Clinical Guidelines — Royal College of Surgeons (2024)

The following documents have been produced by the Faculty's Clinical Standards Committee. Guidelines produced by individual specialty societies, which the Committee has subsequently endorsed are available below.

2024

  • Management of painful Temporomandibular disorder in adults NHS England Getting It Right First Time (GIRFT) and Royal College of Surgeons of England’s Faculty of Dental Surgery.
    by Beecroft E, Palmer J, Penlington C, Avery L, Aggarwal V, Chase M, Davies S, Gerber B, Jagger R, Harrison S, Horton M, Jones L, Kalantzis A, Lie S, McKenna G, McMillan R,Morton M, Murphy E,Renton T, Thayer T, Weden A, Durham J
  1. Patient support document
  2. Clinician summary document
  3. Printable A3 care pathway flowchart

Temporomandibular (TMD) is a common condition that affects the jaw joints and or the muscles around the jaw. Within the guidelines and suggested care pathway there are three questionnaires recommended to help screen for TMD (3Q/TMD), assess the level of psychosocial distress (Patient Health Questionnaire 4, PHQ-4), and assess baseline and post-treatment pain intensity (Characteristic Pain Intensity, CPI). To make it easier for patients and healthcare practitioners the guideline development group chair had these coded to create online calculators that patients can complete and show the results to their healthcare practitioner. The code is open source for these calculators and if healthcare professionals would like to use this on their practice websites it can be provided upon request.

Access the TMD guidelines online calculator.

2023

  • Guideline for the Extraction of First Permanent Molas in Children
    by Noar J, Taylor G, Ashley P, Williams A, Harrison M, Cobourne M

2022

  • Management of the Palatally Ectopic Maxillary Canine
    by Husain J, Burden D, McSherry P, Hania M
  • Management of Unerupted Maxillary Incisors
    by Yaqoob O, O’Neill J, Patel S et al
    (Update of 1997 Guideline written by Burden D, Harper C, Mitchell L et al, previously updated in 2010 and 2016 by Yaqoob O, O’Neill J, Gregg T et al)

2021

  • Clinical guidelines for dental erosion
    by O’Sullivan E, Toor I, Brown L, Watkins S
  • Guidelines for the management of trigeminal neuralgia
    by McMillan R, Zakrzewska J, Bahra A, Beecroft E, Besi E, Chong S, Hale A, Durham J, Etherington C, Kitchen N, Lloyd T, Maidment Y, Phillips N, Praveen P, Sharma M, Stamatis L, Tate A, Thorne L

2020

  • Parameters of care for patients undergoing mandibular third molar surgery
    by Renton T, Coulthard P, Chiu G, Master S, Brookes V, Atack N, Weston P, Drage N, Dewan K, Bishop K, Odell E, Smith S, produced by FDS
  • Antimicrobial Prescribing in Dentistry: Good Practice Guidelines, 3rd Edition
    edited by Nikolaus O Palmer, produced jointly by FDS and FGDP
  • Guidelines for Periradicular Surgery
    by Qualtrough A, Alani A, Bandheri S, Mehta D. Ng Y, Saksena A, Tomson P, created in collaboration with the British Endodontic Society

Archived Guidelines

These guidelines are presented for historical and reference purposes.

Publication year Title
2012 Guidelines for Selecting Appropriate Patients to Receive Treatment with Dental Implants: Priorities for the NHS
by A.Alani, K.Bishop, S.Djemal et al
(Update of the 1997 Guideline)
2008 Consent and The Use Of Physical Intervention In The Dental Care Of Children
by J.Nunn, M.Foster, S.Master et al
A more up-to-date version is available on the BSPD website.
2008 Guideline for the Use of General Anaesthesia (GA) in Paediatric Dentistry
by C.Davies, M Harrison and G.Roberts
This has been partically superseded byGuidelines For The Management Of Children Referred For Dental Extraction Under General Anaesthesia (August 2011) available on the BSPD website.
2006 Pulp Therapy for Primary Molars
by H.D.Rodd, P.J.Waterhouse, A.B.f*cks et al
2006 Extraction Of Primary Teeth - Balance And Compensation
by Faculty Working Party
(2001 guideline, reviewed 2006, unchanged)
2004 Treatment of Intrinsic Discoloration in Permanent Anterior Teeth in Children and Adolescents (2004 revision)
by A.Wray & R.Welbury
(update of 2000 guideline)
A more up-to-date version is available on the BSPD website.
2004 The Management of Patients with Third Molar Teeth
by Faculty Working Party
(1997 guideline, reviewed 2004, unchanged, now currently under review once more)
2002 Managing Anxious Children: the Use of Conscious Sedation in Paediatric Dentistry
by M.T.Hosey
2002 Non-Pharmalogical Behaviour Management
by B.Chadwick
A more up-to-date version is available on the BSPD website.
2001 Restorative Dentistry: Index of Treatment Need - Complexity Assessment
1999 Paediatric Dentistry UK: National Clinical Guidelines and Policy Documents 1999 - Part A
1999

