Community Dental Service
Service Specification
Author: D.H.J. Davies
Completed: March 2011
Reviewed: August 2012
Review date: August 2014
1
Contents
Introduction
3
Main role and responsibility within the CDS
3
Aims and objectives of the CDS
4
Patient groups seen by the CDS
5
CDS clinical services
5
CDS clinics
6
Mobile dental units
7
Domiciliary dental care (DDC)
7
CDS hours of operation
8
Contact details
9
Referral pathways
9
Treatment pathways
11
The CDS team and DDC
12
Shared care
13
Response times, follow up times and waiting times
14
CDS staff and skill mix
14
Physical resources, assets and equipment
15
Record keeping
19
Activity measurement and activity forecast
20
Cost of service per annum
21
Clinical governance
21
References
27
Appendix 1
Community Dental Service Clinics
31
Appendix 2
Request for Oral Assessment/Treatment form
33
Appendix 3
Medical History form
34
Appendix 4
Eligibility Criteria for DDC form
36
Appendix 5
Special Care Dentistry
37
Appendix 6
CDS Organisational Chart
38
2
Introduction
The Abertawe Bro Morgannwg Health Board (ABMUHB) Community Dental
Service (CDS) provides dental care for vulnerable people of all ages in the
Swansea, Neath, Port Talbot and Bridgend areas in accordance with guidance
provided by the Welsh Assembly Government (WAG).1
The WAG is determined that vulnerable people have access to appropriate
dental care through the delivery of comprehensive services and has defined
vulnerable people as those for whom inequality of healthcare has been
demonstrated. For example, people with impairment and disability, mental health
and medical problems, anxiety and phobia. Socio-economic and geographical
factors may also lead to health inequality.
Many of these people may have specific special medical and dental problems
that may result in some or all of their dental treatment needs not being easily or
appropriately provided for within the General Dental Services (GDS).
The WAG sees the flexible CDS services as having or possessing the potential to
take, the prime role in caring for the most vulnerable although the GDS and
Hospital Dental Services (HDS) also have roles to play.1
This specification has been written following a review of WAG guidance on the
role of the CDS1 together with recommendations made following a review of the
CDS in ABMUHB4 and local and national guidance in relation to the clinical
practice of dentistry and related administrative aspects of dental practice.1-48
Main role and responsibility within the CDS
This specification has been prepared by David Davies who is the CDS Clinical
Service Manager/Senior Dental Officer and a Specialist in Special Care Dentistry
and the main point of contact for ABMUHB CDS.
His main contact details are:

Central Clinic, 21 Orchard Street, Swansea, West Glamorgan, SA1 5AT.

Telephone: Clinic: 01792 517838 or Mobile: 07704287638

Email: [email protected]
3
Aims and objectives of the CDS
The CDS aims to ensure that vulnerable people of all ages in the Swansea,
Neath, Port Talbot and Bridgend areas have access to appropriate dental care
via the delivery of comprehensive services. In order to fulfil this aim, the CDS
seeks to satisfy the following objectives:
1. To provide suitable facilities for a full range of treatment to children who
have experienced difficulty in obtaining treatment in the GDS, or for whom
there is evidence that they would not otherwise seek treatment from the
GDS
2. To provide suitable facilities for a full range of treatment to children and
adults who due to their special circumstances require special care
dentistry(SCD)7,8 and/or have experienced difficulty in obtaining treatment
from other services or would not have otherwise sought treatment from
other services (see Appendix 5)
3. To provide health improvement initiatives for children and adults including
preventive programmes and oral health education. This will include
support for the delivery of the local Designed to Smile (D2S) initiative
which is part of a National Oral Health Improvement programme in
Wales2,3
4. To provide timely emergency and interim treatment to those adults who do
not require special care dentistry but are temporarily experiencing difficulty
accessing treatment via the GDS
5. To provide treatment in areas that would not normally support a GDS
practice by reason of being socially or geographically disadvantaged
6. To monitor the oral health of all age groups in the population through
support of the WAG funded dental epidemiological surveys
7. To participate in oral health screening including the screening of children
in state funded schools and other priority groups as appropriate
8. To provide, or support the provision of, general anaesthesia and sedation,
restorative, orthodontic, oral surgery and other specialist services. This
4
may include clinical support of consultant outreach dental services in rural
areas as appropriate
9. To provide training for dental foundation trainees and other dental care
professionals
10. To retain and develop links with pre-school facilities and schools so that
children in Wales have the greatest opportunity of receiving oral health
promotion messages, preventive care, screening and treatment where
necessary
11. To encourage and develop joint working initiatives and liaison with other
health care professionals, organisations and agencies, including the
voluntary sector.
Patient groups seen by the CDS
The vulnerable people seen by the CDS include:

Children and adults who have learning disabilities

Children and adults who are medically compromised

People who have mental health problems

Children and adults who have physical disabilities

Children and adults who experience disproportionate dental anxiety

People who have complex social problems and cannot obtain dental care

People who cannot receive dental care due to geographical isolation and
lack of a local general dental practitioner (GDP)

People who are unable to leave their homes to seek care People in
rehabilitation and secure units

