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​'BDA case mix 2.0': new version of tool for special care and paediatric dentistry

29 March 2019


The BDA launches the new version of the BDA case mix tool today at the Royal College of Surgeons, promising to build on an unrivalled approach to scoring patient complexities, with new criteria covering paediatric dentistry.


The BDA first launched the tool in 2008 to help dentists score the complexity of patients requiring special care dentistry. It has since become the gold standard for scoring patient complexity according to six identifiable criteria. The results are used in both commissioning and contract matters and also wider epidemiological work.


Following calls from commissioners to use the tool to measure paediatric dental patient complexities the tool has received a root and branch update, with new criteria geared around the needs of young patients, following input from the British Society of Disability and Oral Health and British Society of Paediatric Dentistry. Definitions already included for adult patients have also been revised.


Discussions with IT suppliers are already ongoing and the BDA will be producing training on the new tool later in 2019.


Although CDS dentists are its prime users, the tool can be used by general dental practitioners or secondary care providers who are treating patients requiring special care and paediatric dentistry. The BDA is now working across wider health and social care sectors to promote the model.

Chair of the BDA's England Community Dental Services Committee, Charlotte Waite, 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.


"For over a decade BDA case mix has been used by individual dentists to demonstrate the complexity of their caseload and clinical directors to benchmark the clinics within their areas. This new version builds on a tried and tested system which has supported colleagues operating in all four countries of the UK.


"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.


"The sheer complexity and skill of the services we deliver can often be lost on health officials and commissioners. And that's where BDA case mix comes into its own. We have a framework that can help colleagues across the profession break down barriers, reduce health inequalities and deliver high quality dental care for all our patients."


About BDA case mix

The model identifies six independent criteria that, either solely or in combination, indicate a measurable level of patient complexity.


Each criteria covers both actual provision of clinical care for the patient, and the many additional pieces of work needed to facilitate care for many of these patients.


  • Ability to communicate
  • Ability to co‐operate
  • Medical status
  • Oral risk factors 
  • Access to oral care
  • Legal and ethical barriers to care

Each of the criteria is independently measured on a 4‐point scale where 0 represents an average fit and well child or adult attending for dental care, and A, B and C represent increasing levels of complexity.


The complexity may be related to the actual provision of care and/or the many additional actions necessary to facilitate care for such patients. The criteria and the scores given relate to a course of treatment (episode of care), and will normally be assessed when a course is either completed or discontinued.