A summary of: Edwards JA, Ford L, Boyle C. 2015. Dementia and Dentistry. Dent Upd 42(5): 464–472.
Dementia is one of the most common conditions seen In NHS patients with it being estimated over 1 million people will be suffering from it in the UK by 2025 and many more who may be undiagnosed. However early diagnosis can lead to a better prognosis. Dentists may be the first healthcare professionals who encounter these patients and notice initial changes in cognition.
There are several different types of dementia including vascular dementia, mixed dementia, Lewy-body dementia and fronto-temporal dementia each can impact the management and treatment of patients.
Early stages
- Early memory loss
- Difficulty in decision making
- Oral hygiene may deteriorate
Middle stages
- Alteration in behaviour is more apparent – may need to remind pt to wash and eat
- More marked confusion and memory loss
- Confusion and agitation
Later stages
- Increased fragility and mobility problems – difficult to get into the surgery. May be bed confined
- May cause difficulty eating and swallowing
- Loss of speech and communication
- At this stage dental care aimed at comfort
Dental management of dementia patients
- Communication should still be two ways
- Important to understand patient may be more confused and information gathering may be slower
- Simple language, speaking clearly and slowly, but without making patients feel stupid
- Allow time for patients to ask questions
- Maintain eye contact, smile and constantly reassure patients
- May need to repeat or rephrase
- Ensure up to date medical records are kept – liaise with GP
- Try to treat patient on ‘on days’
- Document everything
Consent
- Valid and informed consent must still be obtained.
- Can assess patients capacity by seeing if they can understand, retain, weigh up and repeat back information – under the Mental Capacity Act 2005
- If they can’t see if there is a prior advanced decision, lasting power of attorney or any other court ordered decisions
- Always act in the patients best interest
- In difficult patients where no one can consent for the patient an independent mental capacity advocate (IMCA) can be sought to aid decision making in the patient best interest.
As dementia progresses mental cognition and co-operation may decline and their access to dental care may become less frequent. It may be difficult treating patients as their dementia advances hence treatment planning in accordance with their rate of progression is necessary. This may involve a multi-disciplinary approach.
Summary by Sohum Pandya, University of Newcastle, BDS 5