People with a combination of these factors.
CDS clinical services
The CDS presently provides clinical services via fixed clinics, domiciliary dental
care and mobile dental units.
5
CDS Clinics (see Appendix 1)
The CDS Clinical Service Manager/Senior Dental has implemented the
recommendations made following a Review of the CDS in 2010.4
This includes the centralization of clinical services and the development of high
quality, multiple chair clinical facilities at Central Clinic in Swansea and in the Port
Talbot Resource Centre.
Both of these CDS clinics have 3 dental surgeries, one of which is a dedicated
special care room complete with a ceiling-mounted hoist and good access for
disabled people. The special care room at Central Clinic also has a wheelchair
tilting platform enabling patients who cannot leave their wheelchair to be treated
comfortably and safely.
Digital panoramic radiography facilities are available at these locations.
Conscious sedation services are also available at both of these sites. These
services are appropriate for the provision of treatment in a primary care setting
and include inhalation sedation with nitrous oxide and oxygen and intravenous
sedation with midazolam.5,47
These clinics are well-equipped for the provision of special care dentistry for
vulnerable people and are able to provide a wide range of dental treatments.
Central Clinic in Swansea is also the main administrative site for all CDS
activities. All administrative staff members including the CDS Business Manager
and 2 appointments/waiting list coordinators are based here.
Other CDS clinics include satellite clinics at Pontardawe Primary Care Centre,
Dyfed Road Health Centre in Neath, Sway Road and Bonymaen in Swansea, Ty
Einon in Gorseinon, Cymmer in the Afan Valley, Maesteg Hospital and Quarella
Road in Bridgend.
These satellite clinics will provide care for less disabled people and play an
important role in bringing services closer to more isolated communities.
6
CDS clinicians in the satellite clinics are able to refer any significantly disabled
people to Central Clinic and the Port Talbot Resource centre clinics for more
specialised care when necessary.
An additional dental clinical facility is available for CDS use in the Hillside Secure
Unit in Neath. This facility is used by CDS clinicians who visit the unit to provide
dental care for the residents on a regular basis.
Mobile dental units (MDU’s)
The nature of the patient groups seen by the CDS means that there is a
significant demand for a flexible mobile dental service.
At present, the CDS has a fleet of 2 towed MDU’s and 3 self-drive MDU’s.
The 2 towed MDU’s are presently based at Croeserw and Blaengwynfi in the
Afan Valley. These units are used to provide dental care for schoolchildren in
these high needs areas.
One of the self-drive MDU’S is currently being used to provide dental care for
schoolchildren in high needs areas and homeless people in Swansea. This MDU
also visits special schools in Swansea and Neath.
The second CDS self-drive MDU is presently based at Glyncorrwg Primary
School in the Afan Valley.
The third self-drive MDU is based at Glanrhyd Hospital and will provide MDU
services in the Bridgend area for schoolchildren in high needs areas and a
special school at Heronsbridge. It will also provide dental care for patients with
mental health problems at Glanrhyd Hospital.
The expansion of the Designed to Smile programme3 has resulted in the
acquisition of a new MDU to provide services including a fissure sealant
application programme. This MDU is currently based in the Swansea area.
Domiciliary dental care (DDC)
DDC is a service that reaches out to care for those who are unable to gain
access to dental care themselves. It is intended to include oral health care
7
carried out in an environment where a patient is resident either permanently or
temporarily as opposed to care that is provided in fixed dental clinics or in mobile
dental units.8,9
The CDS considers a referral for DDC6,9 if a patient concerned cannot be
reasonably expected to travel to a dentist to receive treatment. This may be due
to some form of disability that might include:

Physical disabilities causing problems with mobility

Medical conditions leading to disability such as chronic obstructive airways
disease, emphysema, stroke and Parkinson’s disease

Conditions that make them disorientated, confused or panicked when
removed from a familiar environment such as autism, Alzheimer’s disease
or agoraphobia

A learning or mental disability that causes difficulty in making and keeping
surgery-based appointments

A severe dental anxiety and phobia such that people feel unable to enter a
dental surgery

A combination of factors.9
The CDS currently provides DDC for vulnerable people in settings including
their own homes, domiciliary residences, rehabilitation units and elderly longstay hospitals.6 Appropriate referrals for people in short stay hospital wards
who are experiencing some form of dental emergency are also considered.
CDS hours of operation
Services are available between:

8.30am to 5.00 pm on Monday to Thursday

8.30 am to 4.30 pm on Friday
Services are not available during lunch times on:

12.30 to 1.30 on Monday to Thursday

13.30 to 1.00 pm on Friday
There is no evening or weekend service.
8
Contact details
The contact details for all CDS clinics can be found in Appendix 1.
Details of the CDS hours of operation and the out of hours service contact details
are made available at CDS clinics and on clinic telephone answer machines that
are turned on when clinics are closed.
Out of hour’s service
There is an out of hour’s service available and patients can use this service by
contacting:

NHS Direct – 0843 1165523 (after 4pm weekdays and weekends).
General Dental Services
Patients can contact ABMUHB to enquire about the availability of local NHS
dental services on:

