Tier 2 oral surgery: why access needs to improve in dentistry

Specialist oral surgeons Ashana Gupta and Tarun Nagpal talk through the ins and outs of tier 2 oral surgery, and the role in might play in the future.

As the NHS dental reform continues to progress, there’s growing recognition that there are skilled dentists who are suitably experienced to perform tier 2 oral surgery within the comfort of a primary care dental setting.

With nearly one million oral surgery-related hospital appointments recorded in England in 2016–17 alone, the demand is overwhelming an already stretched secondary care system.

At the same time, guidance from the British Association of Oral Surgeons (BAOS) and NHS commissioning groups is clear: there is scope to shift a substantial portion of oral surgery referrals made to hospital to the primary care setting.

What is tier 2 oral surgery?

The current NHS oral surgery model is structured into tiers based on complexity and patient needs:

• Tier 1: simple procedures within the scope of any GDP (eg routine extractions)
• Tier 2: intermediate procedures requiring enhanced skills of a clinician who may or may not be a specialist oral surgeon potentially in a primary care dental practice
• Tier 3: complex or medically compromised patients needing specialist or consultant-led care in secondary care facilities.

Tier 2 cases include: