Dentistry at home in times of pandemic: Providing access to dental care and supporting people with disabilities – Abed – 2021 – Gerodontology

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Home Dentistry (DD) provides oral care to people confined to their home and unable to attend a dental clinic due to severe morbidity, mental health issues, or mobility issues. As many older people require home support, the provision of DD services, regulated in the UK by the Care Quality Commission, is essential for maintaining the health, well-being and independence of these people within their own community.1 People confined to their homes can have more serious and complex oral health problems than the general population, which impacts their general well-being.2 A particular challenge is posed by older people with severe cognitive impairment living in residential care homes,3 severely overweight people4 and those with severe learning disabilities who cannot leave their accommodation for various reasons. Additionally, physically disabled and immobile patients with complex comorbidities due to various impairments (and indeed other special care patients who use wheelchairs5) may experience considerable difficulty in obtaining dental care due to poor accessibility, lack of availability, local shortage of ambulance transportation, or lack of knowledge of available health care options.

Due to the global disruption of COVID-19, accessibility has become more difficult due to limitations in the number of patients that can be seen and treated on any given day due to the need to reduce the risk of contracting COVID-19 and spread of infection. , and to respect the rules of social distancing.6 Thus, the Commissioner’s efforts are focused on improving accessibility for this group of people.seven This can be achieved by using additional service facilities such as mobile dental clinics or DDs within the community.

While people with special needs (including the elderly) are classified as clinically vulnerable, they are at a higher risk of serious illness from COVID-19. Therefore, national guidelines issued by the National Health Services and Public Health England underpin personalized care and the provision of primary care to the most vulnerable groups in society, many of whom may be immobile and permanently confined to their home environment. .8, 9

In the current pandemic, DD is considered advantageous, allowing social distancing and minimizing the number of people who need to be involved; therefore, it could help reduce the spread of infection, supported by strict cross infection control measures. Additionally, visiting a patient’s home can gather more information about the patient’s eating habits and the challenges they face in maintaining their own oral care. The clinician may have direct access to other healthcare professionals involved in the patient’s care (i.e.

By definition, DD is limited to non-invasive dental procedures such as the provision of removable prostheses, simple restorative treatment, unitary tooth extractions, and non-surgical periodontal therapy. Despite these limitations, it forms an essential part of community dental services by providing impactful urgent and emergency interventions for the most vulnerable groups in society.

The dental team is also vulnerable during the home visit, and personal safety issues should be taken into account.1 For example, all visits should be pre-arranged and confirmed prior to the home visit appointment. A phone call is useful to inform them of the appointment and the time of arrival.

Home care requires a strict protocol for risk assessment and cross-infection control measures, both of which are essential to protect both the patient and the dental team. These should be similar to those in the dental office, when the dental team must work in two separate areas: a clean area and another area for unclean instruments. Thus, standard cross infection control precautions should be followed. With the COVID-19 pandemic situation, there is a greater emphasis on the importance of providing DD with the appropriate personal protective equipment to protect the provider and extremely vulnerable people.ten

A newly proposed home risk assessment tool has been published to provide safe DD by expert consensus.11 This was an e-Delphi panel, which included chairmen of local dental work, clinical directors of community dental services in England and chairmen of the three main specialist organizations in special care dentistry in the UK. This risk assessment tool includes 11 elements, nine of which relate to hazard categories (i.e. exterior parking and access, building interior access, dental team safety, fire and electrical , cross infection, manual handling of patients, environmental conditions inside the premises, patients and others). The two remaining items are the Red-Amber-Green risk ratings of the home visit risk and a recommended action based on the overall tool rating.11

DD provides the delivery of essential primary oral care and urgent and crucial dental interventions to the most vulnerable groups in society, with the primary purpose of securing, maintaining and / or stabilizing oral health. This appears to be particularly valid during the global healthcare crisis caused by the pandemic.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

ETHICAL APPROVAL

No ethical approval was required.

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