Paediatric Dentistry UK: National Clinical Guidelines and Policy Documents 1999 - Part C

Contains the following:

‘Paediatric Dentistry Clinical Guidelines’ - RCS Approved (i.e. multidisciplinary FDS of the Royal College of Surgeons of England approved guidelines already published in International Journal of Paediatric Dentistry

  • ‘Treatment of Avulsed Permanent Teeth in Children’ (revised 2004, see above)
  • ‘Treatment of Traumatically Intruded Permanent Incisor Teeth in Children’ (revised 2004, and 2009, a more up-to-date version is now available on the BSPD website.)
  • ‘Continuing Oral Care - Review and Recall’ (reviewed 2004 - see above)
1997

National Clinical Guidelines 1997
by B.Avery, J.S.Brown, J.L.B.Carter, A.M.Corrigan, R.Haskell, P.J.Leopard, J.L.Williams, R.A.Loukota, J.Lowry, J.McManners, D.Mitchell, J.Pedlar, D.Shepherd, G.Taylor, N.Whear, J.K.Williams & S.F.Worrall

This document contains clinical guidelines for five of the dental specialties as follows:

Oral and maxillofacial surgery

Orthodontics

  • Management of the Palatally Ectopic Maxillary Canine (new version 2010 above)
  • Management of Unerupted Maxillary Incisors (new version 2010 above)

Paediatric dentistry

  • Prevention of Dental Caries in Children (reviewed 2004, and then superseded in July 2007 by SIGN Publication No. 47 entitled Preventing Dental Caries in Children at High Caries Risk - Targeted prevention of dental caries in the permanent teeth of 6-16 year olds presenting for dental care.)superseded by sign 138 titledDental interventions to prevent caries in children
  • Treatment of Avulsed Permanent Teeth in Children (reviewed 2004)
  • Treatment of Traumatically Intruded Permanent Incisor Teeth in Children (reviewed 2004 and then superseded in October 2009 by a revised version available above)
  • Continuing Oral Care - Review and Recall (reviewed 2001 , and then superseded in October 2004)

Restorative dentistry

  • Screening of Patients to Detect Periodontal Diseases
  • Guidelines for Selecting Appropriate Patients to Receive Treatment with Dental - Implants: Priorities for the NHS (superseded in October 2012 by a revised version, available above)
  • Restorative Indications for Porcelain Veneer Restorations (currently under review)

Dental public health

Turning Clinical Guidelines into Effective Commissioning

  • Management of Patients with Impacted Third Molar Teeth (reviewed 2004, currently under review once more)
  • Management of Pericoronitis (reviewed 2004)
  • Management and Prevention of Dry Socket (reviewed 2004)
  • Management of Unilateral Fractures of the Condyle (reviewed 2000)

Recommended Guidelines from the Specialty Societies

The above guidelines have all been produced under the auspices of the Faculty's Clinical Standards Committee with full input from and consultation with each of the individual dental specialties on that Committee. The Faculty also approves individual specialty specific guidelines produced by the specialty societies.

The British Society of Periodontology's Guidance on the Basic Periodontal Examination(PDF)

The British Society for Restorative Dentistry's Guidance on Crowns, Fixed Bridges and Dental Implants (PDF)

RD-UK (Restorative Dentistry UK)'s Guidance on Predicting and managing oral and dental complications of surgical and non-surgical treatment for head and neck cancer (PDF)

The British Endodontic Society guide to good Endodontic Practice(PDF)

Also recommended

The Scottish Dental Clinical Effectiveness Programme (SDCEP) has recently published the second edition of its NICE accredited Prevention and Treatment of Periodontal Diseases in Primary Care guidance. The updated guidance is based on the best available evidence and bringstogether the latest advice on periodontal disease classification and treatment within one resource. The guidance provides clear and practical recommendations and advice toenable the dental team to manage the periodontal health of all their patients, including those who are healthy and those who have a diagnosis of gingivitis or periodontitis.For the first time the full guidance is provided within a dedicated website to enable navigation, accessibility and updating. A summary, a downloadable version and a variety of tools to support implementation of the guidance are provided. A news item about this publication is available onNES website. RCS England support for the guidance is noted on guidance website.

