Treatment for Dental Problems

A common query from practices is whether they can or should provide treatment to a patient with a dental problem.

Treating patients with dental problems is not a GP responsibility, even if a patient is not registered with a dentist because:

1. GPs are not trained to deal with dental issues, and
2. Dental treatment is not a contractual requirement.
3. There is a legal restriction on who can provide dental care.

If a patient presents with a toothache or other dental issue they should be advised to contact their local dentist or NHS 111 if their usual dental surgery is closed or they are not registered with a dentist.

The Dentists Act 1984 bars anyone who is not a registered dentists or dental care practitioner from practicing dentistry which is defined as “to include the performance of any such operation and the giving of any such treatment, advice or attendance as is usually performed or given by dentists; and any person who performs any operation or gives any treatment, advice or attendance on or to any person as preparatory to or for the purpose of or in connection with the fitting, insertion or fixing of dentures, artificial teeth or other dental appliances shall be deemed to have practised dentistry within the meaning of this Act.”

There is a caveat that allows registered medical professionals to carry out a medical task for which they are qualified to do so.

So, for the majority (if not all) GPs it would be unlawful for them to provide any treatment for a patient with a dental problem, and “shall be liable on summary conviction to a fine not exceeding the fifth level on the standard scale.”

This would not apply to resuscitation of a collapsed patient or assessment of a patient with systemic symptoms.

BMA guidance states that:
“GPs should not attempt to manage a condition requiring dental skills unless they have the appropriate training and expertise. Both the civil courts and the GMC require doctors to have appropriate skills for any treatment they offer.”

If a GP chooses to treat a patient for dental problems, they should be aware of their legal and contractual obligations.

If refusing to treat a patient for a dental issue, BMA guidance (September 2020) states:

• Before refusing to treat a patient asking for emergency dental treatment, a GP must ascertain that the condition requires only dental treatment. Primary care teams must put themselves in a position to judge the nature of the patient’s condition by undertaking reasonable enquiries, and where appropriate a clinical assessment.
• Having established an apparent dental problem, GPs or practice teams should signpost to a dentist or local emergency service or if they feel necessary refer a patient to secondary care for any further assessment and treatment.
• Everyone in the practice team must do their best to ensure the patient doesn’t need the attention of a GP when signposting.
• If the patient has no usual dentist, or there is no response from the usual dentist, the patient should contact the local NHS 111 service.
• Patients presenting with signs of spreading infection or systemic involvement of a dental infection should be referred immediately to secondary care for appropriate surgical management. Signs and symptoms of this may include diffuse or severe facial swelling, trismus, dysphagia, fever or malaise.
• The GP’s obligation to refer is set out in the GMS and PMS regulations