Treatment outcomes in a community outreach project for paediatric dentistry

Referrals for paediatric dentistry from the general dental services (GDS) to specialist services within the Birmingham Dental Hospital, UK, have increased in recent years. The reasons for referral are not always clear and sometimes inappropriate. A pilot project was undertaken to assess patients in a community, rather than hospital setting and arrange appropriate treatment pathways. Initial findings suggested that a high proportion of the patients were suitable for treatment by non-specialists. Objectives: To evaluate the appropriateness of a primary care setting for patients referred to a specialist paediatric service. Method: Patient record analysis was undertaken for all patients referred from an initial assessment appointment to the Salaried Primary Care Dental Service (SPCDS) and treatment outcomes assessed. Results: A total of 139 patients were assessed, of which 90 (65%) were suitable for a follow-up appointment in the Birmingham SPCDS. Anxiety was cited as a reason for referral in 52 cases (63%). However, only 16 children required treatment under relative analgesia (RA) and 6 required a general anaesthetic appointment. Of 17 children specifically referred for RA, in fact only 7 required it. Seventy-one percent of patients completed one course of treatment and 21% returned for a further course. However, more than 80% of the children failed or cancelled at least one appointment during their treatment. On completion of treatment, almost a quarter (24%) was referred back to their general dental practitioner (GDP). However, a further 23% preferred to receive ongoing care in the SPCDS. Conclusion: Non-specialists working in a salaried primary dental care setting were able to treat the majority of patients referred by GDPs for specialist paediatric dentistry, in this study. Time and service flexibility appear to be important factors in ensuring successful treatment outcomes for anxious child patients. Supported by South Birmingham and Heart of Birmingham Teaching PCTs