Health Board – 01792 601800.
Referral pathways
The CDS accepts referrals for the dental management of vulnerable people from
a wide range of health care professionals including GDP’s, medical practitioners,
hospital staff, Community Support Team members, Health Visitors, Social
workers and carers of disabled people.
This list is not exhaustive and appropriate referrals are considered from other
people working with vulnerable people upon request.
The CDS will not accept self-referrals directly from patients other than in the case
of emergency but asks patients to contact their doctor, health or social worker
and request referral.
The CDS operates a central referral system and patient referrals must be made
to the CDS Appointments/Waiting List Coordinators based in Central Clinic,
Swansea using a standard CDS Request for Oral Assessment/Treatment form
(see Appendix 2).
9
The referrer should also provide details of the patient’s medical history and
medication. This can be provided on a standard CDS Medical History form (see
Appendix 3).
Referrals may be directed to individual CDS clinicians but on receipt these must
be passed onto the appointments/waiting list coordinator.
Assessment of referrals
Upon receipt all referrals for treatment are screened prior to acceptance to
ensure that they are appropriate. Inappropriate referrals are not accepted and are
returned to the referrer.
The receipt of referrals is acknowledged as far as possible and an indication of
the outcome of the referral is given.
Urgent referrals
Urgent referrals can be made by telephone but the referrer is still required to
submit Request for Oral Assessment/Treatment and Medical History forms as
soon as possible.
Referrals for DDC
All referrals for DDC are checked according to the CDS eligibility criteria for
DDC6 (see Appendix 4).
If the patient could be reasonably expected to travel to a dentist, then, by
definition, they would not require domiciliary care. A separate judgement would
then be made as to whether they would qualify for acceptance by the CDS for
special care dentistry (SCD) due to a special dental, medical or social need.
For patients who qualify for SCD but not domiciliary care, the patient’s name will
be placed on a waiting list for examination and assessment at a CDS clinic.
If the patient is considered eligible for DDC by the CDS, the patient’s name will
be placed on a waiting list for examination and assessment by a CDS clinician
who is based in a CDS clinic located close to the patient’s home location.
10
If a patient is referred for DDC but does not qualify either for DDC or SCD care it
will be necessary to make the referrer aware that the request is not appropriate
and has not been accepted.
Treatment pathways
Once accepted for care, a new patient referral will then be allocated to an
appropriately experienced CDS clinician.
Schoolchildren
The CDS receives a large number of referrals for the dental management of
schoolchildren who have been unable to receive care via the GDS for some
reason.
New referrals are allocated to those CDS Dental Officers who provide care for
schoolchildren located in a CDS clinic close to the patient’s home.
Vulnerable children and adults
Many vulnerable people require special care dentistry (SCD)7,8 due to some form
of disability (see Appendix 5).
All new referrals for patients requiring SCD are seen in either Central Clinic or the
Port Talbot Resource Centre by the CDS Specialist in SCD or a Senior Dental
Officer (SDO) in SCD for an initial examination and assessment for care.
This includes referrals for patients who require conscious sedation.
Following the initial examination and assessment, patients are directed to:

The CDS Specialist in SCD or a SDO in SCD if the nature of the patient’s
disability or dental problem requires more specialist care or treatment
involving sedation. Care is arranged at either Central Clinic or the Port
Talbot Resource Centre where a range of facilities for SCD and sedation
are available

A CDS Dental Officer in one of the CDS satellite clinics close to the
patients home if the nature of the patients disability and dental care
requirement means that they can be seen by one of these Officers
11

A shared care arrangement with some care being provided by the CDS
Specialist in SCD or a CDS SDO and other care being provided by a GDP.
This enables the patient and GDP to maintain any long-term care
arrangement

A shared care arrangement with some care being provided by the CDS
Specialist in SCD or a CDS SDO and some by a hospital department

A shared care arrangement with some care being provided by the CDS
Specialist in SCD or a CDS SDO and some by a CDS Dental Officer
The CDS team and DDC
Once the CDS has accepted a patient for DDC, the patient will be allocated to a
CDS clinician based in a CDS clinic located close to the patient’s home. That
clinician will then carry out an initial examination and assessment of the patient
during a domiciliary visit.
Further treatment
After the initial examination and assessment, a CDS clinician may consider a
treatment plan where further care is provided on a mixed and match care basis.
This may mean that the patient is brought into a CDS clinic for completion of
more complex care and afterwards simpler care is completed on a DDC basis.
The CDS also operates a shared care policy during DDC. Essentially this means
that some items of care are provided by the CDS and others by the GDS and
HDS.
Further details of the CDS DDC service can be obtained from the CDS Policy on
Domiciliary Dental Care 2011.6
Mix and match care
This phrase is used to describe instances when domiciliary and surgery-based
care are mixed and matched according to the need to develop rapport and trust
between the patient and the dental team or according to the complexity of the
dental procedures that need to be undertaken.
12
For example, profoundly anxious patients may feel able to attend the surgery
once rapport built with the dental team during a domiciliary visit has helped to
reduce their fear. Alternatively, a disabled patient taking anticoagulants may
attend the surgery for extraction of a tooth because of the risk of postoperative
bleeding, whilst dentures can later be safely constructed on a domiciliary basis.
Complex care such as extractions, surgical procedures and/or restorations can
be more safely and effectively provided in a surgery-based environment. It may
also be necessary to obtain special investigations such as radiographs in the
surgery.
Once more complex care has been completed, simpler care, including prosthetic
treatment, can be completed during DDC.9
Shared care
As far as possible, the CDS tries to arrange care for patients internally but it is
sometime necessary to refer patients to other dental specialties.
The CDS has developed pathways for the referral of patients to the departments
of Oral Surgery and Restorative Dentistry in Morriston Hospital, Swansea.
Referrals to these departments sometimes occur for the management of complex
cases needing specialist oral surgery, restorative care or management under
general anaesthesia (GA). At present the CDS does not have access to its own
GA list.
At present the CDS also refers children without special care requirements to
Parkway Clinic in Swansea for care under GA.
The CDS also accepts referrals of vulnerable people from the HDS for care. This
may occur in the case of inappropriate referrals to the hospital services or where
more complex care has been completed by the hospital services and continuing
care and maintenance is more appropriately provided by the CDS.
The CDS has also developed referral pathways with the hospital services in the
development of a conscious sedation service.5 This system involves the CDS
providing care for patients who fall into groups 1 and 2 of the American Society of
13
Anesthesiologists Physical Status (ASAPS) classification system 10 in a primary
care setting whilst the hospital services will care for patients who fall into ASAPS
groups 3 and above.47
The use of transmucosal conscious sedation techniques is also being developed
within the CDS.
This service development has been greatly facilitated by the introduction of a
CDS/HDS joint clinic in the Port Talbot Resource Centre in 2011.
Finally, it is hoped to develop shared care arrangements with general dental
practitioners (GDP’s) in the Swansea, Neath, Port Talbot and Bridgend areas
particularly in the provision of DDC. The CDS Clinical Service Manager/Senior
Dental Officer is currently discussing this potential development with GDP
representatives, ABMUHB management and a consultant in dental public health.
Response times, follow up times and waiting times
The CDS central referral system enables the appointments and waiting list
coordinator to keep an electronic record of new referrals, their allocation and the
outcome of treatment. Waiting lists can also be closely monitored using this
system in accordance with WAG guidance.
The CDS central referral system uses an electronic patient management and
appointments system (SOEL) currently in use at all of its clinics and mobile
dental units.
This enables an integrated patient management and appointment system to be
used throughout the CDS clinical activities which improves data collection,
analysis and audit.
CDS staff and skill mix
The CDS team includes the following staff members:

