OUT OF HOURS PRESENTATION OF DENTAL EMERGENCIES IN HIGHLAND

1
OUT OF HOURS PRESENTATION OF DENTAL EMERGENCIES
IN HIGHLAND

2
SUMMARY

• Information on patients presenting during a 3
  month period in 1999 for dental
• emergencies (n 141) to the medical and
  dental services in Highland was collected
• Over one half presented to the dental service,
  one third to the hospital A E
• service and one tenth to the out-of-hours
  General Medical service
• Two thirds sought help at weekends with Saturdays
  accounting for 50 of the total
• Over 50 and 80 of presentations to the A E
  department and to the GMS
• service respectively were associated with
  previous attempts to contact the dental service
• Problems encountered by patients in obtaining
  help from dentists were recorded
• Treatment and advice given were recorded
• 50 of patients were actually registered with an
  NHS dentist
• Only half of all patients stating they were
  registered actually were

3
BACKGROUND

• Presentation of dental emergencies is known to
  affect most of the NHS services in Highland
• How much, for what conditions, when and for what
  reason(s), have not been ascertained
• Better understanding of the situation is a
  prerequisite to achieving a coordinated and
  appropriate service for these incidents

4
AIMS

• These were to
• quantify the level of genuine need for emergency
  out of hours service
• assess the quality of service provided e.g.
  proportion
• appropriately managed within 24 hours of
  reporting
• ascertain the registration status of patients
  reporting dental emergencies
• ascertain the reasons why patients report to the
  medical service

5
Scope of the project
Dental medical services covering the
Inverness and Culloden area of Highland
6
Methodology

• Data were collected about all contacts made out
  of hours to the Dental Services and all contacts
  made to the A E department and the GP
  Co-operative
• Three types of data collection sheets were
  designed in collaboration with the various
  services
• Details of all arising cases occurring between
  1st May to 31st July 1999(3 months) were
  collected

7
Main Findings
Presentations by setting
n 141
GP
12
Dentists
A E
54
34
8
Emergencies by setting of presentation and by
gender of patient
Male
Female
150
100
Number of
cases
50
0
Dentists
A E
GP Co-op
All settings
9
(No Transcript)
10
First reporting dental problem by days of the week
70
60
50
40
Number of patients
30
20
10
0
Mon
Tue
Wed
Thu
Fri
Sat
Sun
A E
5
5
4
8
3
14
8
0
3
3
1
2
4
4
Ness Doc
Dentist
4
0
0
0
7
49
15
9
8
7
9
12
67
27
Overall
11
Attempts to seek help from dentists
prior to attending the particular
setting for dental condition
100
80
60
proportion of
attendances
40
20
0
Attending
Attending
Attending
A E
GP
Dentist
24
3
3
Not attempted
Attempted
24
14
73
12
Comments made regarding availability of dentists
by those attending for medical help
13
Registration status of patients reporting
out-of-hours by type of service
100
90
80
70
Lapsed registrations
60
Percentage of patients reporting
50
Not registered
40
Registered
30
20
10
0
presenting to
presenting to
medical services
dental service
14
Registration status as stated by patient
compared with actual
100
90
80
70
60
Not registered
Percentage of patients reporting
50
Registered
40
30
20
10
0
As stated by patient
Actual status
15
Types of advice given by symptom to those who
were not seen and received advice only by dentists
Symptom
Advice Given

• Due to patient not able to travel from Glenelg,
  said
• to contact own GDP in 2-3d if no better
• Painkillers (Ibuprofen) hot salty mouthwash
  to
• find dentist nearer to Elgin (home)
• Check with GP if wished no need for dental
• intervention
• Analgesia dietary advice see GDP ASAP
• Dont bite on it see GDP tomorrow am (Monday)
• If symptoms persist phone back tomorrow am as it
• may be post treatment sensitivity
• No pain so see GDP on Mon/Tues (now Saturday)
• Antibiotics (phoned duty chemist) see own
  dentist

• Pain in palate adjacent to extraction socket
• Impacted tooth
• 8 year old had GA for extraction and was sick
• 7 year old with abscess
• Dressing on fractured tooth fallen out no pain
• Post filling pain hours later
• Filling knocked out
• Severe pain with abscess own GDP had seen

16
6
17
Types of treatment given by AE by mutually
exclusive categories


Treatment

Nos. of patients

of total patients treated

analgesics only

15

42

ant
ibiotics only

9

25

analgesics antibiotics

6

16

suture of sockets

1

3

irrigation drainage of dental abscess

1

3

teeth re
-
implanted splinted

1

3

examination only

1

3

other combined

2

5

Total
36
100.0




Types of treatment given by Ness Doc by mutually
exclusive categories



Treatment given (not mutually
Nos. of patients

of total patients treated

exclusive)

analgesia only

5

42

antibiotics analgesia

4

33

antibiotics only

2

17

unspecified

1

8

total

12

100