"White Fillings" in those who are pregnant or are nursing mothers

06 January 2012

This notice seeks to correct and clarify information circulated on 2 September 2011 with regards to ‘white’ or non amalgam fillings in pregnant patients and nursing mothers.

Dentists will be aware that there is no provision within the Statement of Dental Remuneration (SDR) for the provision of composite resin restorations in the occlusal surfaces of molar and premolar teeth for this group of patients. It came to Practitioner Services’ notice earlier in the year that there has been a common misconception that such treatment could and should be claimed under item 14(f) (1451) in the Statement of Dental Remuneration (SDR).

The narrative for item 1451 states, “Additional fee for patients with an exceptional medical condition for the replacement of one or more amalgam fillings or the provision of a restoration in the permanent or deciduous teeth where a fee is payable under items 14(c)(1) or 14(c)(2) and where the request for approval is supported by the appropriate consultant’s report.”

By definition a pregnancy normally cannot be categorised as an exceptional medical condition therefore the use of this code for the provision of non- amalgam restorations in pregnant patients and nursing mothers is inappropriate and gives rise to an inappropriate claim under item 14(f), given the wording stated in the narrative.

In addition to the information issued in the 1990s regarding the potential risks in placing or removing amalgam fillings for this group of patients, current guidelines suggest that whenever possible dentists should delay such active treatment in these patients until after the baby is born unless the patient is in pain or there is active caries. In those circumstances, when immediate treatment is considered necessary, having carried out a risk versus benefit analysis, the following options for treatment are available under the NHS General Dental Services which comply with the suggested best practise.

Notes

1. A decision will be required regarding whether to remove any amalgam in the tooth or to leave this until post partum / post feeding as well as what treatment is required.
2. Removal of caries, restore or stabilise the tooth / teeth with composite, GIC, IRM, or other appropriate material.
3. Until we can ascribe an individual discretionary code the case should then be submitted to PSD to enable the discretionary code and fee to be applied before re-submitting for payment.
4. The discretionary fee to be applied will be £14.80 which is equivalent to the fee for item 1461 in the SDR.
5. Until we can ascribe an individual code we will require to assign three 99 codes as follows to enable the claim to be made and paid 9900 09, 9900 14 and 9900 20. (All three will need to be applied to make the claim and will be placed on the form by PSD). (The new discretionary code is likely to be 1484 but this will be confirmed as soon as it is in use).
6. We will arrange for a specific code to be applies as soon as possible.

For further guidance please click here.

 

As previously stated the Regulations confirm that the provision of permanent composite resin restorations involving occlusal surfaces of premolar or molar teeth for adult patients including pregnant patients or nursing mothers is not available under the GDS arrangements unless an exceptional medical condition applies. This information updates and supersedes that previously issued earlier in 2011.