The Probe - Proudly serving the dental profession for over 60 years

The pandemic challenges to domiciliary dentistry

News

  Posted by: Dental Design      13th June 2021

Dental practices are the ideal environment for providing dental care but for some patients, visiting the surgery is not always possible. Many elderly individuals, in particular, rely on the dental team to come to them, whether in their own home or a residential care setting. During the COVID-19 pandemic – with “stay at home” guidance often being paramount – there has certainly been a greater demand for domiciliary dentistry in order to reduce the associated infection risks of attending the practice for treatment. This has necessitated the adaption of existing protocols and procedures to ensure the continuity of high quality care. 

One of the many challenges to domiciliary dental services – particularly during the first national lockdown in the UK – has been communicating with the elderly population and triaging appointments remotely for this patient demographic. Dental teams have worked closely with other allied healthcare professionals, as well as patients’ family members and carers, to ensure the accessibility of essential treatment. In this regard, video consultations and remote treatment monitoring platforms have been incredibly useful in limiting the need for high-risk patients to attend the practice, thus minimising opportunities for cross-infection.

Clinicians have been able to utilise digital technology to its fullest extent in order to educate patients and emphasise the importance of disease prevention through regular interdental cleaning and twice-daily toothbrushing with fluoride toothpaste. Regular telephone and/or video consultations have been an ideal means to provide consistent oral hygiene advice and instructions to support vulnerable patients that may struggle to clean their teeth properly on a day-to-day basis. This has been particularly invaluable for those with advanced mental health complications such as dementia, which can frustrate efforts to maintain good oral health.   

In that same vein, dental teams have also had to contend with the challenges of elderly patients with complex and/or extensive medical histories, who are often prescribed multiple medications to manage their condition. There was no doubt that it became more important for the team to liaise with general practitioners (GPs) so as to ensure a patient’s complete medical history was accessible and, therefore, could be used to inform how dental clinicians approached domiciliary visits. Similarly, professionals may have also liaised with pharmacists to ensure prescriptions for any dental treatment provided were posted to patients whenever possible and appropriate.

Before any domiciliary services could be provided, dental professionals would have had to be properly fit-tested for personal protective equipment (PPE). It was important that domiciliary care settings were treated as high-risk areas for cross-infection, which underscored the need for stringent protocols involving the donning, doffing and disposal of full PPE that would typically be used for aerosol generated procedures (AGPs). Additionally, guidance on attending domiciliary visits would have revolved around safely travelling to such sites (with emphasis placed on avoiding public transport as much as possible), and performing regular COVID-19 screening/testing.

Of course, many clinicians are likely to have used their own vehicles to travel between domiciliary visits, following procedures on the set up and cleaning of the vehicles to minimise cross-infection risks. Collaboration with care home staff or family members/carers was essential to ensure an appropriate “clinical space” was provided for each visit. This is likely to have involved making sure that the area was well-ventilated and positioned in such a way as to minimise unnecessary movement within the home or residential care setting, which can increase the risk of an infection being transmitted. During domiciliary visits, the tools at a dental professional’s disposal would have also been vital to the provision of timely and effective care.

Clinicians may have benefitted immensely from portable solutions such as handheld x-ray devices, which facilitate accurate, chairside diagnostics. Some dental teams could have been limited to using only manual instruments to perform treatments such as prophylaxis – leading manufacturer, W&H offers an alternative with the Proxeo TWIST Cordless. This cable-free handpiece is not connected to an air or water supply, which helps minimise opportunities for cross-infection during oral prophylaxis treatment. The highly ergonomic Proxeo Twist Cordless handpiece features a cordless foot control and innovative W&H 

disposable prophy angle heads, making it the instrument of choice for performing prophylaxis within a domiciliary care setting.

The COVID-19 pandemic has proved incredibly challenging for everyone within the dental profession. Practice teams have had to adapt to ever-changing guidelines and regulations, in addition to the difficulties imposed by regional and national lockdowns. One particular challenge has been providing domiciliary care to those who are unable to attend the practice, including some elderly patients. Dental professionals have demonstrated how resilient and flexible they can be in adapting protocols according to patient need. Clinicians will, no doubt, continue to develop, monitor and re-evaluate these protocols to ensure the continued provision of domiciliary dentistry both now and in the future as we recover from the COVID-19 crisis.   

 

To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com


Join our
Mailing List

Sign up to our newsletter and keep up to date on the latest happenings in the dental market.

Sign up today