delayed. These changes, together with a dry mouth due to xerogenic medicine, significantly increase caries risk.


PREVENTIVE DENTAL CARE Access to dental care can become more problematic as memory deteriorates. Communication of pain can be less specific, and it may become necessary to consider other behavioural changes such as altered demeanour, sleep and eating patterns, alongside objective signs such as swelling or reaction to palpation of soft and hard tissues. Anxiety and cognitive decline can mean reduced


cooperation in dental treatment and it may become necessary to consider intravenous sedation or general anaesthesia in some cases. It is vital to carefully balance the risks of these procedures against the benefits of treatment. Medical comorbidities, such as chronic cardiorespiratory disease, may present increased risks such as aspiration pneumonia or post-operative delirium in the cognitively impaired patient. Prevention of oral disease remains the foundation of


care for people with dementia. The best time to discuss possible future problems associated with dementia is following diagnosis, whilst cognition and the ability to accept care are largely unchanged. Removal of non- functional, non-aesthetic, carious and heavily restored teeth may be advised, rather than providing treatment which is unlikely to be maintained in the longer term. The shortened dental arch approach may be considered, with the overall aim of providing a functional, easily maintained dentition with good long-term stability. Regular preventive planning, including fluoride application, can be provided through a team approach using hygienists and therapists to deliver appropriate care – and this may be vital in establishing a continuing relationship with patients.


A patient living with dementia should be supported


to make their own treatment decisions for as long as possible, with information pitched at the right level and pace. Where capacity is shown to be lacking, any action taken must be in the patient’s best interests, taking into account any advanced decisions, previous wishes and beliefs. Those close to the patient should be consulted and the least restrictive options chosen. Onward referral to a more experienced or specialist colleague may be necessary where assessment of capacity is unclear.


CARE PATHWAYS AND CLINICAL NETWORKS Local structures will vary across the UK but the principle remains of using the right skill mix for patients matched to the complexity of their care. Supporting GDPs to provide care for people with dementia offers the benefit of establishing a familiar contact within the local community. Many dentists will have always provided long-term holistic care for patients with dementia and will continue to do so. These skills and experiences can be shared with healthcare colleagues. A whole-team approach is recommended, as


receptionists and dental nurses have a vital role to play in identifying ways to support patient care and could be the first to spot behaviour changes or difficulties which may indicate progression of dementia. Sometimes simple adjustments and greater general awareness of dementia can greatly benefit the patient/carer experience, and increase their ability to access dental care in the longer term.


Specialist services will always be required for those with complicated cognitive and medical issues, but these should be reserved for the most complex cases. Thorough early assessment, regular review and tailored evidence-based prevention can have a significant impact on maintenance of good oral health in the long term, and can be effectively provided by the primary care dental team.


Suzanne Burke is a specialty trainee in special care dentistry at Liverpool University Dental Hospital


Lesley Gough is a consultant in dental public health at Public Health England (North West Centre)


Andy Kwasnicki is a consultant in special care dentistry, Liverpool University Dental Hospital


Access the full Dementia Friendly Dentistry toolkit at tinyurl.com/h74krcx


MDDUS INSIGHT / 15


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