GIRFT guidance to standardise and improve coding for hospital dentistry specialties

Detailed guidance to help standardise and improve outpatient coding across four hospital dentistry specialties is available from Getting It Right First Time (GIRFT), working in close collaboration with the Faculty of Dental Surgery of the Royal College of Surgeons. The new guides for outpatient activity coding coverorthodontics,paediatric dentistry,oral surgeryand restorative dentistryand aim to better capture consistent and accurate coded data for dental interventions, leading to a more meaningful comparison of activity across outpatient, day case and inpatient settings. The guidance delivers on a recommendation inGIRFT’s national report for hospital dentistry (2021)which highlighted how poorly defined treatment codes made it difficult to identify variation in clinical outcomes. The report recommended a wider coding review to ensure accurate recording of treatment to measure outcomes, assure quality and support workforce planning and service improvement. GIRFT formed working parties with the Faculty of Dental Surgery of the Royal College of Surgeons, as well as the British Orthodontic Society (including Consultant Orthodontist Group), British Society of Paediatric Dentistry and Restorative Dentistry UK, to look at the codes commonly used and to agree standardised and recommended OPCS-4 procedure codes. The resulting guidance documents should be used by dentists and others involved with capturing OPCS-4 procedure codes for dental procedures in an outpatient setting, with the aim that the improved data will input into care quality metrics, support service design and visibility of activity, help understand rates of specialised care, and support future commissioning. GIRFT’s 2021 national report was led by orthodontist Liz Jones, who visited 106 hospital dental departments and units as part of her review of services. She said: “It is important that all consultants and their teams follow this guidance and use the codes as suggested in this booklet. This, in turn, will help us to drive the changes required and ensure ongoing improvement in the quality of specialist dental care we provide.”

Paediatric Dentistry

The Office of The Chief Dental Officer has published revised Paediatric Dentistry.The document details the clinical standards for paediatric dental treatment in primary, community and specialist care settings. The document defines the NHS England minimum clinical standards and dental care pathway for children and young people (CYP) that all providers of paediatric dental services must adhere to.

Clinical standard for Oral Medicine

The Office of The Chief Dental Officer has published a revised Clinical Standard for Oral Medicine.The document is intended as a guide for the specialist in Oral Medicine services. Oral Medicine is the specialty of dentistry concerned with the care of children and adults with a diagnosis of chronic, and recurrent medically related disorders of the mouth, face and jaws. The specialty of Oral Medicine involves the diagnosis and non-surgical management of those patients.

Oral SurgeryClinical Standard

The Office of The Chief Dental Officer has published a revised Oral Surgery Clinical Standard.The standard sets out a framework for local work and is primarily designed to support NHS England commissioning teams to work with dental professionals locally and with the Managed Clinical Networks (MCNs).

The Faculty of Dental Surgery of the Royal College of Surgeons of England is pleased to endorse the Clinical guidelines for sustainability in dentistry. The aims of the guidelines are to:

  • Raise awareness and understanding of the environmental effects of oral health care across the dental profession and the public
  • Provide direction to the profession on how they might manage change to their practice to provide environmentally sustainable dental health care
  • Reduce levels of carbon emissions, especially emissions resulting from patient and staff transportation.

Endorsed by all four of the Royal Surgical Colleges, the new 2014edition of Good Surgical Practice is recommended to all surgeons. Guidelines For The Prevention Of Endocarditis: Report Of The Working Party Of The British Society For Antimicrobial Chemotherapy: published in April 2006, this document is the result of a wide ranging consultation process and is, as far as possible, evidence-based. In addition, the Faculty of Dental Surgery is making available for download aPatient Information Sheetapproved by the BSAC working party.

COPC Frailty Guidelines were launched on 30 October 2021, co-written by the COPIC and British Geriatrics Society. They cover the perioperative journey of a patient and are very relevant for all hospital-based specialties.

  • Guideline
  • Guideline infographic
  • Guideline launch

Related guidelines

The Faculty of General Dental Practice publishes its own guidelines.

Clinical audit

The Clinical Effectiveness Committee has also produced a document which deals with the process of the audit itself. 'Methodologies for Clinical Audit in Dentistry' is designed to encourage and improve the audit process at the local level.

By focusing on particular cases, it looks at how the audit process has led to improvements in services and better patient care, and it is hoped that others will be stimulated to carry out their own audit programmes.

Dr Jacqueline Dutchak, director of the National Collaborating Centre for Acute Care, gave a presentation in January 2004 on the 'Development of Clinical Practice Guidelines for the NHS'

Updated SDCEP Anticoagulants and Antiplatelet Drugs dental guidance published March 2022

The Scottish Dental Clinical Effectiveness Programme (SDCEP) has published a second edition of its Management of Dental Patients Taking Anticoagulants or Antiplatelet Drugs guidance. This guidance aims to provide clear and practical recommendations and advice to enable the dental team to manage and treat this patient group and covers assessment of bleeding risk, treatment planning and management of dental patients taking the various types of medication. The guidance is aimed primarily at members of the dental profession but also has relevance for medical and pharmacy professionals who prescribe and dispense anticoagulants or antiplatelet drugs. The full version of the guidance, together with a summary ‘Quick Reference Guide’ and information for patients, can be accessed via the SDCEP website.

Clinical Guidelines — Royal College of Surgeons (2024)
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