
  • Severe crowding of incisors. 

Types of occlusal problem in the permanent dentition:

  • All other malocclusions.
  • Patient aware of need for good oral health and diet during treatment.
  • All active dental disease under control prior to commencement of orthodontic treatment.
  • Index of Orthodontic Treatment Need (IOTN) score recorded.
  • When referring a patient to a specialist for orthodontic treatment, the specialist will be able to confirm whether the patient qualifies for NHS treatment on the basis of IOTN.
  • ppropriate advice sought when there are severely hypoplastic/carious first molars of poor long-term prognosis.
  • Any relevant radiographs and salient information included in any referral letter including:2 
    Details of any previous dental treatment especially trauma.
    - IOTN grade.
    - Urgency.
    - Patient awareness of referral.
    - Previous orthodontic treatment.
  • Written consent obtained.
  • Check patient committed to wearing appliances during treatment.
  • Check patient committed to long-term wear and maintenance of retainers once active treatment is completed.
     

 

 

 

 

 

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.
  4. British Orthodontic Society. Quick reference guide to orthodontic assessment and treatment need. London: British Orthodontic Society; 2014

2.6 Management of acute pain

Aspirational

Basic

Conditional

  • Radiographs appropriate to the diagnosis and management of pain have been selected, justified, taken to excellent standard (rating 1)1 and reported on. 
  • Appropriate photographs taken.
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Immediate pain relief at initial appointment. 
  • Written diagnosis, differential or definitive noted. Rationale for pain treatment plan and aim of treatment provided to patient

 

 

 

  • Examination undertaken in accordance with FGDP(UK) guidelines.2 
  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.2 
  • Structured pain history. 
  • Radiographs appropriate to the diagnosis and management of pain have been selected, justified, taken to an acceptable standard (≥70% rating 1; <20% rating 2; <10% rating 3)1 and reported on. 
  • Appropriate action to relieve pain taken. 
  • Follow up/review appointment if required. 

 

 

 

  • Special tests appropriate to the presenting condition.
  • Oral health/systemic health interactions explained and appropriate advice given to patients with systemic health issues that may be exacerbated by or exacerbate their pain.
  • Where indicated, antibiotics used in line with FGDP(UK) antimicrobial prescribing guidelines.3 
  • Appropriate management techniques utilised to relieve pain.
  • Written pain relief treatment plan provided to patient.
  • Appropriate signposting for future care to achieve dental health. 
  • Written consent obtained. 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Faculty of General Dental Practice (UK). Antimicrobial prescribing for general dental practitioners. London: FGDP(UK); 2016.

​​​​2.7 Periodontics 

Aspirational

Basic

Conditional

  • Radiographs appropriate to management of the periodontal condition have been selected, justified, taken to excellent standard (rating 1)1 and reported on. 
  • Appropriate photographs taken. 
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Full consideration given to all prognostic indicators (endodontic, periodontic and restorative). 
  • Written diagnosis, rationale for treatment plan and aim of treatment provided to patient.

 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.2 
  • Appropriate health screening. 
  • BPE recorded. 
  • Appropriate indices recorded following BPE (6PPC, plaque and bleeding scores) when necessary. 
  • Radiographs appropriate to management of the periodontal condition have been selected, justified, taken to an acceptable standard (≥70% rating 1; <20% rating 2; <10% rating 3)1 and reported on.
  • Extent and severity of disease documented and patient advised.
  • Consideration given to most significant prognostic indicators (endodontic, periodontic and restorative). 
  • Written treatment plan provided to patient. 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3
  • Consideration of oral hygiene and plaque as a causative factor.
  • Initial disruption of biofilm by patient and operator in conjunction with elimination of plaque retentive factors. 
  • Further disruption of biofilm incorporating scaling and root surface debridement in conjunction with patient home-care.
  • Appropriate periodontal maintenance plan tailored to risk profile of patient.
  • Oral-health/systemic-health interactions explained and appropriate advice given to patients with systemic health issues that may be exacerbated by or exacerbate their periodontal condition.
  • Appropriate written diagnosis, treatment plan and prescription provided for hygienist/therapist.
  • Smoking cessation advice given in accordance with guidelines.3
  • Appropriate onward referral.4 
  • Where indicated, antibiotics used in line with FGDP(UK) antimicrobial prescribing guidelines.5
  • Written consent obtained.

