Provision of specialist‐led minor oral surgery service in Scottish NHS dental practices – analysis of benefits and costs

Abstract

This article evaluates the benefits of specialist-led minor oral surgery service in Scottish primary care dental practice. Objectives: The aims of the study were to: 1 Study practice-based minor oral surgery service delivery. 2 Estimate waiting times for these patients. 3 Explore complications. 4 Evaluate cost allocated for procedures in minor oral surgery in primary and secondary sector. Materials and Methods: Retrospective analysis of procedures carried out, waiting times, complications and comparative cost in minor oral surgery from two NHS dental practices located in Lothian health board area. Results: A total of 1896 procedures in 982 patients having minor oral surgery were analysed across two sites. Of procedures, 51% (971) were simple extractions; 31% (580) of the procedures were surgical removal of non-third molar teeth; 15% (275) of the procedures were surgical extraction of third molars; and 3% (70) of the procedures were complex procedures such as surgical exposure of canines, removal of simple cysts and closure of oroantral communication. Two hundred and nine procedures were carried out under intravenous sedation. It was difficult to estimate waiting times although all patients were treated within 4 weeks. The overall complication rate was 8.1%. There is a considerable difference in cost allocated to similar procedures in primary and secondary care and the money allocated for carrying out minor oral surgery in primary care is not cost neutral. Conclusions: It is cost efficient to treat minor oral surgery patients in primary care. Like for like procedures in minor oral surgery are expensive and potentially wait longer before receiving treatment in secondary care. Clinical RelevanceOral Surgery practice is multifaceted and a significant amount of its clinical activity can be safely carried out in a primary care setting. We analysed the procedures delivered in two Scottish NHS dental practices and studied the wait times and complications. We evaluated the cost differential between similar procedures in a Scottish primary and secondary care setting. The proposed model of delivery of minor oral surgery in Scottish primary care appears useful and needs further evaluation.

An Evaluation of A Practice-Based Minor Oral Surgery Service

“…2018;7(3): [30][31][32][33][34][35][36][37] Existing UK data from oral surgery services based in primary care report acceptable referral systems, better accessibility, shorter waiting times and lower costs than those provided in hospital services, yet with comparable outcomes. [8][9][10][11][12][13] However, with few exceptions, previous evaluations have been narrow in focus and assessed certain aspects of the quality of care and undertaken before the publication of recent commissioning guidance. 4 Service evaluations can take a range of forms, 14 but they broadly assess whether the aims of a service are being met and analyse the reasons for any discrepancies.…”