Caseload complexity demystified

    The complex needs of the patients treated by community and special care dentists can be lost on health officials and commissioners, according to Charlotte Waite, Chair of the BDA's England Community Dental Services Committee.

    She was commenting on the updated Case Mix tool, a software-based scoring system to help clinicians identify the particular issues vulnerable patients encounter in accessing dental treatment. Speaking at the launch of the revised tool, she said: 'Since its inception, BDA case mix has demonstrated to commissioners the challenges and value of the work community and special care dentists do. This new version will take this approach to the next level.'

    Following input from the British Society of Disability and Oral Health and the British Society of Paediatric Dentistry, the tool has been extended while definitions already included for adult patients have also been revised.

    The tool was first launched in 2008 to help dentists score the complexity of adult patients requiring special care dentistry and has become the gold standard for such scoring, according to six identifiable criteria. These are:

    • ability to co-operate

    • ability to communicate

    • medical status

    • oral risk factors

    • access to oral care

    • legal and ethical barriers to care

    Results are used in commissioning and contract matters as well as in wider epidemiological work. Although CDS dentists are its prime users, the tool can be used by general dental practitioners or secondary care providers. Most dental software providers already provide case mix scoring in their programes and work is underway to upgrade these.

    Dr Waite added: 'The NHS Long Term Plan pledges links to learning disability and autism services, and a holistic approach to care. It's an approach we take on a daily basis, empowered by BDA case mix, and now children can benefit fully with a system designed around their unique needs.' Case Mix 2019 is available at

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