 

 

 

 

 

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.
  4. British Society of Periodontology. The good practitioner’s guide to periodontology. London: British Society of Periodontology; 2016.
  5. Faculty of General Dental Practice. Antimicrobial prescribing for general dental practitioners. London: FGDP(UK); 2016.

2.8 Direct (plastic), coronal and root surface restorations

Aspirational

Basic

Conditional

  • Appropriate use of rubber dam.
  • Radiographs appropriate to assess and plan restoration have been selected, justified, taken to excellent standard
    (rating 1)1 and reported on. 
  • Appropriate photographs taken.
  • Full consideration given to prognostic indicators
    (endodontic, periodontic and restorative).
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these.
  • Written diagnosis, rationale for treatment plan and aim of treatment provided to patient.

     

 

 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in
    accordance with current recommendations.2
  • Appropriate health screening.
  • Radiographs appropriate to assess and plan
    restoration have been selected, justified, taken to
    an acceptable standard (≥70% rating 1; <20% rating
    2; <10% rating 3)1 and reported on.
  • Patient informed of complexities and prognostic
    indicators relevant to restoration. 
  • Consideration given to most significant prognostic
    indicators (endodontic, periodontic and restorative).
  • Written treatment plan provided to patient. 
  • Consideration given to preventable disease risk
    indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3 
  • Appropriate materials, equipment and technique
    tailored to suit case.
  • Preservation of tooth structure where possible. 
  • Occlusal harmony sought.
  • No visible plaque-retaining factors caused by
    restoration.
  • Appropriate instruction on care of restoration. 
  • Recalls in accordance with risk status and
    recommended guidelines.4
  • Appropriate material type selection following consultation with patient.

 

  • Appropriate contact points maintained.
  • Appropriate behavioural management technique utilised on journey to achieve oral health.
  • Written consent obtained.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.

2.9 Indirect coronal restorations (crowns, beidges, onlays, veneers)

Aspirational

Basic

Conditional

  • Radiographs appropriate to assess and plan
    restoration have been selected, justified, taken to excellent standard (rating 1)1 and reported on. 
  • Appropriate photographs taken. 
  • For veneers: preparation remains entirely in enamel if possible.
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these.
  • Full consideration given to prognostic indicators (endodontic, periodontic and restorative). 
  • Written diagnosis, rationale for treatment plan and aim of treatment provided to patient. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.2 
  • Appropriate health screening. 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3 
  • Radiographs appropriate to assess and plan restoration have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating
    2; <10% rating 3)1 and reported on. 
  • Consideration given to most significant prognostic indicators (endodontic, periodontic and
    restorative). 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3 
  • Patient informed of complexities and prognostic indicators relevant to indirect coronal restoration. 
  • Written treatment plan provided to patient. 
  • Preservation of tooth tissue. 
  • Adequate form and reduction to suit final
    restoration. 
  • Selection and use of appropriate impression
    material or digital impression technique to suit individual case. 
  • Tooth preparation recorded suitably with
    impression.
  • Sufficient other teeth recorded in impressions. 
  • No damage to teeth adjacent to preparation and un-prepared tooth tissue. 
  • Maintenance of space and gingival health. 
  • Occlusal harmony sought.
  • Appropriate instruction on care of restoration. 
  • Recalls in accordance with risk status and recommended guidelines.4
  • Statement of manufacture retained and offered to
    patient.

 

 

  • Appropriate onward referral. 
  • Appropriate disease management undertaken prior to provision of restoration.
  • Material consideration to suit both aesthetic and functional needs of final restoration. 
  • Appropriate tissue retraction techniques. 
  • Appropriate prescription to dental technician.
  • Appropriate assessment of occlusion.
  • Written consent obtained. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.
  4. NICE. Clinical guideline [CG19]: Dental checks: intervals between oral health reviews. London: NICE; 2004

2.10 Endodontics

Aspirational

Basic

Conditional

  • Radiographs appropriate to management of the endodontic condition have been selected, justified, taken to excellent standard (rating 1)1 and reported on. 
  • Appropriate photographs taken.
  • Full consideration given to prognostic indicators (endodontic, periodontic and restorative). 
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Use of electronic apex locator. 
  • Written diagnosis, rationale for treatment plan and aim of treatment provided to patient. 