1 Clinical Service Manager/Senior Dental Officer and Specialist in SCD

2 Senior Dental Officers with experience in SCD

10 Dental Officers with varying degrees of experience and expertise
14

1 Dental Foundation Trainee

2 Dental Therapists

1 CDS Business Manager

1 Senior Dental Nurse

16 Dental Nurses

1 Oral Health Promotion Officer

2 Receptionist/Waiting List Coordinators

1 Receptionist
A CDS organisational chart can be found in Appendix 6.
D2S staff and skill mix
The D2S team includes the following staff members:

1 Designed to Smile Programme Manager

9 Designed to Smile Programme health Promotion educators

2 Drivers/Administrators
The D2S team are based at Cwmbwrla, Cwmavon and Glanrhyd Hospital (see
Appendix 1).
Physical resources, main assets and equipment
Fixed clinics (see pages 16 and 17)
Special care dentistry (SCD) services are largely centralised in 2 main CDS
clinics at Central Clinic, Swansea and the Port Talbot Resource Centre.
These 2 clinics offer good access for disabled people and are fully equipped for
the provision of SCD and conscious sedation.
Satellite clinics provide services for specific areas. The quality of the access
facilities for disabled people varies at these clinics but some of these clinics have
good access and also have facilities for SCD.
All CDS clinics and MDU’s are computerised and have access to SOEL.
15
Clinic
Bonymaen Clinic, Swansea
Facilities
1 dental surgery on ground floor. Limited access
for SCD. In need of modernization. Conventional
intra-oral radiography.
Bridgend Clinic
1 dental surgery on ground floor. Good access for
(Quarella Road)
SCD. Facilities for inhalation sedation.
Conventional intra-oral radiography.
Central Clinic, Swansea
3 modern dental surgeries on 1st floor.
Ramp to ground floor and lift to 1st floor. 1 SCD
surgery with:

ceiling hoist

wheelchair tilting platform

inhalation and intravenous conscious
sedation
2 other dental clinics well equipped for ablebodied patients. Digital panoral radiography.
Conventional intra-oral radiography.
Cwmbwrla Clinic, Swansea
No CDS clinic/surgery. D2S only.
Cwmavon Clinic
No CDS clinic/surgery. D2S only.
Cymmer Clinic
1 dental surgery on 1st floor. No lift available.
Limited access for SCD. In need of modernization.
Conventional intra-oral radiography.
Dyfed Road Clinic, Neath
Ground floor clinic with 2 dental surgeries which
are modern and well equipped for able-bodied
patients. Limited access for SCD.
Conventional intra-oral radiography.
Ty Einon Clinic, Gorseinon
1 dental surgery on ground floor. Good access for
SCD. Ceiling Hoist available. Modern equipment.
Conventional intra-oral radiography.
16
Maesteg Hospital
1 dental surgery on ground floor. Good
access for SCD. Conventional intraoral radiography.
Morriston Clinic, Swansea
1 surgery on ground floor. Ramp and
good access for SCD. Ceiling hoist
available. Modern equipment.
Conventional intra-oral radiography.
Pontardawe Clinic
1 surgery on 1st floor. Ramp and lift
available. Good access for SCD.
Modern equipment. Conventional intraoral radiography.
Port Talbot Resource Centre, Port
3 modern dental surgeries on ground
Talbot
floor.
Good access to surgeries. 1 SCD
surgery with:

