For many people and communities, travelling to the dentist at a dental practice can be a big barrier to care... whether that be because of issues with mobility, inability to afford travel or many other reasons. So taking care to patients in their environment, what are the options?
Domiciliary Dental Care
I have previously blogged about what domiciliary care or 'doms' is here and my top tips. The perception might be that doms is limited to care homes, but it is taking care out into peoples' homes which can include care or residential homes, but also people's own homes or even hostels or hospitals.
Domiciliary care can vary depending on what equipment is available to the dentist providing the service as well as the suitability of the patient and environment. I have worked in Community Dental Services providing doms and even between different CDSs, the care varied. Some used hygienists and therapists to provide aspects of care, some had access to mobile equipment such as handpieces and portable suction and x ray equipment; but some did not have access to all of this. On the whole the majority of care provided in a doms service is limited to the following, unless more equipment is available:
- Examinations
- Prevention and fluoride varnish application
- Simple restorations using Atraumatic Restorative Technique (ART), some services also are piloting the use of Silver Diamine Fluoride (SDF)
- Denture construction
- Simple scaling
- Simple extractions
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| Going out on doms in the one of the CDSs I worked in... medical emergency kit and oxygen in hand/on back! |
For each domiciliary visit, a risk assessment must take place which will cover aspects such as assessing the environment for potential risks (e.g. what floor it is on, how far away is parking, trip hazards etc), the patient suitability (e.g. medical risk, manual handling risks, behaviour risks) and treatment risks (for example, if an extraction is needed how complex is it, do you have the correct equipment etc). There are guidelines which should be followed when providing domiciliary care.
Currently on the NHS, the only services that can provide domiciliary care need to have an Advanced Mandatory Service contract - therefore the majority of these services are as part of a CDS although not all of patients who require domiciliary care require the input of a special care dental service. There are some private services or dentists who will provide doms, but these are not very common as the legislation surrounding logistics of this model of care (CQC requirements to carry medical emergency equipment for example) put services off.
Mobile Dental Surgeries
Mobile Dental Surgeries or Units are dental surgeries on wheels in the back of a van or trailer. They can be expensive to purchase and run, but give the flexibility of taking a fully-equipped dental chair (including x rays, handpieces etc) out and about in communities.
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| An example of a MDS/MDU |
MDS/MDUs are still used up and down the country by CDSs and other dental services including charities. They often provide care for populations such as:
- People experiencing homelessness
- Care at Special Schools
- Care home residents
- 'Hard to Reach' communities such as fishermen and their families, asylum seekers, people in rural areas
- Care in prisons or secure units
In order to provide care in this way, it might take more staff (for example to drive the vehicle) and resources (such as parking facilities) but it can increase engagement for people who would often not engage, or struggle to engage, with dental services otherwise. You can also provide more treatments than just a domiciliary visit alone. Many MDS/MDUs can be adapted for people with accessibility problems - for example I have worked on units with chair lifts or even hoists for people in wheelchairs.
Overall, taking dental care out to communities where access is a problem can increase engagement and allow people to get dental treatment. Domiciliary or mobile dental care using MDS/MDUs might suit some of the following populations:
- Older people in care or residential homes (or in their own home) where they might struggle to get to a dental appointment due to medical, physical, psychological or social reasons
- People who experience homelessness who wouldn't engage with fixed appointments at fixed site practices
- Prisons or secure units where residents cannot be brought out of their residences
- Schools (particuarly Special Educational Needs schools)
- Rural environments or populations with little access to dental clinics
- Fishing communities
- Gypsy and Roma Travellers - lack of trust might stop them leaving their community to access care
- Asylum seekers and Refugees living in accomodation such as hotels
- Health 'one stop shops' or pop-up health events in the community e.g. Crisis at Christmas
- People in hospital, hospices, or as part of End-of-Life Care.
And I am sure there are many more...
Have you worked on doms or on a MDS/MDU? What were your experiences and challenges? Please leave them in the comments below.
