The Appointment a film to support working towards

dementia friendly dental practices

Katy Kerr MSc BDS DDPH RCS(Eng) PGCertCE

Regional Dental Advisor HEETV/W

• Key public health drivers behind the project

• Explore why oral health is important, especially for a person with dementia

• Watch the film “The Appointment”

• Dementia awareness in general dental practice

• Ways to promote good oral health and help carers with mouth care

Aims

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• Cost of poor oral health

• Dental diseases are preventable

• Impact of disease on treatment outcomes

• Core standards and quality of care

• Complaints/ safeguarding

• Common risk factors

Key drivers for change

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Poor dental health costs the NHS

£3.4 billion a year

compared with

£4.7 billion

for excess body weight

PHE Sugar reduction: responding to the challenge. June 2014

Dental diseases are expensive

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Dental diseases are preventable

• Effective daily mouth care using

correct products

• Person centred approach

• Dietary considerations

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Oral health affects quality of life

• Direct effects e.g. dental pain, missing

teeth, Xerostomia (dry mouth)

• Impacts on eating, sleep, rest and social

roles

• Oral disease can increase risk of systemic

disease

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“Dementia costs the UK economy £17 billion

a year.” Living well with dementia: A National Dementia Strategy (Department of

Health 2009)

The resident population of

England and Wales in 2011

was 56.1 million

One in six people were aged 65 or over

(16 per cent = 9.2 million)2011 Census England and Wales

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Poor oral health for older people

• Painful teeth, ulceration and

mouth infections

• Dry mouth

• Ill fitting or lost dentures

• Increased risk of dental disease

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Demonstrated

association between

bacteria in the mouth

and aspiration

pneumonia

• Change in oral health could be early sign of

memory loss

• They experience higher levels of untreated

disease and it is more difficult to access dental

care

• Both pain and infection can decrease cognitive

function

Oral health in dementia patients

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The Appointment

Film available (free)

on YouTube

or from HEETV Dental School

website

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This video is based on an established collection of dementia awareness

DVDs called “Barbara’s Story” originally produced by Guys & St Thomas’s

NHS Foundation Trust and White Boat TV

Resource pack available for reflective learning

To raise awareness regarding the issues that affect provision of dental services for an individual with dementia

• Increase knowledge about dementia including identifying the early stages

• To consider how oral care may be delivered

• To gain insight into challenging behaviour and to be compassionate whilst caring for patients with dementia

• To maintain the dignity of the individual at all times

The film aims:-To support patients with dementia to

live well

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www.hee.nhs.ukwww.thamesvalley.hee.nhs.uk

• What have you learned from watching this film?

• How may your practice now change?

• What other actions may you take?

• Have any training/ further learning

needs been identified?

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Watch together as a team

Reflective learning

• Promote effective communication in the dental practice to

enable supporting people with dementia

• It can be stressful to treat people with dementia so it is

also important to build supportive relationships within the

team so that issues can be raised and

problems shared

Use a whole team approach

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Dementia Friendly CommunitiesThe Alzheimer’s Society have a vision to

empower people with dementia to have high

aspirations, confidence and know they can

contribute

How dementia friendly

is your dental practice?

• Dementia champion

• Training

• Audit using ISPACE

• Action plan

• Date for review

@NHS_HealthEdEng (Wessex Academic Health Science Network).

= Accreditation

• Carers can help the person by providing

company, assistance and help with

communication during a dental visit

• Maintaining oral hygiene if the person with

dementia is no longer able to do this.

Importance of Carers

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What’s the problem?

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Oral hygiene 48%

Safe staffing for older people’s wards 2012

Nurses reporting that activity was

left undone, or was done

inadequately on their last shift

due to lack of time

Care-resistive behaviour

•Refusal, not opening mouth

•Needing prompting

•Not understanding caregivers' instructions

•Not able to rinse or spit

•Biting toothbrush or caregiver

•Physical/verbal aggression

•Not permitting removal/insertion of dentures

Chalmers et al (2008) Spec Care Dentistry

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Patient compliance

• Motivation

• Behaviour

• Cognitive ability

• Dexterity

• Anxieties

• Sensory perception

• Consent

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Depends on:-

• Identifying who is responsible

• Not using an assessment

• Not having a routine for mouth care and the correct products

• Poor patient compliance

• Staff perceive that mouth care is not a high priority

• Other health issues prevent oral care

Common issues

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Products available

• Pink sponges/ lemon and glycerine swabs

• Water

• Toothbrush with a large head

• Strong tasting, foaming toothpaste

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• CQC registered Nursing homes must have Registered

Nurse and witness if Medication(s) are dispensed.

• Nurses are responsible for writing care plans

• Nurses can influence other care givers and

ensure mouth care is carried out

Important to train nurses

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An e-learning package to support the training of all healthcare professionals involved in mouth care

Three levels:

• Introduction to mouth care

• Mouth care for Adults

• Mouth care for people with

additional needs

Improving mouth care

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Interactive

Video links

Further reading and

practical exercises

PDFs of paperwork

Scenarios

(Developed in consultation with staff involved in the pre-registration nurse training and

piloted by students in Oxford Brookes, Southampton General and the John Radcliffe)

Content

• Evidenced based mouth care- for natural teeth and dentures

• Checking the mouth

• Assessment, care plans and documenting care

• Products

• Addressing common problems

• Strategies when oral care is difficult

Dementia care threaded

through all the modules

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CHIN

C • Check

H • Help

I • Inform

N • Note

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A clean mouth is essential

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People

may need

help

How to offer

supportAddressing

specific problems

Dementia care

• Formalising scheme for dementia friendly dental practice

• Raising the profile of oral health and influencing the care provided, including correct products

• Making training more widely available in mouth care

• Promoting the use of assessments and the inclusion of mouth care in care plans so that we ensure patients are receiving the correct advice and assistance

• Ensuring mouth care recorded in documentation

Currently working to promote

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Lots more work to be done ….

• Oral health included in dementia strategies, policies, guidance

• Oral health becomes integral part of health risk assessment in

care homes and hospitals

• Commissioning and funding for access to dementia friendly

dental care within suitable environments and domiciliary visits

when appropriate

• Robust referral and integrated care pathways

to appropriate local specialist dental care

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E-learning modules available on

E-Learning for Health

Thank you for listening

Improving Mouth

Care

Any questions?

@NHS_HealthEdEng

Katy Kerr Katy.Kerr@thamesvalley.hee.nhs.uk