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Mr Nigel Harradine
Tel no: 0117 342 4390
Specialist Areas: Orthodontics & Jaw Deformity

Miss Nicola Atack
Tel no: 0117 342 4390
Specialist Areas: Orthodontics

Mr Christian Day
Tel no: 0117 342 4390
Specialist Areas: Orthodontics

Mr Scott Deacon
Tel no: 0117 342 4390
Specialist Areas: Orthodonics, Cleft Lip & Palate

Prof Jonathan Sandy
Tel no: 0117 342 4390
Specialist Areas: Orthodontics

Dr Tony Ireland
Tel no: 0117 342 4390
Specialist Areas: Orthodontics


Please refer using the standard referral form

Further information on referral guidance for Orthodontics can be found here.

All patients are assessed under the care of a consultant for impartial expert advice and treatment planning regardless of their suitability for hospital treatment. The following guidelines should assist any decision to make a referral.

The following patients are appropriate for Hospital treatment by Consultants and Senior Trainees under supervision:

  • Cases requiring combined orthodontic and orthognathic surgical treatment.
  • Ectopic teeth requiring combined orthodontic and oral surgery treatment.
  • Cases requiring combined orthodontic and complex restorative treatment. e.g. hypodontia and advanced toothwear cases.
  • Patients with cleft lip and palate or other craniofacial anomalies (Mr. Deacon).
  • Medically compromised and handicapped patients with orthodontic needs.

A large number of other more routine orthodontic problems are required and highly valued for training undergraduates and postgraduate specialists. At times, such cases when referred to Frenchay and Southmead Hospitals may be offered treatment at Bristol Dental Hospital.

Adult patients not requiring multidisciplinary treatment may be suitable for treatment by trainees, but this is less likely if there have been previous extractions or orthodontic treatment.

There are no trainees in or geographically adjacent to Weston General Hospital. Cases in that area who require specialist treatment but are not appropriate for the hospital Orthodontic Service will therefore usually be referred onward to the local specialist practitioner.

All patients requiring active orthodontic treatment should have good dental health with regard to caries, periodontal disease and erosive diet.

Some patients not meeting the above dental health requirements - for example children with carious/hypoplastic first molars - may still benefit from a Consultant opinion. This is because judicious extractions or very simple treatment may be of benefit. This almost never applies to adult patients who should not be referred for orthodontic treatment unless in good dental health and prepared to wear fixed orthodontic appliances.

Orthodontic extractions under GA

With the recent and far-reaching changes in Guidelines for Provision of General Anaesthesia for Dental Procedures, it is helpful to clarify the situation relating specifically to extractions of permanent teeth as part of orthodontic treatment. These guidelines have arisen following discussions with colleagues in all relevant dental specialties in Bristol and have indeed been part of a National discussion within the Consultant Orthodontists' Group. They are intended to help us achieve best practice in this area. Specifically, the guidelines are intended to:

  • Focus the provision of general anaesthesia in this field entirely on appropriate cases
  • Minimise inappropriate referrals for general anaesthesia
  • Ensure that the type of anaesthesia to be used during extraction is clarified at the time of orthodontic diagnosis so that, for example, the consequences of a patient feeling unable to accept local anaesthesia can be part of the revised orthodontic plan which may well involve a decision not to provide orthodontic treatment.


Orthodontic extraction of permanent teeth should normally be under local anaesthetic unless there are clear and positive indications for general anaesthetic.

Common indications for consideration of general anaesthetic would be:

  • Extraction of first molars in younger patients
  • Patients with special needs resulting in all treatment requiring general anaesthesia; each case will be individually assessed on its own merit.
  • If the patient does not fall in one of the categories for consideration of general anaesthesia but refuses to contemplate local anaesthesia, then strong consideration should be given to altering the orthodontic treatment plan to one which does not require extraction. This might mean planning no orthodontic treatment at all or planning greatly modified orthodontic treatment. This modification of the plan is clearly the responsibility of the clinician carrying out the orthodontics.
  • If the patient is referred for orthodontic extractions these decisions should have been discussed and agreed by the orthodontist, patient and parents.

The role of guidelines

These guidelines are intended to help patients, parents and clinicians strike the best balance between the potential benefits of orthodontic treatment and the very small chance of serious complications from general anaesthesia. As with all guidelines, they aim to assist decision making in general in a particular area. As always, there will be individual patients for whom these decisions remain difficult in spite of these guidelines.

If there are any queries about the guidelines in general or about a specific patient, then please contact a Consultant in the appropriate specialty.

Information for patients