Patients often attend medical practices with problems affecting the teeth, gums or mouth. These conditions usually require dental care rather than medical treatment.

This guidance helps non-dental medical practitioners assess safely, recognise serious illness, and direct patients to the right service.

Core principles

• Medical practitioners are not responsible for providing dental treatment.

• Most dental conditions require care from a dental professional.

• The medical role is to:

• Assess the patient.

• Identify serious or life-threatening problems.

• Direct or refer appropriately.

Why this happens

Medical practices commonly see patients with dental pain or infection because of:

• Difficulty accessing dental services.

• Cost of dental care.

• Misunderstanding about where to seek help.

Assessment responsibilities

Before deciding not to treat, the clinician should:

• Make reasonable enquiries.

• Decide whether the condition is:

• A dental problem, or

• A medical problem affecting the mouth.

• Carry out a basic clinical assessment if needed.

If the condition is dental:

• Direct the patient to:
• A dentist.

• An urgent dental service.

• Local emergency care pathways where relevant.

Practice staff should help ensure the patient does not require medical treatment before signposting.

Conditions medical practitioners should not manage

Unless they have appropriate dental training, clinicians should not attempt to manage:

• Toothache caused by decay.

• Dental abscess requiring drainage.

• Broken, displaced or lost teeth.

• Lost fillings or crowns.

• Gum infections needing dental procedures.

Health professionals must work within their competence and training.

Red flags - urgent hospital referral

Refer immediately to emergency or specialist care if there are signs of spreading infection or systemic illness:

• Swelling of the face or neck.

• Difficulty swallowing.

• Difficulty breathing.

• Inability to open the mouth (trismus).

• Fever or signs of sepsis.

• Rapidly worsening infection.

• Immunocompromised patient with dental infection.

These patients may need urgent surgical treatment.

Acute dental pain and infection

Evidence shows first-line treatment is usually a dental procedure, such as:

• Tooth removal.

• Root canal treatment.

• Surgical drainage.

Antibiotics

Antibiotics should not be routinely prescribed for dental pain.

They are appropriate only if:

• There are signs of infection spreading locally.

• There are signs of systemic illness.

• The patient is moderately or severely immunocompromised.

Antibiotics alone do not remove the source of most dental infections.

Mouth injuries and bleeding

• Early dental assessment is important.

• Refer urgently to a dentist or emergency dental service.

Oral cancer and other mouth disease

Patients may present with abnormal changes in the mouth.

Urgent referral is needed for:

• Ulcers that do not heal after 2–3 weeks.

• Red or white patches.

• Unexplained lumps in the mouth or neck.

• Persistent pain, numbness, or difficulty swallowing.

Use the local urgent cancer referral pathway.

Non-urgent mouth problems

• Advise the patient to see a dentist for a full oral examination.

Prescribing considerations

Patients may ask medical practitioners for prescriptions after seeing a dentist.

Key points:

• Dental professionals are responsible for prescribing for their patients.

• If a medical practitioner prescribes:

• They take full clinical responsibility.

• The patient must be clinically assessed.

• Do not rely only on the patient’s report of dental advice.

• If there is no clear medical need, prescriptions should not be issued.

If the patient has no dentist

Advise the patient to contact:

• Local urgent dental services.

• Community dental clinics.

• National health helplines.

• Public health services.

Working with local dental services

Medical and dental services should maintain communication pathways to:

• Clarify referral routes.

• Resolve access problems.

• Support safe patient care.

Summary for medical practices

• Assess whether the problem is dental or medical.

• Identify red flags.

• Do not provide dental procedures without training.

• Avoid unnecessary antibiotics.

• Use urgent cancer referral systems when needed.

• Direct patients to appropriate dental services.