 

 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.2
  • Appropriate use of rubber dam. 
  • Primary disease (caries and periodontal diseases) addressed and controlled. 
  • Pain history, sensibility testing and diagnosis. 
  • Sufficient coronal dentine to permit post root treatment restoration. 
  • Radiographs appropriate to management of the endodontic condition have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)1 and reported on. 
  • Extent and severity of endodontic problems documented and patient advised. 
  • Consideration given to most significant prognostic indicators (endodontic, periodontic and restorative). 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3 
  • Written treatment plan provided to patient. 
  • Access cavity appropriate to allow entry into root canal system, preserving as much tooth structure as possible. 
  • Appropriate use of irrigants to reduce bacterial load. 
  • Working length determination. 
  • Appropriate canal obturation. 
  • Appropriate coronal seal. 
  • Recalls in accordance with risk status and recommended guidelines.4

 

  • Appropriate onward referral.
  • Straight line access and use of appropriate burs. 
  • Use of heated techniques to fill the 3D root canal space. 
  • Appropriate canal enlargement to permit flow of irrigants. 
  • Radiographic confirmation of working length.1
  • Root filling which extends to within 2mm of full working length. 
  • Root canal material trimmed back to allow retention of post or core material, leaving at least 3-5mm of apical GP. 
  • Appropriate protection of remaining tooth structure. 
  • Written consent obtained. 
     

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. London: Public Health England; 2017.
  4. NICE. Clinical guideline [CG19]: Dental checks: intervals between oral health reviews. London: NICE; 2004

2.11 Removable partial dentures 

Aspirational

Basic

Conditional

  • Radiographs appropriate to provision of removable partial dentures have been selected, justified, taken to excellent standard (rating 1)2 and reported on. 
  • Appropriate photographs taken. 
  • Full consideration given to prognostic indicators (endodontic, periodontic and restorative). 
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Written diagnosis, rationale for treatment plan and aim of treatment provided to patient. 

 

 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.2 
  • Appropriate health screening. 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3 
  • Radiographs appropriate to provision of removable partial dentures have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)1 and reported on. 
  • Consideration given to most significant prognostic indicators (endodontic, periodontic and restorative). 
  • Patient informed of complexities and prognostic indicators relevant to partial denture construction including any denture-bearing teeth. 
  • Written treatment plan provided to patient. 
  • Denture design undertaken and recorded.
  • Appropriate denture material and design used to suit clinical situation. 
  • Selection and use of appropriate impression material or digital impression technique to suit individual case.
  • Impression records key anatomical structures to allow construction of denture. 
  • Occlusal harmony sought.
  • Denture care and hygiene advice. 
  • Recalls in accordance with risk status and recommended guidelines.4
  • Statement of manufacture retained and offered to patient.

 

  • Appropriate onward referral. 
  • Healthy oral environment achieved prior to construction of dentures. 
  • Denture design to allow optimal hygiene and care. 
  • Written consent obtained. 

 

 

 

 

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.
  4. NICE. Clinical guideline [CG19]: Dental checks: intervals between oral health reviews. London: NICE; 2004

 2.12 Complete dentures

Aspirational

Basic

Conditional

  • Any unstable lower complete dentures retained by a minimum of two dental implants. 
  • Appropriate photographs taken.
  • Written diagnosis, rationale for treatment plan and aim of treatment provided to patient. 
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 

 

 

 

 

 

 

 

  • Valid consent.
  • Medical and socio-behavioural history checked in accordance with current recommendations.1
  • Appropriate health screening and advice, especially with regard to smoking cessation.
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.2
  • Patient informed of complexities and prognostic indicators relevant to complete denture construction.
  • Written treatment plan provided to patient.
  • Selection and use of appropriate impression material or digital impression technique to suit individual case. The impression should record key anatomical structures to allow construction of denture.
  • Occlusal harmony sought.
  • Denture care and hygiene advice.
  • Recalls in accordance with risk status and recommended guidelines.3
  • Statement of manufacture offered to patient.