Ceiling hoist

Inhalation and intravenous
conscious sedation
Other dental clinics well equipped for
able-bodied patients. Digital panoral
radiography. Conventional intra-oral
radiography.
Decontamination
The CDS observes local and national guidance in decontamination in primary
care dental practice37,38,39 and autoclaves and washer disinfector units have been
installed in all CDS clinics. The CDS complies with essential requirements on
decontamination from the WAG and HTMO1-05 and is currently working towards
full compliance with best practice requirements.37
This will entail the refurbishment of Cymmer Clinic and the introduction of a
central decontamination system with dedicated decontamination facilities at
17
Central Clinic, Cymmer Clinic and Glanrhyd Hospital. It is hoped to implement
this central decontamination system in stages over 2012-13.
Conscious sedation
The CDS is able to provide inhalation sedation using nitrous oxide and oxygen
and intravenous sedation using midazolam in Central Clinic, Swansea and the
Port Talbot Resource Centre clinics.
This CDS conscious sedation service is provided in a primary care setting and is
intended to care for patients who fall into groups 1 or 2 of the American Society
of Anesthesiologists Physical Status (ASAPS) Classification System.5,10,47 The
service is provided by suitably trained and experienced CDS clinicians and is
subject to careful monitoring and audit.
The service is provided in partnership with colleagues in the ABMUHB HDS
Restorative Dental Department.
A joint clinic at the Neath Port Talbot Hospital is staffed by clinicians from the
CDS and the Restorative Dental department for the assessment of patients
referred for conscious sedation and general anaesthesia. Patients falling into
groups 1 and 2 of the ASAPS classification system will be seen by the CDS
whilst patients falling into group 3 and above will be seen by the Hospital dental
Service in a secondary care setting.5,47
Secure unit
The CDS provides dental care for young offenders housed in Hillside Secure
Unit, Neath, SA11 1UL.
There is 1 well-equipped dental surgery in this unit with conventional intra-oral
radiography.
This surgery has good access for able-bodied people but very limited or no
access for SCD.
18
Domiciliary dental care (DDC)
The CDS currently provides DDC in the Swansea, Neath, Port Talbot and
Bridgend areas to patients’ homes, domiciliary residences, adult day care
centres, long-stay hospitals for elderly patients and rehabilitation units. Treatment
provided during DDC is limited largely to prosthetics, simple restorations and
hygiene treatment. Wherever possible, patients requiring more complex care are
brought into a nearby CDS clinic for this treatment.
Portable dental equipment is available for simple care only during DDC. Mixed
care is encouraged.
Mobile dental units (MDU’s)
At present, the MDU service is provided by a fleet of 3 driveable MDU’s and 2
static, towable MDU’s in the Swansea, Neath, Port Talbot and Bridgend areas. It
is targeted at areas of relative isolation with lack of dental services and high
dental treatment needs.
The D2S team also has a MDU which is self-sufficient and able to visit sites
without connections for power and water being installed, thus increasing the
flexibility of the service. This MDU is being used for expansion of the D2S
programme.
The MDU’s are well-equipped for the provision of a wide range of dental
treatments. Three MDU’S have lift platforms enabling wheelchair users to
access the vehicles.
Record keeping
An ITC improvement programme was completed in 2012 which has seen the
provision of inter and intranet access for CDS staff including the availability of
Email. This has greatly enhanced communication within the CDS.
The SOEL electronic patient clinical management and administrative system has
been extended into all CDS clinics and MDU’s. This allows data on CDS
activities to be recorded and analysed later.
19
Activity measurement and activity forecast
The CDS collects data on its clinical activities using the electronic SOEL
management system. This includes the use of the Case-mix tool8,48 to enable an
objective assessment of the complexity of provision of care for people with
disability.
Data are collected by the ABMUHB Community Information Department and
summarised into reports for the WAG.
Period 2010-11
There were 14699 episodes of care within the CDS. These comprised:
 11547 treatments in CDS fixed clinics
 562 treatments provided during domiciliary dental care visits
 186 treatments provided during hospital visits
 2147 treatments provided on mobile dental units
 184 orthodontic treatments were provided at Neath Port Talbot Hospital
 25 patients were seen in PEG clinics
 51 treatments were provided at a secure unit.
A total of 7082 appointments were not kept by patients.
Of the patient treatments provided by the CDS:
 11303 were for children aged up to 16 years of age with no disabilities
 3396 were for vulnerable people with some form of disability.
Period 2011-12
There were 14107 episodes of care within the CDS. These comprised:

12453 treatments in CDS fixed clinics

272 treatments provided during domiciliary dental care visits

445 treatments provided during hospital visits

720 treatments provided on mobile dental units

47 patients were seen for assessment during a SCD joint clinic held at
NPTH between the CDS and the Restorative Dental Department

121 orthodontic treatments were provided at Neath Port Talbot Hospital
20

15 patients were seen in PEG clinics

34 treatments were provided at a secure unit.
A total of 6925 appointments were not kept by patients.
Of the patient treatments provided by the CDS:

10546 were for children aged up to 16 years of age with no disabilities

3561 were for vulnerable people with some form of disability.
Future activity
The role of the CDS is to provide dental care for vulnerable people of all ages.1 It
is likely that the numbers of vulnerable people seen for care by the CDS will
increase in the future in line with the role of the CDS and the provision of SCD.
The CDS is working with the GDS, ABMUHB HDS services, Mental Health
Teams and other Health Board departments and agencies to make SCD services
more widely known and available for vulnerable people.
ABMUHB CDS has only been providing dental care in the Bridgend and Maesteg
areas since April 2012. Services in these areas are currently being developed
and include improved dental services for patients with mental health problems at
Glanrhyd Hospital.
The CDS CSM/SDO is also currently working with his counterpart in Hywel Dda
and an ABMUHB HDS representative to develop a managed clinical network
(MCN) in SCD for ABMU and Hywel Dda Health Boards. The aim of the SCD
MCN is to make SCD services more widely known and available across both
Heath Boards.
Cost of service per annum
The budget for the financial year 2012-13 is approximately £1,500,000.00.
Clinical governance (CG)
CG has been defined as a framework through which National Health Service
organisations are accountable for continuously improving the quality of their
21
services and safeguarding high standards of care by creating an environment in
which excellence in clinical care will flourish.11
The CDS is committed to fulfilling this requirement in accordance with the Welsh
Assembly Government requirements published in Doing Well Doing Better:
Standards for Health Services for Wales, 2010.12 The CDS will operate within a
clear and robust operational framework to delivery its intended services1 and
observe ABMUHB organisational values and standards of behaviour and comply
with local and national legislative requirements.
The CDS will also ensure that resources are used efficiently, effectively and
economically in accordance with accepted evidence based practices and
safeguard its assets including its staff via good governance at all times.
Procedures are implemented within the CDS to comply with accepted local and
national standards in relation to:
Equality, diversity and human rights.
The CDS recognises the needs of staff, patients, carers and other members of
the public encountered during care, whatever their identity and background and
seeks to uphold their individual rights in accordance with local and national
policy.13,14 CDS staff members will be encouraged to observe these values as
part of their annual appraisal and review process and the Agenda for Change
policy.32,33
Health Promotion, prevention and public health.
The CDS will observe evidence-based prevention policies for common oral
diseases and conditions appropriate to the needs of the local population and
consistent with local and national priorities. These include links to existing oral
health promotion initiatives such as Designed to Smile2,3, healthy eating and
diet15, tobacco use cessation and alcohol consumption advice. 16
22
Staff, patient, public and environmental safety.
The CDS will ensure that policies are implemented to ensure compliance with
risk management17 and the Reporting of Injuries, Diseases and Dangerous
Occurrences Regulations.18 Relevant safety alert bulletins will be disseminated
to staff via regular staff meetings and internal mail and requirements met to
ensure that all medical devices are CE compliant and that staff training for usage
is provided.
All medicines/materials will be appropriately obtained and stored including
medical emergencies drug kits for each clinical location including domiciliary
dental care.6,9
The CDS will also implement operational policies ensuring compliance with:
 The Carriage of Dangerous Goods and Use of Transportable Pressure
Equipment Regulations, 200719
 The Hazardous waste regulations, 200520 and the management of waste
amalgam and/or mercury
 The Health and Safety at Work Act, 197421
 The Management of Health and Safety at work Regulations, 1999 22
 The Workplace (Health, Safety and Welfare) Regulations, 199223
 The Control of Substances Hazardous to Health Regulations, 2002.24
Clinical records, patient privacy and confidentiality
The CDS ensures that all its staff members are aware of their duty to comply
with:

