An eReferral Management & Triage System for minor Oral surgery referrals from primary care dentists: a cost-effectiveness evaluation

Objective Oral surgery referrals from NHS dental practices are rising, increasing the pressures on available hospital resources. We assess if an electronic referral system with consultant or peer (general dental practitioner) led triage of patient referrals from general dental practices can effectively divert patients requiring minor oral surgery into specialist led primary care settings at a reduced cost whilst providing care of the same or enhanced quality. One year of no triage (all referrals treated in secondary care) was followed by one-year of consultant led triage, which in turn was followed by year of peer-led triage. Method A health economic evaluation of all patient referrals from 27 UK dental practices for oral surgery procedures. The follow-up is over a three-year period at hospital dental services in two general hospitals, one dental hospital, and a single specialist oral surgeon based in two primary care practices. The evaluation is a comparison of mean outcomes in the hospitals and in specialist primary care dental services between the study periods (i.e. periods with and without the triage system). The main outcomes of interest are mean NHS cost saving per referral (costs to the NHS and costs to broader society), proportion of diverted referrals, case-mix of referrals and patient reports of the quality of dentistry services received at their referral destination. Results The proportion of referrals diverted to specialist primary care was similar during both periods (45% under consultant-led triage and 43% under GDP-led triage). Statistically significant savings per referral diverted were found (£116.11 under consultant-led triage, £90.25 under GDP-led triage). There were no statistically significant changes in the case-mix of referrals. Cost savings varied according to the coding (and hence tariff) of referred cases by the provider hospitals. Patients reported similarly high levels of satisfaction scores for treatment in specialist primary care and secondary care settings. Conclusions Implementation of electronic referral management in primary care, when combined with triage, led to appropriate diversions to specialist primary care. Although cost savings were realised by referral diversion these savings are dependent on the particular tariff allocation (coding) practices of provider hospitals.

Management of Impacted Third Molars

Third molar impactions is one of the commonest minor oral surgical procedures in the realm of the oral and maxillofacial surgeon. Many basic principles of minor oral surgery have to be applied in a logical manner to attain a good healing. The assessment, clinical and radiographic evaluation plays an important role in selecting the right technique to ensure good results. This chapter aims to go through the basics of third molar impactions in a sequential way to guide the clinician to take the right decisions.

Prevalence of systemic diseases in patients undergoing minor oral surgeries

It is of interest to evaluate the prevalence of systemic disorders in patients undergoing minor oral surgeries at a dental hospital. This will help to take necessary precautions prior to oral surgeries. We used the digital case records of 1288 patients who underwent minor oral surgeries in a hospital. Demographic details and systemic diseases of the patients were recorded from digital case records. Data shows that 103 patients (7.9%) of the total number of patients undergoing minor oral surgeries had systemic diseases with 3.8% of patients diagnosed with diabetes. Statistically significant associations were found between type of minor oral surgery and the type of systemic disease (p<0.001); age of patients and type of minor oral surgery (p<0.001); age and type of systemic diseases (p<0.001) and gender of patient and type of minor oral surgery (p = 0.005). Thus, data shows the prevalence of systemic diseases in patients undergoing minor oral surgeries was 7.9%.

Minor Oral Surgery and Dental Extraction Procedures Management of Patients with Antithrombotic Drugs Administration

Patients who are undergoing antithrombotic drugs therapy whether it was alone or in combination can increase the bleeding complications after performed minor oral surgery or tooth extraction. If the termination of using antithrombotic drugs to prevent bleeding isn’t right, it’ll trigger thrombosis. Therefore appropriate consideration is needed in the management of patients undergoing antithrombotic drug therapy that requires minor oral surgery or dental extraction. The purpose of this literature review is to examine management of minor oral surgery and dental extraction procedure in patients with antithrombotic drugs. Management of minor oral surgical procedures and tooth extraction in patients using antithrombotic drugs must be adjusted to the type of antithrombotic drugs used by the patient. Patients who use antithrombotic drugs are advised to undergo minor oral surgery or tooth extraction treatment in the morning or on weekends. Local hemostatic agent has been shown to be effective to stop bleeding locally on minor oral surgical procedure or tooth extraction in patients undergoing antithrombotic drug therapy alone or in combination.