The Appointment: a film to support working towards dementia friendly dental practices - presentation at the Faculty of Public Health annual conference 2016

1. 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

2. • 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
@NHS_HealthEdEng

3. • 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
@NHS_HealthEdEng

4. 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
@NHS_HealthEdEng

5. Dental diseases are preventable
• Effective daily mouth care using
correct products
• Person centred approach
• Dietary considerations
@NHS_HealthEdEng

6. 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
@NHS_HealthEdEng

7. “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
@NHS_HealthEdEng

8. Poor oral health for older people
• Painful teeth, ulceration and
mouth infections
• Dry mouth
• Ill fitting or lost dentures
• Increased risk of dental disease
@NHS_HealthEdEng
Demonstrated
association between
bacteria in the mouth
and aspiration
pneumonia

9. • 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
@NHS_HealthEdEng

10. The Appointment
Film available (free)
on YouTube
or from HEETV Dental School
website
@NHS_HealthEdEng
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

11. 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
@NHS_HealthEdEng

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

13. • 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?
@NHS_HealthEdEng
Watch together as a team
Reflective learning

14. • 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
@NHS_HealthEdEng

15. Dementia Friendly Communities
The Alzheimer’s Society have a vision to
empower people with dementia to have high
aspirations, confidence and know they can
contribute

16. 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

17. • 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
@NHS_HealthEdEng

18. What’s the problem?
@NHS_HealthEdEng
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

19. 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
@NHS_HealthEdEng

20. Patient compliance
• Motivation
• Behaviour
• Cognitive ability
• Dexterity
• Anxieties
• Sensory perception
• Consent
@NHS_HealthEdEng
Depends on:-

21. • 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
@NHS_HealthEdEng

22. Products available
• Pink sponges/ lemon and
glycerine swabs
• Water
• Toothbrush with a large head
• Strong tasting, foaming
toothpaste
@NHS_HealthEdEng

23. • 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
@NHS_HealthEdEng

24. 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
@NHS_HealthEdEng
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)

25. 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
@NHS_HealthEdEng

26. CHIN
C • Check
H • Help
I • Inform
N • Note
@NHS_HealthEdEng

27. A clean mouth is essential
@NHS_HealthEdEng
People
may need
help
How to offer
support
Addressing
specific problems

28. Dementia care

29. • 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
@NHS_HealthEdEng

30. 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
@NHS_HealthEdEng

31. 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