Impact of a geriatric assessment and optimisation-based preoperative clinic on the management of older patients receiving dental treatment under general anaesthetic or conscious sedation: A service evaluation.

OBJECTIVES: The main objectives of the study were to review patient characteristics, recommendations made and treatment outcomes of frail/older patients referred to a specialist multidisciplinary geriatric assessment and optimisation-based preoperative clinic (PROKARE), prior to patients receiving dental treatment under general anaesthesia (GA) or conscious sedation (CS). BACKGROUND: Although the use of preoperative comprehensive geriatric assessment to improve pre/peri and postoperative mortality has been reported for many surgical domains, its use prior to dental surgery has not been reported previously. METHODS: The data were collected retrospectively from the dental notes of 52 patients referred from the Special Care Dental (SCD) Department to the PROKARE service for optimisation prior to dental treatment under GA/CS using a case note study approach. The data extracted included patient demographic characteristics, medical history, clinical management and the treatment outcomes for each patient. The data extracted was analysed with descriptive statistics. RESULTS: Key reasons for referral were caries management, retained roots and poor co-operation. Multiple co-morbidities were noted among the patients referred, with 14 (27%) having four or more co-morbidities. The PROKARE assessment identified issues such as treatment could be carried out under CS instead of GA; consent; and the need for medication change and/or further medical investigations. As per recommendations from PROKARE, 39 patients (75%) received dental treatment while five (10%) did not receive treatment, and a further eight (15%) died prior to treatment. CONCLUSION: Geriatric assessment and optimisation-based preoperative clinics in the dental management of frail, elderly patients having treatment under GA or CS techniques is valuable, but further research and assessment of current service provision are needed to increase the evidence base.

Hospital admissions for dental disorders in patients with severe mental illness in Southeast London: A register-based cohort study.

In people with mental disorders, adverse general health is well recognized but dental diseases remain underinvestigated. The objective of this study was to investigate risk factors for hospital admissions for dental disorders in patients with severe mental illness (SMI) and/or depressive disorder. De-identified electronic mental health records from the South London and Maudsley NHS Foundation Trust (SLaM) were linked to national Hospital Episode Statistics (HES) data for analysis. Data were extracted for adults with a diagnosis of SMI (schizophrenia, schizoaffective disorder, bipolar disorder) and/or depression, who had received care at SLaM between 1 January 2010 and 31 March 2017. In the cohort of 18,999 patients thus obtained, the following factors were independently associated with hospital admission for dental disorders: female gender [odds ratio (OR) = 1.48, 95% CI: 1.31-1.68)], Health of the Nation Outcome Scales (HoNOS) problem drinking/drug taking (OR = 1.12, 95% CI: 1.05-1.19), HoNOS physical illness/disability (OR = 1.18, 95% CI: 1.12-.25), diabetes (OR = 1.24, 95% CI: 1.06-1.43), recorded current/past smoking (OR = 1.35, 95% CI: 1.06-1.43), treatment with antidepressant medication (OR = 1.48, 95% CI: 1.31-1.68), and depressive disorder (OR = 1.36, 95% CI: 1.11-1.68). Building on previous research in this population, which indicated a relatively high risk of acute care hospitalizations with dental disorders as discharge diagnoses, a number of demographic and clinical characteristics were found to be independent predictors over a 7-yr period. Further research into these predictors would facilitate a better understanding of how adverse dental outcomes might be prevented.

Dysphagia and dentistry.

Dysphagia is defined as a 'difficulty in swallowing' and is commonly found in the general population, particularly in the elderly. This article gives an overview of the more frequently encountered swallowing disorders and provides advice on how to manage the dysphagic patient in the dental surgery. Clinical Relevance: By identifying patients with dysphagia and being aware of the potential problems that the clinician may experience when treating them, the risk of aspiration, choking and healthcare-acquired upper respiratory tract infections may be reduced.

Sedation for patients with movement disorders.

UNLABELLED: The general features of the movement disorders are outlined and the effects of inhalational sedation with nitrous oxide and oxygen and intravenous sedation, using midazolam, are described.Two case reports of patients with cerebral palsy treated in a community care setting are presented, and the advantages of intravenous and inhalational sedation are explained. CLINICAL RELEVANCE: Inhalational sedation (IS) with nitrous oxide and intravenous sedation (IVS) with midazolam can be useful aids to reduce unwanted movements in patients with movement disorders during dental treatment.

The Impact of Dementia on Oral Health and Dental Care, Part 1: Setting the Scene for Dental Care Provision.

There are over 850,000 people living with dementia in the UK and this figure is expected to rise to over a million by 2021. Increasingly, oral healthcare professionals in primary care will see more patients affected by dementia at varying stages of the disease, and it is therefore crucial that they have a basic understanding of the disease and how these patients can be managed in a primary care environment. The first article in this series of two provides a definition of dementia and describes the symptoms of the disease along with the key issues related to oral health, such as oral pain. Oral pain can have far reaching consequences, but identifying it can be problematic, particularly in the latter stages of the disease. This article will therefore cover how to diagnose pain in patients with dementia. Information is also provided about how to make dental surgeries more 'dementia friendly'.

The Impact of Dementia on Oral Health and Dental Care, Part 2: Approaching and Planning Treatment.

Dementia has been described as the biggest health and social care challenge of this century; its impact on dental care cannot be ignored. Dementia affects cognitive ability and decision making, so it is important that oral healthcare professionals are conversant with current mental capacity legislation and issues that may be raised when treatment planning for patients living with the condition. This second article in the series considers the impact of dementia on dental care provision and covers a range of issues which are relevant to both general and specialist practice. These include assessment of capacity, use of different treatment modalities, such as sedation and general anaesthesia, and the factors that may be relevant when deciding to offer treatment or to refer to a secondary care setting for dental treatment. Advanced care planning is detailed to support general dental practitioners considering the longer-term wishes of their patients with an early diagnosis of dementia.

A Qualitative Exploratory Study of Informal Carers' Experiences of Identifying and Managing Oral Pain and Discomfort in Community-Dwelling Older People Living with Dementia.

Increased prevalence of dementia and poor oral health in older people is associated with more people living with dementia who experience oral pain and discomfort. However, little is known about how informal carers manage oral pain for people living with dementia in the community. This study aimed to explore informal carers' experiences of identifying and managing oral pain and discomfort in people living with dementia, and barriers and enablers they encountered. Focus groups with informal carers of people living with dementia were conducted, transcribed verbatim, and analysed using thematic analysis. Carers' accounts suggested that day-to-day contact was required to identify oral pain and discomfort, and a symptomology of the signs and symptoms was developed. Carers' accounts also highlighted issues in maintaining oral health, difficulties in accessing the mouth, managing dentures, competing demands, and difficulties in accessing treatment due to health service-, behavioural- and treatment- related barriers. Enablers included informal carers' pivotal role in the identifying and managing oral pain and discomfort in people living with dementia. The study concludes that carers want more partnership work with dental professionals, and clearer care pathways are required to meet the oral health needs of people living with dementia who experience oral pain.