 

  • Appropriate onward referral.
  • Healthy oral environment achieved prior to provision of dentures.
  • Written consent obtained.
  • Radiographs, where appropriate for provision of complete dentures, have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)4 and reported on.
  • Statement of manufacture, when not accepted by patient, retained by practice for lifetime of device.

 

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  2. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.
  3. NICE. Clinical guideline [CG19]: Dental checks: intervals between oral health reviews. London: NICE; 2004.
  4. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.

 2.13 Oral medicine

Aspirational

Basic

Conditional

  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Rationale for treatment plan and aim of treatment provided to patient. 

 

 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.1
  • Appropriate health screening. 
  • Extra-oral examination including

    - Lymph nodes.
    - Temporomandibular joint palpation.
    - Facial symmetry.
    - Assessment of skin and lips.

  • Intra-oral examination including:
    - Inspection and assessment of all hard and soft tissues.
    - Assessment of changes in saliva.

  • Appropriate initiation of care within the scope of the practitioner. 

  • Written treatment plan provided to patient.

  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3 

 

 

  • Radiographs/scans, where indicated for diagnosis, risk and treatment planning, have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)2 and reported on.
  • Appropriate onward referral for presenting condition.
  • Appropriate onward referral for co-morbid illness that may affect the management. 
  • Two-week referral for any lesions where there is a suspicion of cancer. 
  • Oral-health/systemic-health interactions explained and appropriate advice given to patients with systemic health issues. 
  • Smoking cessation advice given in accordance with guidelines.3
  • Alcohol identification and brief advice given in accordance with guidelines.3,4 
  • Appropriate pain history of orofacial pain, dysaesthesia, paraesthesia and numbness.

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. London: Public Health England; 2017.
  4. NICE. Public health guideline [PH24]: Alcohol-use disorders: prevention. London: NICE; 2010.

 2.14 Minor oral surgery

Aspirational

Basic

Conditional

  • Radiographs appropriate to oral surgical management have been selected, justified, taken to excellent standard (rating 1)1 and reported on.
  • Appropriate photographs taken. 
  • Full consideration given to prognostic indicators (endodontic, periodontic and restorative) prior to extraction. 
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Written diagnosis, rationale for treatment plan and aim of treatment provided to patient.
  • Use of Local Safety Standards for Invasive Procedures (LocSSIPs) for preventing wrong site extraction.2 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.3
  • Appropriate health screening. 
  • Consideration given to all systemic risk factors. 
  • Radiographs appropriate to oral surgical management have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)1 and reported on. 
  • Consideration given to most significant prognostic indicators (endodontic, periodontic and restorative) prior to extraction. 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.4 
  • Written treatment plan provided to patient.
  • No iatrogenic damage to adjacent teeth or structures where possible. 
  • Bone preservation where possible. 
  • Haemostasis achieved. 
  • Post-operative advice and instructions given. 
  • Appropriate analgesic regime established. 
  • Follow up/review appointment if required. 
  • Recalls in accordance with risk status and recommended guidelines.5 

 

 

 

 

  • Treatment plan in accordance with current guidelines.6 
  • Where indicated, antibiotics used in line with FGDP(UK) antimicrobial prescribing guidelines.7 
  • Appropriate behavioural management techniques utilised. 
  • Achieve adequate local anaesthesia.
  • Tooth sectioning as appropriate. 
  • When surgical extraction indicated, flap design allowing adequate access and appropriate bone removal. 
  • Where sedation is used, appropriate protocols and guidelines utilised.
  • Written consent obtained. 
  • Appropriate onward referral.  

