Our friends at the Dental Elf have brought these updated guidelines to our attention. This is what they said:
These guidelines were originally a joint initiative between the Development Group for Community Dental Practice of the Faculty of Dental Surgery of The Royal College of Surgeons of England and the British Society for Disability and Oral Health. The aim of these Guidelines is to improve the oral health of people with learning disabilities by increasing the knowledge and skills of all those involved in the provision of their care.
The guidelines have a wide target audience: Everyone involved in the care of people with learning disabilities – including service users, their parents and families, carers and advocates, health and social service commissioners and providers, dental and health professionals, education and training establishments, private and voluntary sector organisations, and planners and politicians.
The authors hope that these guidelines will provide the foundation for local guidelines and protocols for this group of patients. To this end there are large number of recommendations, the majority of which are based on expert consensus, as high quality evidence is not often available for this widely varied patient group. In addition to recommendations there is practical advice and information regarding a number of other useful UK resources as well as recommendations for future research.
The full guideline is available to download from the BSDH website
Clinical Guidelines and Integrated Care Pathways for the Oral Health Care of People with Learning Disabilities 2012
British Society for Disability and Oral Health
Making sure that people with learning disabilities are aware that oral hygiene is important can be very difficult for their care givers. Cleaning one’s teeth is a part of everyone’s daily ablutions, but if that person has challenging behaviour it can be nigh on impossible to get them to cooperate in the task of cleaning their teeth.
It is however good to see guidelines being suggested that makes care organizations aware of the importance of good oral care.
My own son who has a learning disability has always been keen to make sure he cleans his teeth twice a day and I am thankful for that. The dentists that oversee his oral care are and always have been very caring, patient and very professional in their dealings with him. (He has been seeing them for the last thirty years since he was ten). However there has been a new directive coming down from our heathcare board which now states that ‘if you fail to attend an appointment, or cancel at short notice, you will be informed that if you fail to attend again, you will be discharged from the Special Care Dental Service’ Whereas I quite agree in normal circumstances these rules are quite reasonable, where a service user has challenging behaviour it is unreasonable to penalise their oral health care if on the morning of their appointment they have one of their challenging episodes. The fact that this clinic is run specially for people who have special needs, I would have thought that these sort of situations would have been treated much more sensitivity and I find this new directive quite cruel.
Thanks for your comment and once again sharing your personal experience. I understand the need for any clinical service to manage its resources and ensure that it keeps non attendance down to a minimum. Equally, I can’t help but feel that the situation you describe runs counter to personalisation/patient centred care and the need to make reasonable adjustments.
I wonder if other readers have anything to add about experiences in their area?
It is a difficult area. Most Special Care Dental Services are oversubscribed and thus very busy.
As a rule we do not dischrge peple from our books although we do stop sending letters and attempting to phone repeat on-attenders, instead waiting for them to contact us.
The issue is not usually so much with the patients themselves but with carers. They are the ones who forget, don’t organise transport, don’t check diaries, don’t realise the needs of their patients, etc
I’m involved with Nottheast Autism, and also have a daughter with Autism who has very limited communication and lives in supported provision. In her case it’s getting past the anxiety of accessing dental services at all, so we’ve had some false starts in the past. Nowadays we have been developing a process where she has a general anesthetic on an annual basis, and that is now well planned in advance, and the associated inspection and treatment must have saved her suffering toothache which she could not explain. Her local hospital (sunderland Royal) are now developing a pathway for this sort of event. I quite agree that it’s very difficult to ensure that adjustments are made, and as ever it requires a robust proactive advocate (usually a parent) to smooth out the wrinkles.