Does the Referral and Selection for NHS-Funded Dental Implant Treatment in the UK Follow National Guidelines?

Abstract

The Royal College of Surgeons of England (RCSE) has provided a national guideline document detailing specific selection criteria for National Health Service (NHS) dental implant therapy in the UK. The aim of this study was to investigate whether these guidelines are being observed both in the referral and selection of patients. Information was collected prospectively from 8 consecutive implant assessment clinics at Guy's and St Thomas' Hospital Trust over a 6-month period, via a questionnaire concerning the reason for referral for implant treatment, dental/smoking/radiotherapy status, and the consultant decision on whether an application would be made for NHS implant funding. Of the 103 referred patients who attended the appointment, 83 (80.6%) fell within the established priority groups for NHS implant therapy: in particular, hypodontia and teeth lost through trauma. However, up to a quarter of patients had untreated caries or periodontitis (n = 23, 22.3% and n = 26, 25.2%, respectively), a contra-indication for NHS implant therapy. The proportion of patients with caries was more than double for general dental practitioner-referred (28.3%) than hospital-referred subjects (12.5%) with the difference approaching statistical significance (P = 0.061). Selection for implant funding application was highly dependent on whether or not a patient belonged to a priority group of the national guidelines (P < 0.001). Although in most respects there is good adherence to the RCSE national guidelines both in the referral and selection of patients for NHS implant therapy, about a quarter of patients particularly those referred from general dental practitioners rather than hospitals, would be contra-indicated from NHS therapy because of untreated caries or periodontitis.