 

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Royal College of Surgeons of England. Toolkit for local safety standards for invasive procedures (LocSSIPs) for wrong site extraction in dentistry. London: RCS; 2015.
  3. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  4. Public Health England. Delivering better oral health: an evidence-based toolkit for prevention. London: Public Health England; 2017
  5. NICE. Clinical guideline [CG19]: Dental checks: Intervals between oral health reviews. London: NICE; 2004.
  6. NICE. Technology appraisal guidance [TA1]: Guidance on the extraction of wisdom teeth. London: NICE; 2000.
  7. Faculty of General Dental Practice (UK). Antimicrobial prescribing for general dental practitioners. London: FGDP(UK); 2016.

 2.15 Implantology

Aspirational

Basic

Conditional

  • Full consideration given to prognostic indicators (endodontic, periodontic and restorative). 
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Radiographs/scans appropriate for diagnosis, risk and treatment planning have been selected, justified, taken to excellent standard (rating 1)1 and reported on. 
  • Appropriate photographs taken.
  • Patient-specific document accompanies consent.

 

 

 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.2 
  • Appropriate health screening.
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Radiographs/scans appropriate for diagnosis, risk and treatment planning have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)1 and reported on. 
  • Extent and severity of disease documented and patient advised. 
  • Consideration given to most significant prognostic indicators (endodontic, periodontic and restorative). 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.3
  • Written diagnosis, treatment plan, rationale and aim of treatment provided to patient. 
  • Anatomical and functional factors incorporated in planning and execution of treatment. 
  • Bone augmentation methodology and materials recorded in notes. 
  • Implant specifications recorded. 
  • Statement of manufacture retained and offered to patient. 
  • Appropriate implant maintenance plan tailored to risk profile of patient. 
  • Implant care and hygiene advice. 
  • Oral-health/systemic-health interactions explained and appropriate advice given to patients with systemic health issues. 
  • Appropriate onward referral. 
  • Written consent obtained. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  3. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.

2.16 Management of dental trauma 

Aspirational

Basic

Conditional

  • Radiographs appropriate to management of trauma have been selected, justified, taken to excellent standard (rating 1)1 and reported on. 
  • Aesthetics restored if possible. 
  • Appropriate photographs taken.
  • Written diagnosis, rationale for trauma treatment plan and aim of treatment provided to patient. 
  • Consideration given to all systemic risk factors and evidence that advice has been given to address these. 
  • Consideration given to preventable disease risk indicators and appropriate preventative advice given in accordance with the prevailing guidelines.2 

 

 

 

 

 

 

 

 

 

 

 

 

  • Valid consent. 
  • Medical and socio-behavioural history checked in accordance with current recommendations.3
  • Trauma history checked.
  • Radiographs appropriate to management of trauma have been selected, justified, taken to an acceptable standard (>70% rating 1; <20% rating 2; <10% rating 3)1 and reported on. 
  • Complete clinical examination of all the teeth and surrounding tissues including sensibility status of any affected teeth. 
  • Extent and severity of trauma documented and patient advised. 
  • Appropriate trauma guidelines followed. 
  • Appropriate action taken to stabilise trauma. 
  • Appropriate follow-up plan developed. 

 

 

 

 

 

 

 

 

 

 

 

  • Appropriate onward referral. 
  • Valid consent from parent/guardian. 
  • Structured pain history. 
  • Haemostasis achieved. 
  • Wounds washed and all foreign debris removed. 
  • Anti-tetanus prophylaxis if indicated. 
  • Where indicated antibiotics used in line with FDGP(UK) antimicrobial prescribing guidelines.4 
  • Provision of appropriate splint and dietary advice.
  • Immediate pain relief at initial appointment. 
  • Follow-up appointment. 
  • Consideration of safeguarding issues where there are grounds for suspicion.
  • Written trauma treatment plan provided to patient. 
  • Written consent obtained.

 

 

 

 

  1. Faculty of General Dental Practice (UK). Selection criteria for dental radiography. London: FGDP(UK); 2018.
  2. Public Health England. Delivering better oral health: An evidence-based toolkit for prevention. London: Public Health England; 2017.
  3. Faculty of General Dental Practice (UK). Clinical examination and record-keeping. London: FGDP(UK); 2016.
  4. Faculty of General Dental Practice (UK). Antimicrobial prescribing for general dental practitioners. London: FGDP(UK); 2018.

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