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F E AT URE D E N TAL PR A C T I C E


DEMENTIA FRIENDLY DENTISTRY


Dental care for patients with dementia presents some obvious challenges – but also opportunities


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ARELY a week goes by without another media story about the growing number of people living with dementia and the challenges we face as a society. Current predictions are that by 2025 there will be over one million people with the condition in the UK. So what are the implications for the dental team? Whilst the increasing number of people with dementia can bring challenges, there is also an opportunity for the primary care dental team to make a real difference. Good oral health enables people to enjoy a healthy


and varied diet, to smile and interact socially – these are especially relevant for people living with dementia to support adequate nutrition and a good quality of life. Dental pain can be detrimental to all of these aspects, thus mouth care and effective oral disease prevention should be a high priority. Even experienced special care dentists will agree that


the provision of operative dental treatment in the later stages of dementia can be challenging. A thorough oral assessment as soon as possible after diagnosis and careful treatment planning and prevention can significantly reduce the chances of future dental problems and allow patients to make decisions for themselves. Visiting the dental practice can be bewildering for people with dementia, even in the earlier stages. The appointment and reminder systems, busy waiting rooms, complicated forms and even shiny floors can all present difficulties.


TOOLKIT Cheshire and Merseyside are exploring a partnership approach to dental care for this patient group. Each dental practice in the region could have as many as 120 patients with dementia seeking dental care by 2025. Community dental services and hospital-based special care dentistry services have clinicians with additional skills and expertise – but care pathways and shared care arrangements with general dental practitioners are also needed. To this end a toolkit for the primary dental care team


was recently developed and tested in Cheshire and Merseyside as part of a ‘dementia friendly dentistry’ programme. Subsequent phases of this programme will establish systems to direct those who are newly


14 / MDDUS INSIGHT / Q1 2017


diagnosed with dementia to local dental practices for early assessment and care planning, and to streamline the dental care pathways between general dental practice, community and hospital services.


DEMENTIA AND ORAL HEALTH Following a dementia diagnosis, there are many issues to consider around the health and well-being of a patient and their future care – and oral health is an important component. In the early stages of dementia, oral care follows the same principles as for any patient. Preventive strategies should be tailored to the individual risk of oral disease, including caries, periodontal disease, oral cancer and toothwear. Current guidelines may be used to identify appropriate intervals for recall, radiographical examination and fluoride regimen. Early treatment decisions should take into account the


expected disease course and result in a dentition which can be maintained long term. As dementia progresses, risk of plaque-related disease increases and it may become more difficult to achieve a high standard of plaque control, particularly where a third party is relied upon for personal care. Advanced restorative dentistry, for example fixed bridgework and implant retained prosthesis, can present a particular challenge when dementia has progressed and oral hygiene may deteriorate. A number of other factors may affect diet and nutrition and as a consequence increase the risk of dental caries. These include an increased reliance on convenience foods, changes to taste and appetite, increased snacking and subsequent increase in sugar consumption. Dietary choices may be made by a patient’s carers,


or directed by medical needs. Nutritional supplements may be required in order to increase calorie intake, but these can also be high in sugar. Chewing may become more difficult, fluids may need to be thickened to prevent aspiration, and clearance of food from the mouth may be


“Special care dentists will agree that the provision of operative dental treatment in the later stages of dementia can be challenging”


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