The Data Protection Act 199825

Caldecott Guidelines 1997, Access to Health Records 1998 and
Confidentiality Code of Practice199826
Staff members are required to conform with departmental and ABMUHB
confidentiality requirements. Regular staff meetings will be held and updates
provided to ensure compliance with these requirements. 28,29
23
Child protection and the protection of vulnerable adults
All new CDS staff members undergo appropriate identification and Criminal
Records Bureau checks.30
The CDS also maintains and updates its child protection policy which is
consistent with local and wider policies including staff training requirements. 31
Regular updates in the protection of children and vulnerable adults are provided
via CDS staff meetings and ABMU Health Board mandatory training
programmes.
Staff involvement and development
The CDS observes the requirements of Agenda for Change32 and the Community
Dental Service (SPDCS) Wales Summary Agreement (May, 2008)33 and the
relevant employment policies with appropriate job descriptions for all posts.
The CDS Clinical Service Manager liaises with ABMUHB Human Resources staff
during staff involvement and development issues where necessary and
documents any involvement.
Regular appraisal and review will continue to be undertaken for all CDS staff and
appraisal and personal development plans implemented. These are regularly
updated.34,33
Appropriate staff training will be undertaken and/or provided where necessary
and records of staff training maintained.
Clinical staff requirements
All CDS clinical staff will be required to satisfy their annual General Dental
Council (GDC) professional requirements including:

