Treating patients with dental problems: advice for GPs

As dental practices were forced to close in response to the first wave of the COVID-19 pandemic, we're aware that GPs have received more requests from patients about dental care.

Dental practices were instructed to close between March and June 2020 and asked to defer routine, non-urgent dental care to limit the transmission of COVID-19. This has meant a significant number of patients will not have been seen by their dentists in 2020.

According to NHS Digital statistics published in 2020, over half of adults have not been seen for NHS dental treatment in the last two years and 47% of children have not been seen for NHS dental treatment in the last year. Analysis of the data acknowledges the decline in patients visiting dentists, as well as a steep decline in patient numbers at the same time as the shutdown of dental practices.

If a patient asks you for help with a dental problem, consider the following medico-legal issues.

Your ethical responsibility

GPs have an ethical responsibility to offer help in an emergency. This can include providing medical treatment for patients requiring urgent treatment, such as for pain or sepsis, even if the underlying cause might be a dental problem.

The GMC advises that when providing emergency assistance, you must 'take into account your own safety, your competence and the availability of other options for care'.

Under the Dentists Act 1984, dentistry practice is restricted to registered dental professionals and those in training. While GPs are not able to treat dental conditions, they can provide urgent and necessary medical treatment if the patient is not able to contact a dentist.

As with any consultation, it's important to keep a record of any treatment and advice you provide to the patient.

You should also be aware of relevant guidance, such as the NICE clinical knowledge summary on managing dental abscesses in primary care.

BMA guidance

The BMA advises GPs and practice staff to be 'aware of in-hours and out-of-hours dental services available locally to manage urgent and emergency dental conditions'. This includes NHS Choices, NHS 111, local dental access centres and local NHS dentists (arrangements vary locally).

Case scenario

A woman in her 40s attended 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. The MDU medico-legal 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.

This page was correct at publication on 17/12/2020. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.