Supporting information for prescribing policy statement for dental conditions on FP10

Appropriate prescribing for treatment of dental conditions by the GP

  • Management of dental abscess in the absence of immediate attention by a dental practitioner1:
  • Antibiotics
  • For people who are systemically unwell or if there are signs of severe infection (e.g. fever, lymphadenopathy, cellulitis, diffuse swelling).
  • For high risk individuals to reduce the risk of complications (e.g. people who are immunocompromised or diabetic or have valvular heart disease).

If the decision is made to provide treatment, inform the patient that they MUST seek a dental appointment as soon as possible and ensure you keep adequate records of your history-taking, examination, decision making, the treatment you provide and instructions to the patient. Do remember that if the patient is systemically unwell and you prescribe, it is your responsibility to provide adequate follow-up.

  • Dental preparations after head and neck cancer treatment on the recommendation of a specialist consultant.
  • In special circumstances where dental practitioners are unable to prescribe on FP10D due to the exclusion of the drug from the dental formulary e.g. tranexamic acid products

Rationale for not prescribing medicines for dental conditions on FP10
GPs should not accept requests from dentists to prescribe medicines that the dentist could prescribe. / Dentists can issue NHS prescriptions for medicines from the Dental Practitioners’ Formulary. They are able to prescribe or direct their patients to self-care.
GPs should not accept requests from patients to issue FP10 prescriptions for items prescribed on a private prescription during private dental treatment. / Dentists can issue private prescriptions and are able to prescribe or direct their patients to self-care.
Patients should be directed to book a dental appointment if toothache persists for more than one or two days and self-care by taking painkillers such as paracetamol or ibuprofen until they see the dentist. / Dentists are best placed to assess dental problems and prescribe and monitor medicines for them. Dentists, like other healthcare professionals, are also able to signpost patients to appropriate forms of self-care.If they have a regular NHS dentist and need urgent treatment, advise them to contact their dentist for advice.
GPs are advised that dental abscesses must be treated by dentists and they should not prescribe antibiotics in healthy individuals while patients await definitive treatment from the dentist. / Antibiotics are generally not indicated for otherwise healthy individuals when there no signs of spreading infection. If they have a regular NHS dentist and need urgent treatment, advise them to contact their dentist for advice.
Patients refusing to see a dentist should be advised that serious complications may happen if the abscess is not treated correctly by a dentist. / Dentists are usually best placed to assess dental problems, prescribe and monitor medicines for them.Prescribers are advised to keep adequate records of your history-taking, examination, decision making, the treatment you provide and instructions to the patient.
Patients should be signposted to purchase painkillers, such as paracetamol and ibuprofen while awaiting dental treatment. / This will help with the symptoms until they see the dentist.
When GPs prescribe medicines for dental conditions they are responsible for both the prescribing and any consequent monitoring required. / GPs may not be the most appropriate clinical practitioner.Involving GPs unnecessarily in prescribing medicines for dental conditions uses valuable appointments and GPs’ time, which could be better utilised.
Patients who are not registered with a regular dentist / If the patient does not have a regular NHS dentist, ask them to contact NHS 111 where the details of out-of-hours dental services in this area will be provided.

References

1CKS (2015) ‘Dental abscess’, Available at: (Accessed: 29/07/16)

2BNF (2016) ‘List of Dental Preparations’, Available at: (Accessed: 29/07/16)

Author: North East Essex CCG Medicines Management Team October 2016 Review due: October 2018