GDC registration/enrolment

Continuing Professional Development requirements

Handling of complaints

Dealing with poor performance (including “whistle blowing” policy).28
The CDS will regularly monitor and compliance with this requirement.
24
Evidence-based practice
Policies are in place and regularly updated for the various clinical services
provided by the CDS including clinical dental procedures, conscious sedation,
decontamination, the use of MDU’s and domiciliary dental care.
Relevant NICE guidelines are followed where available and clinical care is
informed by other evidence-based guidelines.27,35,36
CDS staff members with areas of special interest audit areas of CDS clinical
activity including conscious sedation,5 radiography, laboratory work, COSHH24
and domiciliary dental care.6
Infection control
The CDS will comply with local and national guidance issued in the control of
infection.37,38,39 An infection control policy for use within the CDS is available. This
includes guidance on infection control during all aspects of CDS clinical activities.
The CDS also has an induction programme for new staff that includes training in
infection control procedures and regular audit is carried out into compliance with
infection control guidance.37
Dental radiography
Procedures and policies are in place in accordance with the Ionising Radiations
Regulations 199940 and the Ionising Radiation (Medical Exposure) Regulations
200041 regulations. These include a quality assurance system and the CDS also
maintains records of staff training and updates and X-ray equipment
maintenance.
The CDS regularly updates its Ionising Radiation policy and local rules for use of
equipment and audits its radiography services regularly.42,43,44
A Radiation Protection Supervisor has been appointed from within the CDS
dental team and a senior ABMUHB Radiation Physics team member has been
appointed as the CDS Radiation Protection Adviser.
25
Patient involvement and information
Patients’ and carers’ views on services are sought regularly and acted upon
when concerns are identified. Patient satisfaction and access audits are
regularly carried out within the CDS. Patient information leaflets are available
together with a language line service in languages prevalent in the local
population.
There is a well-publicised complaints system that is supportive of patients and
the CDS acts to improve services on the receipt of patient feedback.
Information is available for patients on how to access CDS services and NHS
care out of hours.
Fair and accessible care
CDS staff members are encouraged to comply with the Race Relations
(Amendment) Act 200045 and Human Rights Act 1998.14
Interpreting services are available and all reasonable efforts are made to comply
with the Equality Act 201013 to ensure accessible services for disabled people.
Emergency/urgent appointments are available during the day at CDS clinics.
Clinical audit and peer review
Staff meetings are held regularly and all CDS staff members are encouraged to
identify priorities for service improvement and become involved in clinical audit
and/or peer review wherever possible.
Members of a CDS Health and Safety Group support the Clinical Service
Manager/Senior Dental Officer in the identification of hazards or risks and help to
audit services.
Reports
A CDS departmental risk register is maintained by the CDS Clinical Service
Manager/Senior Dental Officer who reports to the ABMUHB Dental Clinical
Governance Committee and Bridgend Locality Directorate on CG and/or risk
issues concerning the CDS.
26
References
1. EH/ML/014/08 - Dental Services for Vulnerable People and the Role of the
Community Dental Service. Welsh Assembly Government, 2008. Available at:
http://wales.gov.uk/docs/phhs/publications/ministerial14/081031letteren.doc
2. Welsh Health Circular (2008) 008. Designed to Smile – A National Child Oral
Health Improvement Programme Promoting Better Oral health and Delivering a
Fluoride Supplementation. Available at:
http://wales.gov.uk/dhss/publications/health/whc/whc0808
3. Ministerial Letter EH/ML/032/09. Expansion of Designed to Smile – A National
Oral Health Improvement Programme. (23.10.09). Available at:
http://wales.gov.uk/docs/dhss/publications/091023letter03209en.pdf
4. National Public Health Service for Wales. A Review of the Community Dental
Service in ABMU Health Board, 2010.
5. Community Dental Service. Protocol for Conscious Sedation in Dentistry,
2010.
6. Community Dental Service. Policy for Domiciliary Dental Care, 2011.
7. Joint Advisory Committee for Special Care Dentistry. A case for need:
proposal for a speciality in special care dentistry. British Society for Disability and
Oral Health, 2003. Available at: http:// www bsdh.org.uk/misc/ACase4Need.pdf
8. Dougall A and Fiske J. Access to special care dentistry, part 1. Access. Br
Dent J 2008; 204(11): 605-616.
9. The British Society for Disability and Oral Health. Guidelines for the Delivery of
a Domiciliary Oral Health Care Service. BSDH, 2009. Available at:
http://www.bsdh.org.uk
10. Malamed SF. Physical and psychological evaluation. In: Sedation A Guide to
Patient Management. 4th. Edition, pp. 26-54. St. Louis: Mosby, 2003.
11. Department of Health. A First Class Service: Quality in the new NHS.
London: Department of Health, 1998.
12. Welsh Assembly Government. Doing Well Doing Better: Standards for Health
Care Services in Wales 2010. Available at:
http://www.nhswalesgovernance.com/Uploads/Resources/FRyudnkym.pdf
27
13. Equality Act, 2010. Available at:
http://www.equalities.gov.uk/equality_act_2010.aspx
14. Human Rights Act, 1998. Available at:
http://www.direct.gov.uk/en/Governmentcitizensandrights/Yourrightsandresponsi
bilities/DG_4002951
15. Levine and Stillman-Lowe. Scientific Basis of Oral Health Education, 2004.
16. Helping smokers stop: A guide for the dental team. 2004. Available at:
www.publichealth.nice.org.uk/page.aspx?o=502735
17. ABM University NHS Trust. Directorate of Surgery and Urology. Risk
Management Policy, 2009.
18. Reporting of Injuries, Diseases and Dangerous Occurrences Regulations
(RIDDOR) 1995. Available at: http://www.hse.gov.uk/riddor/report.htm
19. Carriage of Dangerous Goods and Use of Transportable Pressure Equipment
Regulations 2007. SI 2007 No 1573. HMSO, 2007. Available at:
www.opsi.gov.uk/si/si2007/uksi_20071573_en_1
20. Hazardous Waste (England and Wales) Regulations 2005. SI 2005 No: 894.
Available at: www.opsi.gov.uk/si/si2005/20050894.htm
21. Health and Safety at Work Act 1974. HMSO, 1974.
22. Management of Health and Safety at work Regulations, 1999. Available at:
http://www.legislation.gov.uk/uksi/1999/3242/contents/made
23. Workplace (Health, Safety and Welfare) Regulations 1992. Available at:
http://www.legislation.gov.uk/uksi/1992/3004/contents/made
24. Control of Substances Hazardous to Health Regulations (COSHH) 2002. SI
