Oral pain and discomfort in people living with dementia

Paul Newton from the University of Greenwich developed a project, funded by Health Education Kent, Surrey and Sussex, to explore current practices, perceptions and experiences of identifying and managing dental pain in older people living with dementia in Kent.

Background

Approximately 800,000 people in the UK are living dementia, with the prevalence set to double in the next 30 years. At the same time, people are ‘keeping their teeth’ to old age and there is an increased prevalence of tooth decay and dental pain in the older population. For patients living with dementia there is an increased risk of deteriorating oral health – and thus the potential to experience dental pain – brought about by factors such as to poor monitoring of oral hygiene and the effects of poly-pharmacy.

Good Practice

The projects’ objectives were to identify training needs and inform the development of training resources that promote the management of dental pain in older adults living with dementia by:

1) Identifying and describing current help-seeking and treatment pathways when people ‘living with dementia’ experience dental pain;

2) Gauging healthcare professionals’ and informal carers’ knowledge, skills and attitudes towards managing dental pain in people living with dementia;

3) Exploring any barriers and enablers that carers experience in identifying and managing dental pain in people living with dementia;

4) Integrating the findings of into an assessment of current training needs.

A mixed-method research process was used:

First, a patient case note review was conducted to explore pathways to special care dentistry. It was found that informal carers in the community and family members most frequently sparked referrals for people living with dementia to access special care dentistry. This was due to carers having close day-to-day contact that enabled them to the spot signs and symptoms of oral pain.

Secondly, a survey of healthcare professionals on managing dental pain in people living with dementia was conducted. This found that many healthcare professionals were unsure about how to manage dental pain in people with dementia and would welcome more training in this area.

Thirdly, focus groups were conducted to explore informal carers’ experiences of identifying and managing dental pain in people living with dementia. It was found that there was poor awareness if special care dentistry services amongst informal carers and greater outreach by these services was needed. Carers felt that their role in helping people living with dementia to get treatment was important, and that both carers and dental professionals could benefit from training in managing behaviour in dental settings.

Finally, a ‘nominal group technique’ meeting was conducted – where key stakeholder representatives (carers, dentists and commissioners) ‘problem-solved’ issues arising from the data and offered advice. The key recommendations arising from the study were that:

1) Special Care Dentistry staff actively participate in local dementia groups to raise awareness of the service;

2) Dental practitioners receive training in managing people with dementia, and sign-post their practices as dementia friendly;

3) A training package for carers on behaviour management whilst brushing teeth, and when visiting dental settings be developed.