Figures from the Health and Social Care Information Centre show that half of adults and 40% of children have not visited the dentist in the past two years. Given this statistic, it is perhaps not surprising that GPs are seeing more patients presenting with dental problems.
Research suggests that 600,000 patients a year see their GPs with dental problems, instead of a dental professional. The British Dental Association says this trend is caused by dental charges, which mean patients often get advice on emergency dental problems, such as toothache or abscesses from a GP, even though the BDA says doctors are ‘unequipped to provide dental treatment’.
If a patient asks you for help with a dental problem, there are some medico-legal issues to bear in mind.
GPs have an ethical responsibility to offer help in an emergency, which could include providing medical treatment, for example where the patient requires urgent treatment for pain or sepsis, even where the underlying cause might be a dental problem.
This duty is set out in paragraph 26 of the GMC’s Good Medical Practice which adds that doctors providing assistance in emergencies should take account of their own safety, be aware of the limits of their competence and consider the availability of other options for care.
From a legal perspective, the Dentists Act 1984 restricts the practice of dentistry to registered dental professionals and those in training. This means that, unless dually qualified and appropriately registered with the General Dental Council, GPs are not able to treat dental conditions, but they can provide urgent and necessary medical treatment if the patient is not able to contact a dentist.
It would be inappropriate for a doctor to attempt to manage a condition requiring dental skills. But as with any consultation, it is important to keep a record of any treatment provided to the patient and the advice offered. GPs should also be aware of relevant guidance such as the NICE clinical knowledge summary on managing dental abscesses in primary care.
The BMA’s recently updated guidance on patients presenting with possible dental problems advises GP and practice teams to be ‘aware of in hours and out-of-hours dental services available locally to manage urgent and emergency dental conditions.’ This can include NHS Choices, NHS 111, local dental access centres and local NHS dentists, but arrangements vary locally, the BMA explains.
If a complaint or claim arises from the emergency treatment provided by a GP to manage a dental problem, the doctor can ask for support from their medical defence organisation. Take the following example of a fictitious case, based on the types of queries raised by MDU members:
A woman in her 40s saw her GP complaining of a severe pain in her mouth, a fever and facial swelling. The GP examined the patient’s mouth and found what appeared to be a severe dental abscess.
The GP asked the patient if she had a dentist that she could make an urgent appointment with, but the patient explained that she hadn’t been to the dentist for a number of years as she had a dental phobia. The patient said that she also struggled to afford the cost of dental treatment and asked the GP if he couldn’t prescribe some antibiotics and painkillers which she felt would clear the problem up.
The GP rang the MDU for advice and the adviser explained that, while the GP could provide any emergency treatment he thought was immediately necessary, he should also explain to the patient that he was not a qualified dentist and was unable to provide dental treatment.
The GP explained to the patient that it would be in her best interests to be seen by a dental professional and that legally and ethically, he couldn’t provide dental treatment as he wasn’t qualified to do so. He offered to arrange to contact the local dental access centre on the patient’s behalf which she accepted and arrangements were made for her to be seen urgently by an NHS dentist.
- Dr Sissy Frank is a medico-legal adviser at the MDU