An analysis of patients presenting dental problems at medical practices

Key Points

• Patients with dental problems account for a small minority of attendances at general medical practices.

• Some of these attendances might be related to a perceived or actual lack of dental services, for example at weekends.

• Routinely collected medical consultation data can be extremely useful in assessing the scale and nature of specific medical and dental problems.

• Dental attendance at medical practices cannot be considered a major problem, except possibly for certain practices, or if there is evidence of inappropriate treatment.

Abstract

Objective To describe the characteristics of attendances and patients who present to family medical practitioners with oral or dental problems.

Design Secondary analysis of standard consultation data.

Setting 30 family medical practices in the General Practice Morbidity Database for Wales.

Subjects All patients who presented at the practices with an oral or dental complaint during 1996.

Results Of the 1,650,882 patient attendances at the 30 medical practices in the study year, 4,891 (0.3%) were for oral/dental problems. The frequency of these attendances varied considerably between practices (ranging from 0.02 to 0.67% of all attendances); 44.2% of the attendances included tooth-related problems, and 42.3% were for diseases of soft tissue, salivary glands or the tongue. On average patients with dental problems attended their doctor twice as frequently as other patients. The majority (75%) of oral/dental attendances were related solely to these problems. Patients with tooth-related dental problems were three times more likely to seek treatment at weekends than patients attending for other reasons.

Conclusions The rate of attendance for oral/dental problems varies substantially between practices, but is generally low. The higher rate of attendance for tooth-related problems at weekends suggests that some of the attendances for oral problems might be related to a perceived or actual lack of dental services at these times.

Main

Patient presentation at medical practices with dental problems: an analysis of the 1996 General Practice Morbidity Database for Wales Anderson R, Richmond S and Thomas D W Br Dent J 1999; 186: 297–300

Comment

The presentation of the results of this study could not have been more timely, following on as they do from the publication of the latest guidance notes to general medical practitioners from the General Practice Committee of the BMA.¹ A document no doubt being discussed by many LDC's and their associated LMC's up and down the country.

While the limitations of the coding used in recording consultations is recognised in this study nonetheless the information presented, from an analysis of the Welsh General Practice Morbidity Database covering 30 medical practices, serves to give some indication of the extent to which patients present at medical practices with dental problems. This is identified as a very small proportion of total attendances (0.3%). Additionally by analysing attendances according to whether they were tooth related or were for diseases of the soft tissue, salivary glands or the tongue, enables an initial view on the 'appropriateness' of the presentation to the GP to be taken. Unfortunately information is not collected on the database which would identify if patients were registered with a general dental practitioner and therefore if they could be expecting a service from that source. Nonetheless general medical practitioners appear to agree that soft tissue oral conditions are an appropriate reason for patient attendance.² Add to this the fact that many patients may be unaware that their symptoms are of dental origin,² or that they may be attending additionally for other medical problems, and it can be seen from this data that the problem may not be the major one some have thought it to be. Additionally it is interesting to note that large practices saw fewer tooth related attendances and that the average person with oral or dental problems who attends their general practitioner visits twice as frequently as the average patient who attends for general medical problems only.

How much is this finding describing the doctor/patient relationship? Or the location of the practice? Or the non-availability of locally accessible dental services particularly at weekends? These and other questions are recognised by the authors as needing more research. In the meantime this study is to be welcomed as one which provides further information for the debate concerning the appropriateness of patients with dental problems attending general medical practitioners and the ethical dilemma dental practitioners have with regard to the scope of their duty of care.