Patients with dental problems

  • Safety

Patients often contact their GP because they have a dental problem. GPs are not able to fully assess and treat dental problems.

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. 

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 practice team should know of local in-hours and out-of-hours dental services that manage urgent and emergency dental conditions so that they can direct patients accordingly. This includes:  

  •  The NHS website 
  •  NHS 111  
  •  Local dental access centres  
  •  Local NHS dentists 

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 

Oral cancer/ pathology

Patients may present oral pathologies including suspected oral cancers to their GP. GP surgeries must be aware of the local arrangements in place for the urgent referral pathway for suspected oral cancer cases. A patient with a non-suspicious oral pathology should be advised to see a dentist for a full examination as soon as possible.