TOOTH GERM: LD

Additional Procedures for Patients with Learning Disabilities undergoing Dental Treatment under General Anaesthesia

Publications all seem to come at once... the latest I've co-authored has just been published in Learning Disability Practice and is about additional procedures for patients with learning disabilities having general anaesthetic for their dental treatment.

I have written about the use of GA in Special Care Dentistry previously here. GA is an important adjunct for patients who have additional needs who are not able to cope with dental treatment under less restrictive measures. This can be patients with cognitive issues, severe dental phobia, severe mental health issues or patients with learning disabilities.

When coordinating dental care for these patients, GA or sedation episodes can be excellent opportunities to potentially carry out additional procedures which would otherwise either not be possible for these patients, or very difficult. It can also mean that patients do not have to have multiple anaesthetic episodes for multiple procedures which is unnecessary and can be traumatising for the patient.

Examples of Additional Procedures

Blood tests
Ear nose and throat procedures such as removal of ear wax (suctioning), examinations
Gynaecological procedures e.g. smear tests, coil (re)placements
Additional images e.g. MRI scans
Vaccinations e.g flu, COVID
ECGs
Personal care e.g. hair cuts, finger or toenail cutting

Coordination of care can sometimes be the trickiest part of planning for additional procedures, for example liaison between different medical specialities. Often, as what we advocate in this paper, this can be done by Learning Disability Nursing teams.

Not only will co-ordination of care avoid multiple GA episodes, but can pick up potentially undiagnosed issues in these patients - something known as diagnostic overshadowing.

What is important when planning for additional procedures in these patients is that decisions are made in their best interests if they lack capacity to consent and the least restrictive measure is taken. For example, GAs are not given just for blood tests, but is there an option for acclimatisation, behaviour management or anxiety management in order to optimise getting bloods?

To read the full article click here.

Have you organised multiple procedures for patients having their dental treatment done under GA or sedation? Please share your experiences in the comments below.

TWITTER . INSTAGRAM . LINKED IN . FACEBOOK

14:47

1 Comments

Learning Disabilities and Oral Health

As a Special Care Dentist, I spent a lot of my time managing and looking after people who have Learning Disabilities... so what adaptations do I have to make?

What is Learning Disability?

A learning disability (LD) is a reduced intellectual ability and difficulty with everyday activities such as household tasks, socialising or managing money. This affects someone for their whole life. According to the charity MenCap, people with a learning disability tend to take longer to learn and may need support to develop new skills, understand complicated information and interact with other people.

There are different types of learning disability, which can be mild, moderate, severe or profound. In all cases a learning disability is lifelong. People who are at the more profound end of the spectrum will need more care and support in areas such as mobility, personal care and communication.

A learning disability occurs when the brain is still developing which can be before, during or soon after birth. There are several causes of a learning disability, such as if the mother has an accident while she is pregnant, or from genetic mutations, or from deprivation of oxygen during childbirth, or premature birth.

You are described as disabled under the Equality Act 2010 if you have a mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities.

Approximately 1. 5 million people in the UK have a learning disability.

What about the Oral Health of People with Learning Disability?

There has been evidence to show people with disabilities have a poorer standard of oral health, with:

Higher levels of periodontal disease
Greater gingival inflammation
Higher numbers of missing teeth
Increased rates of edentulism
Higher plaque levels
Greater unmet oral health needs
Poorer access to dental services and less preventative dentistry

Access to generic high street services can be challenging as they are often designed without the input of a person living with disabilities. While more specialist services exist to cater for disabled people such as community or hospital dental services, there can still be barriers which prevent access for these groups such as:

1. Accessibility

People with learning disabilities may find getting to a clinic difficult in the first place. Services may not be close to public transport links or be centrally located so patients do not have to travel great distances or have parking facilities for patients who need to travel by car.
Patient pathways may not be clear, with difficulty getting into a service or being able to self-refer themselves to services.
Many patients with learning disabilities also have physical disabilities and are confined to wheelchairs. This could mean ensuring there are accessibility barriers for patients who are wheelchair users with services lacking ramps, ground floor surgeries or lifts, or specialist equipment such as hoists or wheelchair tippers. Not only the dental surgery itself, but the building it is in may have barriers, such as lack of adaptations including wide doors, bariatric waiting chairs and toilets and disabled toilets such as a Changing Places toilet.
The environment may not be designed so it is calming for patients with mental or social disabilities such as autism; calm music being played, toys or paintings for example can help.
A disability-friendly service should be available for people to access at an accepted distance to travel for these patients. There should not be a postcode lottery as to what facilities services are commissioned to do. Commissioners should follow the Special Care Commissioning guidance in order to provide an equitable standard of care across regions.

2. Affordability

We know that patients with learning disabilities are more likely to live in poverty. The cost of dentistry itself might not be affordable for these patients.
If they are NHS patients, it may not be clear and easy to find out whether the patient is exempt from dental charges.
Appointments might not be at convenient times for carers/relatives to bring patients to, or the clinic be too far away for patients who may struggle to afford to pay for travel to the clinic.

3. Consent, Cooperation & Communication

Many patients with learning disabilities may not have capacity to consent, although it should always be assumed that the patient has capacity. The principles of the Mental Capacity Act should be followed to make reasonable adjustments to help patients understand the consent process if possible, or if not, clinicians act in their best interests.
Independent Mental Capacity Advocates may need to be consulted where decision making is unclear.
Patients with learning disabilities may have difficulty in communicating. This may be as profound as being unable to communicate if they are experiencing dental pain, but also whether they understand instructions given by clinicians or to express decisions.
Aids such as easy-read, pictures or Makaton may be useful aids for communication,
Many patients are anxious, uncooperative or have compounding factors such as hypersensitive gag reflexes or tremors and therefore would require sedation or general anaesthetic to be able to manage treatment.
Not all dental services provide these; with a lack of appropriate facilities, such as theatre space, as well as appropriate staff training and skill mix or staff who are used to working with these patient’s needs.

4. Education & Social History

People with learning disabilities may not be aware of the importance of oral health, or how to access a dentist when they need it. This may result in an increased burden of dental disease, or patients not accessing services regularly.
People who care for patients with learning disabilities may not value oral health above the other health and social care needs of their patients. If these patients are housed together, managing the needs of multiple people with social care staff who may be understaffed or under-motivated could result in lack of oral care, or delayed presentation to dental services.

5. Co-Morbidities

Some patients with learning disabilities have other co-morbidities that affect their oral health.
For example patients with Down Syndrome while have learning disabilities, are more prone to periodontal disease and other tooth anomalies.
Patients with Autism Spectrum Disorder could suffer from trauma following an epileptic seizure or with stimming habits that affect their oral health.

To find out more, check out this great guidance document by Public Health England about Dentistry and Learning Disabilities.

Do you have any questions about learning disabilities and dentistry? Please leave them in the comments below

TWITTER . INSTAGRAM . LINKED IN . FACEBOOK

21:04

0 Comments

Additional Procedures for Patients with Learning Disabilities undergoing Dental Treatment under General Anaesthesia

Examples of Additional Procedures

Learning Disabilities and Oral Health

What is Learning Disability?

What about the Oral Health of People with Learning Disability?

1. Accessibility

2. Affordability

3. Consent, Cooperation & Communication

4. Education & Social History

5. Co-Morbidities

About me

Follow Me

Popular Posts

Categories

Top Categories

Follow on instagram