Until March, when dental practices and clinics were told to suspend routine treatments, I spent a lot of time managing broken or painful teeth and problems, including in some really challenging circumstances. Often more drastic approaches have to be taken when care is sought at a later stage.
Working in Community Dental Services as a Specialist in Special Care Dentistry I only see patients with more complicated backgrounds and conditions that affect their ability to access a general dentist. A large component of this is people living with dementia referred from general dentists or care homes. The patient I see have a range of dental presentations but my experience matches what the epidemiological studies would suggest: people living with dementia have worse oral health outcomes than other patients of similar ages and have more dental pain, more decayed teeth and more plaque.
Dementia impacts dental health and care in a manner not really seen in other situations. Patients’ ability to experience or describe pain, to consent for treatment or to cope with treatment can all be affected. As dementia progresses, complexity of treatment delivery increases too. A major challenge arises in that sorting these problems may include removal of teeth which can cause further pain, loss of function for eating and speaking and an even greater impact on a person’s appearance. In extreme circumstances sedation or general anaesthetic is needed to manage dental complaints though this carries a range of medical and psychosocial risk. Figuring out what to do here can be highly challenging and there’s little evidence to guide clinical practice.
Here’s where my work comes in. Though this is difficult to manage clinically and there’s not too much evidence, there were still a range of ways the situation could be improved and research could focus on any of these. With support from the Alzheimer’s Society Research Network, the North East Dementia Alliance Network and local PPI representatives a project was designed to focus on decision-making and figure out, for patients and dentists, what dental care is most appropriate for each person.
We’re working to gain insight into patients’ and dentist’ experiences and viewpoints to help identify how we can make decisions about dental care in a more patient-centred manner, whether a person has capacity to consent or not. The plan was to observe dental visits and interview the dentists and patients involved. We gained Ethical and HRA approval in March 2020 though it quickly became clear that access to the dental clinics would be limited.
This has meant that some dentists have a bit more free time, so it’s been fascinating to speak to a range of dentists so far, and use Zoom to do so. Zoom has also been excellent in speaking to patients or carers! It’s been really effective in the midst of an unusual global situation and has opened up communication with those across the country that I may not have been able to speak to face-to-face. This approach wasn’t in the original protocol and an amendment was quickly approved to allow this approach: seeing peoples’ reactions and facial expressions provides a better experience for both parties than phone alone would have done. Even when COVID-19 is mostly behind us, this approach will be built into any of my further qualitative work and I’d encourage anyone else to give it a go! Overall, progress is slow in a pandemic but is being made bit by bit. There’s plenty to learn both as the project moves on and by doing it in such a strange time. At the back of my mind, though urgent dental care is available, is the ongoing worry about those unable to access dental care and the problems they may be experiencing, especially for groups who may struggle to express this. The aim to help this group is motivating me to keep making progress.
Andrew Geddis-Regan is a NIHR Doctoral Research Fellow, Senior Dental Officer and Specialist in Special Care Dentistry at Newcastle University & North Cumbria. Dementia impacts dental health and care in so many ways with people living with dementia having far worse oral health and more complex pain identification and management. Andrews research focuses on Dental Care Decision Making in Dementia, hoping to improve care and the lives of people living with dementia.