Orthodontics Service Specification Service Commissioner Lead Provider Lead Period 5. Orthodontics (SBCH Ref No. SS_049) 1. Purpose 1.1 Aims To provide a Consultant-led service for assessment for referred patients, to advise on appropriate management and treatment and, where appropriate, provide secondary or tertiary orthodontic treatment within the Hospital. 1.2 Evidence Base Major variants in tooth alignment, tooth positioning and facial skeletal and soft-tissue relationships have adverse effects on dental health and on dental and facial appearance. A nationally agreed Index of Orthodontic Treatment Need relates dental and occlusal anomalies with the need for orthodontic treatment. 1.3 General Overview Orthodontic treatment in the UK is provided by general dentists with a special interest, by orthodontic specialists in primary care and by Consultants, specialist and training grades within a hospital secondary care setting. All NHS-funded orthodontic treatment has to be graded (IOTN) as having a moderate or high level of treatment need. The appropriate treatment provider is determined by the level of treatment complexity. Within the Dental Hospital the most complex treatment is undertaken with particular emphasis on treatments requiring multi-disciplinary planning or treatment delivery. 1.4 Objectives - To see all appropriate referred patients for Consultant assessment regarding dental and occlusal anomalies even though active orthodontic appliance treatment might not be appropriate. - To see such referrals within 5 weeks of receipt. - On assessment to advise patient and, subsequently referring practitioners, of treatment needs and options so that informed decisions can be made. - Where appropriate advise referring practitioners on simple interceptive and preventive measures to guide the developing occlusion. - If orthodontic treatment within the Hospital is required, to commence treatment within 18 weeks of referral once the patient is ready to start treatment. 1.5 Expected Outcomes Successful completion of planned treatment All completed cases will be subjected to PAR scoring and entered on the Regional database There will be a mean reduction in PAR greater than 70%. 2. Service Scope
2.1 Service Description Orthodontic Treatment This involves the use of orthodontic appliances ( braces ) to produce changes in tooth positioning, alignment and relationships, within a dental arch and between dental arches. Typically in the late mixed or early permanent dentition (ages 10-14 years) active treatment will take about 2 years, followed by a period of passive retention; earlier or later orthodontic intervention might be appropriate. The orthodontic specialty works closely with other dental specialties to deliver integrated treatment which requires multi-disciplinary assessment, treatment planning and treatment delivery. - Orthodontic treatment in conjunction with Restorative Dentistry Children and adults with absent or malpositioned teeth may require orthodontic treatment to change tooth positioning prior to restorative tooth replacement. - Orthodontic treatment in conjunction with Paediatric Dentistry These specialties work closely together in the management of the developing dentition. Severe Hypodontia (congenital absence of many teeth) requires multi-disciplinary planning and treatment by the Orthodontic Paediatric and Restorative Dentistry specialties. - Orthodontic treatment in conjunction with Oral Surgery Joint assessment and planning is required in the management, in particular, of unerupted and ectopic teeth, submerging deciduous teeth, supernumerary teeth and other dental pathology. - Orthodontic treatment in conjunction with Oral & Maxillofacial Surgery Major variants in jaw, and therefore tooth, relationships can only be treated with elective Orthognathic surgery. This requires integrated case assessment and treatment planning for a phased treatment delivery involving both specialties. Can only be considered in the adult patient. - Orthodontic Treatment and Craniofacial Surgery Birmingham is one of four regional craniofacial referral centres in England. The orthodontic department aims to be involved in the management of patients with severe craniofacial deformity. - Orthodontic treatment of the Cleft Lip and Palate Patient The orthodontic service is closely integrated with the Regional Cleft Lip and Palate Centre based at Birmingham Children s Hospital. The majority of orthodontic treatment for cleft patients in Birmingham, Solihull and the Black Country is carried out at Birmingham Dental Hospital. 2.2 Accessibility/acceptability As a secondary and tertiary treatment service, all referrals are made by primary care practitioners or consultant colleagues and accepted according to referral criteria. Patients vary in complexity and many will require multi-disciplinary management. 2.3 Whole System Relationships The service provision requires close working with other clinical specialties and support services within the Hospital. The service delivery is also integrated with the West Midlands Workforce Deanery in the provision of one of the largest postgraduate specialty training programmes in the country. 2.4 Interdependencies
- Other clinical specialty areas - School of Dentistry University of Birmingham - Schools of Dental Nursing and Dental Hygiene and Therapy - The Workforce Deanery - The Trust Corporate Services 2.5 Relevant networks and screening programmes Work is on-going in conjunction with the consultants in Public Dental Health for the Birmingham Solihull & Black Country Area Team s in the development and strengthening of a managed clinical network. 3. Service Delivery 3.1 Service model This is a Consultant-led outpatient assessment and treatment service: Orthodontic treatment is undertaken by Consultants, Orthodontic Specialists and postgraduate/orthodontic Trainees. The department is heavily involved in postgraduate training and contributes to the undergraduate training programme. 3.2 Care Pathways All pathways are initiated by a primary or secondary care referral. Pathways will vary, dependent on the assessed treatment needs. 4. Referral, Access and Acceptance Criteria 4.1 Geographic coverage/boundaries Like all Birmingham Dental Hospital clinical services Orthodontics is a regional service but with a majority of referrals originating in Birmingham, Solihull and the Black Country. There are no out of region referrals unless a clinical exception has been made. 4.2 Location(s) of Service Delivery Birmingham Dental Hospital, with the majority of clinical activity taking place in the Department of Orthodontics (3 rd Floor). 4.3 Days/Hours of operation Monday Friday 9.00am 5.00pm with some variations. Bank holidays are closed. 4.4 Referral criteria & sources For a referral to be accepted it should: Include all appropriate demographic information Give the reason for referral with an indication as to why this cannot be managed in the primary care setting Provide relevant dental, medical and social history Enclose recent relevant radiographs. 4.5 Referral route Primary or secondary providers refer directly to a named consultant or to the Department of
Orthodontics. Patient needs to be under a routine dental hospital/specialist. Orthodontic walk-ins are rare but would be dealt with. 4.6 Exclusion criteria Patients will only be accepted for treatment if they are in a position to accept and support such treatment. Adult treatment will only be accepted if multidisciplinary management is required. 4.7 Response time & detail and prioritisation National targets apply. 5. Transfer of and Discharge from Care Obligations Following completion of orthodontic treatment patients will be discharged to primary care practitioners: - end of active treatment (18-24 months) - end of period of retention (case specific) - following post-retention review - in long-term retention for primary care review This will be dependent on treatment carried out and consistent with pre-treatment planning. 6. Self-Care and Patient and Carer Information Patient will be instructed in post-treatment dental care and if appropriate maintenance of retention regime. 7. Quality Requirements Performance Indicator Quality Indicator Threshold Method of Measurement Consequence of breach Performance & Productivity 8. Activity 8.1 Activity Performance Indicators Threshold Method of measurement Consequence of breach
8.2 Activity Plan 8.3 Capacity Review 9. Prices & Costs 9.1 Price Basis of Contract National Tariff plus Market Forces Factor Non-Tariff Price (cost per case/cost and volume/block/other)* Unit of Measurement Price Thresholds Expected Annual Contract Value Total