Reasons for referral of very elderly patients to the community dental service in rural England and the implications for developing oral health care services

Evidence summary: why is access to dental care for frail elderly people worse than for other groups?

In August 2009, members of the newly redeveloped Primary Care Dentistry Research Forum (http://www.dentistryresearch.org) took part in an online vote to identify questions in day-to-day practice that they felt most needed to be answered with conclusive research. The question which received the most votes formed the subject of a critical appraisal of the relevant literature. Each month a new round of voting will take place to decide which further questions will be reviewed. Dental practitioners and dental care professionals are encouraged to take part in the voting and submit their own questions to be included in the vote by joining the website.This paper details a summary of the findings of the first critical appraisal. In conclusion, the critical appraisal has identified that primary research is needed to look at the subject of access to dental care for frail elderly people. Similar barriers to accessing care for this group of people are still being reported today as they were 20 years ago.

Provision of domiciliary dental care by Scottish dentists: a national survey

Demand for domiciliary dental care is increasing as a result of a growing population of elderly and functionally dependent patients, legislative pressure and an increasingly dentate population.

OBJECTIVE

To estimate the amount and types of dental care currently being undertaken on a domiciliary basis in Scotland and to examine the barriers to the provision of such care.

METHOD

A descriptive study, involving a self-administered postal questionnaire was employed. All general dental practitioners (n = 1,995) and community dental officers (n = 200) in all Health Board areas across Scotland were included in the postal survey. Data were analysed in SPSS.

RESULTS

The valid response rate was 66%. Sixty-seven percent of dentists undertook at least one domiciliary visit per year, mainly for elderly patients. Prosthetic treatment was undertaken most commonly. Other types of treatment were delivered mainly by the community dental service. Many dentists did not carry a light source or emergency essential drugs and half of the dentists overall were not confident to administer emergency drugs. Significant problems were identified in relation to the packaging and carriage of contaminated instruments and clinical waste. Of those respondents not providing domiciliary care, 19% stated that they would never consider doing so. Barriers to the provision of domiciliary care included time, poor remuneration, concerns about infection control, emergency drugs and lack of suitable equipment, and the difficulties of carrying equipment.

CONCLUSION

Staff training, specialist equipment and new service models for the delivery of domiciliary care are required.

Public dental health care program for persons with disability

The objectives of the study were (1) to describe the organization and content of the Danish public oral health care program for persons with disability, and (2) to analyse possible variations in relation to the goals and requirements set by the health authorities. Data were collected by means of self-administered questionnaires completed by the person responsible locally for the program in each municipality. The response rate was 84%. The following topics were included: (1) Number of persons attending the program, (2) procedure for identification of persons eligible for the program, (3) payment of service, (4) providers of oral health care, (5) special training of staff, 6) dental services delivered, (7) ethical issues, and (8) patient rights. Less than one-third of persons estimated by the health authorities were enrolled in the program. On average, 0.4% of the municipal population attended the program, ranging from 0.03% to 1.53%. In large municipalities, and where internal providers delivered oral health care, relatively more persons were enrolled in the program (p < 0.001). Overall, more than 20 categories of personnel were involved in the selection procedure; attitude and lack of knowledge of oral health and oral health care for persons with disability were barriers to equal access to the program. Preventive dental services were the most frequent services delivered, although relatively few oral hygienists were involved in the program. Special training was most frequent in large municipalities. To secure equal access for persons with disability, it is recommended that joint collaboration between smaller municipalities should be made regarding procedures of such programs. Special training of dental personnel and of the staff responsible for selecting persons for the program should be systematically organized at a higher administrative level. The pattern of dental services delivered justifies further involvement of oral hygienists in the program.