The Scottish Government

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Annex A
General information about dentistry

NHS and private dental services provided in Scotland

A range of options for treatment may be possible for any given situation. Under the NHS or privately, your treatment should be provided:

• to a good clinical standard;
• in your best interests; and
• safely.

Private care may offer more treatment choices and some treatment options that are not available within the NHS.

If you are a registered NHS dental patient, your dentist is required under their contract with the NHS to offer to provide items of treatment which are necessary to secure and maintain your oral health and are listed on the Statement of Dental Remuneration ( SDR). Under this system, there are some limitations on dental materials and types of laboratory work that can be used and the dental treatments that can be provided.

Some dental treatments that are unlisted may be valid options for you to consider (for example, cosmetic treatments such as tooth-coloured fillings in back teeth, tooth-coloured crowns on molars or dental implants). Your own dentist may be able to provide these privately. If not, they may refer you to another practice which does provide this care (a wholly private practice, mixed NHS and private practice, or specialist practice). Dentists are only required to provide treatment that they are competent to carry out.

How to get primary care dentistry

You can choose which dentist, either NHS or private, you want to attend for your regular dental visits. You can also choose to move to another dental service. The decision to accept new patients is at the discretion of the dental service.

Each local NHS Board is responsible for providing NHS dental services in its own area. For different reasons, the maximum number of patients that can be seen or treated can vary from one dental service to another. This may result in a dental service closing its list to new patients.

At present, an increasing number of dentists are reducing or stopping NHS general dental services for adults. If this happens at your dental service, the dental team will tell you. If your existing NHS dental services close down, the NHS Board will provide you with a list of NHS dental services in your area, or may in some cases advise you where alternative arrangements are available.

The relationship between primary dental care, secondary care and specialist services

Primary care dentists will provide routine dental care and treatment. Some primary care dentists develop particular skills so that they can do more specialist treatments within the service. For some more complex or specialist treatments that your own dentist does not carry out (for example, orthodontics), you may be referred to a specialist in another dental service or a hospital (secondary care). Dentists who advertise their services as a specialist must be registered as a specialist by the General Dental Council.

Looking after your own oral health

What are your responsibilities?

• You should take an active role in developing a treatment plan that you are happy with. Sometimes the 'ideal' treatment is not possible, due to health, special needs, co-operation difficulties or costs. To understand this, the people involved must know and agree when the 'ideal' treatment is not possible.
• Good treatment will depend on you co-operating in attending appointments, having treatment done and following advice.
• It is important that you let your dentist know of any changes to your general state of health or medication that may effect the treatment you receive.
• Dental diseases such as tooth decay and gum disease are largely preventable. With advice and encouragement from the dental team, you have an important role in improving your own oral and dental health.
• It is important that you understand and follow any advice and instructions the dental team gives you in relation to controlling infection.
• For patients who are very young or who have special needs, a carer may need to be responsible for home care routines such as toothbrushing or denture hygiene.

Preventing oral health problems

• Dental decay is a process which starts with food debris and bacteria gathering on teeth to form 'plaque'. Bacteria in the plaque use sugar from the diet to produce acid that destroys teeth. This results in dental decay (dental caries). You can reduce the disease by twice-daily toothbrushing with fluoride toothpaste and having less sugar, less often. Limiting intake of acidic drinks is also important to prevent erosion (excessive wear) of the teeth.
• Gum disease is the process where plaque bacteria cause damage to the gums and bone that support the teeth. There are two main gum diseases, called gingivitis and periodontitis. Some people are more likely to get these diseases, but good toothbrushing, cleaning between the teeth with floss, visits to the dentist or hygienist for scaling, and not smoking will help prevent them.
• Oral cancer is cancer of the mouth, jaws or surrounding areas. There are about 500 new cases of the disease in Scotland per year. The dental team has an important role in finding problems early and improving the outcome for patients. They will also give advice on stopping smoking and cutting down on alcohol, which are the main causes of oral cancer.
• 18% of adult Scots have no remaining natural teeth. The majority of those wear dentures to replace their missing teeth and some have implants to help improve stability of dentures or to support replacement teeth. For this group of patients, it is important to have a check-up at least once a year to check for oral cancer, signs of infection and other diseases and conditions which can affect patients who have no natural teeth.
• Monitoring surveys between 1988 and 2003 have confirmed the poor health of Scotland's school children. At the age of 5, over 56% of all Scottish children have dental disease. By the time they are 14 yrs, 68% of children have suffered from dental caries in their adult teeth. Dental disease can also be one of the signs of more general poor health and well-being. The Scottish Executive has set out a raft of proposals for improving the oral health of children and young people and has set a target of achieving, by 2010, 60% of children (a) at age 5 and (b) 11-12 year olds with no signs of dental disease. This will be monitored through the National Dental Inspection Programme. Improvements in oral and dental health and services for children are addressed through local inter-agency planning which includes the local NHS Board's Integrated Children's Services Planning Arrangements.

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