2002 No 2677. HMSO, 2002. Available at:
www.opsi.gov.uk/si/si2002/20022677.htm
25. The Data Protection Act, 1998. Available at:
http://www.legislation.gov.uk/ukpga/1998/29/contents
26. Patient confidentiality and access to health records. Available at:
http://www.dh.gov.uk/en/Managingyourorganisation/Informationpolicy/Patientconf
identialityandcaldicottguardians/index.htm
28
27. Faculty of Dental Surgery. Royal College of Surgeons of England. Clinical
Guidelines. Available at: http://www.rcseng.ac.uk/fds/docs
28. General Dental Council. Standards for Dental Professionals, 2005.
Available at: http://www.gdc-org.uk
29. Records Management: NHS code of practice. Available at:
www.nhsia.nhs.uk/infogov/igt
30. Criminal Records Bureau. Available at: http://www.crb.homeoffice.gov.uk/
31. Child protection and the Dental Team. Available at: http://ww.cpdt.org.uk
32. Department of Health. Agenda for Change. Final Agreement. December
2004. Available at:
http://www.wales.nhs.uk/sites3/Documents/433/FinalAgreementDecember2004.p
df
33. Welsh Assembly Government. Introduction of the 2007 Salaried Primary
Dental Care Contract. May 2008. Available at:
http://www.wales.nhs.uk/document/98633
34. The NHS Knowledge and Skills Framework (NHS KSF) and the Development
Review Process (October 2004). Available at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy
AndGuidance/DH_4090843
35. National Institute for Health and Clinical Excellence. Available at:
http://www.nice.org.uk/guidance/
36. Scottish Intercollegiate Guidance Network. Available at:
http://www.sign.ac.uk/guidelines/published/index.html
37. Health Technical Memorandum 01-05: Decontamination in Primary Care
Dental Practices. Welsh Edition, 2010. Available at: www.spaceforhealth.nhs.uk
38. Advice Sheet A12. Infection control in dentistry (England). British Dental
Association, December 2009.
39. Infection Control Manual. Department of Infection Control. ABM University
NHS Trust, 2008.
40. Ionising Radiations Regulations, 1999. Available at:
http://www.legislation.gov.uk/uksi/1999/3232/contents/made
29
41. Ionising Radiation (Medical Exposure) Regulations, 2000. Available at:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicy
AndGuidance/DH_4007957
42. Advice sheet A11. Radiation in dentistry. British Dental Association, 2003.
43. National Radiological Protection Board. Guidance Notes for Dental
Practitioners. Available at:
http://www.hpa.org.uk/radiation/publications/misc_publications/dental_guidance_
notes.pdf
44. Selection Criteria for Dental Radiography, Faculty of General Dental
Practitioners (UK). Royal College of Surgeons of England, London.
45. Race Relations (Amendment) Act, 2000. Available at:
http://www.legislation.gov.uk/ukpga/2000/34/contents
46. Faulks D and Hennequin M. Defining the population requiring special care
dentistry using the international classification of functioning, disability and health
– a personal view. J Disabil Oral Health 2006; 3: 143-152.
47. Girdler NM, Hill CM and Wilson KE. Clinical Sedation in Dentistry. Chichester:
Wiley-Blackwell, 2009.
48. British Dental Association. Case-mix model training pack. London: BDA,
2007.
30
Appendix 1
Community Dental Service Clinics
Bonymaen clinic
Caernarvon Way, Bonymaen, Swansea, SA1 7HJ
Telephone: 01792 651170
Bridgend Clinic
Quarella Road, Bridgend, CF31 1JS
Telephone: 01656 667925
Central Clinic
21 Orchard Street, Swansea, SA1 5AT.
Telephone: 01792 517838
Cymmer Health Centre
Cymmer, Port Talbot, SA13 3HR
Telephone: 01639 851908
Dyfed Road Health Centre
Dyfed Road, Neath, SA11 3AP
Telephone: 01639 632396
Gorseinon Clinic
Ty Einon Centre, Princess Street, Gorseinon, Swansea, SA4 4US
Telephone: 01792 545782
Maesteg Hospital
Neath Road, Maesteg, CF34 9PW
01656 737396
31
Morriston Health Centre
Sway Road, Morriston, Swansea, SA6 6HS
Telephone: 01792 700566
Pontardawe Primary Care Centre
Industrial Estate, Pontardawe, SA8 4JU
Telephone: 01639 860819
Port Talbot Resource Centre
Moor Road, Baglan, Port Talbot, SA12 7BJ
Telephone: 01792 683057
Hillside Secure Unit
Hillside, Neath, SA11 1UL
Telephone: 01639 641648
CDS Oral Health Promotion
Pontardawe Primary Care Centre
Industrial Estate, Pontardawe, SA8 4JU
Telephone: 01639 860820
Designed to Smile Centres
Cwmavon Health Centre
Glanrhyd Hospital
Penllyn, Cwmavon, Port Talbot, SA12 9BA
Ward 15, Tondu Road,
Telephone: 01639 889086
Bridgend CF31 4LN
Cwmbwrla Health Centre
Caebricks Road, Cwmbwrla, Swansea, SA5 8NS
Telephone: 01792 301098
32
Appendix 2
Request for Oral Assessment/Treatment form
33
Appendix 3
Medical History Form
34
35
Appendix 4
Eligibility Criteria for DDC form
36
Appendix 5
Special Care Dentistry
Special care dentistry (SCD) has been described as being concerned with
providing and enabling the delivery of oral care for people with an impairment or
disability, where this terminology is defined in the broadest of terms as: ‘The
improvement of oral health of individuals and groups in society who have a
physical, sensory, intellectual, mental, medical, emotional or social impairment or
disability or, more often, a combination of a number of these factors’. 7
Dougall and Fiske8 have suggested that SCD is defined by a diverse group of
people with a range of disabilities and complex additional needs and includes
people living at home, in long stay residential care and secure units, as well as
people who are homeless.
The definition of SCD provided above is very wide and in an effort to provide a
more objective boundary, Faulks and Hennequin46 described three groups of
people who require SCD:
1. People who experience disability due to impairment of oral function and/or
structure and who are limited in their activity and/or participation directly by
their oral status
2. People who have a condition that has direct or indirect repercussions on
their oral health
3. People who are disabled by their social, environmental or cultural context,
which reflects on their oral health.
It is important to remember that not everyone with disability requires SCD, as not
all disability limits oral health.
Also, those persons able to express need and able to easily access mainstream
dental services, despite disability, are not in need of SCD. Whereas, those
people unable to express need or unable to access care because of disability (for
example, due to reduced communication, fear, inability to co-operate or because
of inappropriate service provision) require SCD. Some people may also require
SCD at certain periods in their life and not at others.8
37
Appendix 6
CDS Organisational Chart
Clinical Service Manager/Senior Dental Officer
Specialist in Special Care Dentistry
Senior Dental Officers
CDS
in Special Care Dentistry
Dental Officers
Business Manager
Therapists
Senior
Dental Nurse
Oral Health Promotion
D2S Coordinator
Receptionists/Waiting
List Coordinators
Dental Nurses
Officer
D2S staff
38