Helen Paisley, CEO of Community Dental Services CIC and ADG board member, highlights the work of community dental services.
Community dental services care for children and adults with complex additional needs such as moderate or severe learning disabilities, autism and mental health issues. We are a referral service, and our acceptance criteria responds to the needs of our ICBs and local authorities where sections of the community cannot be cared for in general dental practice. For example, this may be children with poor oral health and extreme anxiety or homeless rough sleepers in some areas.
Specialist skills
Our patients require complex interventions, and the teams are consultant or specialist led to navigate the complex legal and medical care considerations to prepare a patient for safe treatment, especially under a general anaesthetic (GA). Consultant led care ensures cases can be treated without referral to the dental teaching schools – keeping care in their community.
Services fund specialist equipment themselves, including bariatric wheelchair recliners, the wand for needle phobic patients or sedation. An ageing population, more complex health needs and an increase in children with high levels of decay are all creating a significant rise in demand for our services – an area of dentistry often overlooked by policy makers.
Innovation is central to our vision, we are the first dental provider to gain full access to the NHS Spine system of clinical records, a development that could benefit all services with a wider roll-out.
Our teams’ skills lie in supporting patients with complex needs, often combined with communication difficulties. Many cannot speak for themselves and best interest meetings with relatives and advocates reflect increasingly complex care plans, around assessment and clinical holding to deliver safe care kindly.
Beyond clinical skills, our teams require patience, empathy, and an ability to adapt to unconventional working positions sometimes! Clinicians are skilled in treating patients with sedation or in hospital where we have GA lists, in peoples’ homes with a portable domiciliary kit, and on our mobile clinics.
Impact of the lack of access in general dental services
We care for the most vulnerable people in society and our patients deserve the best care we can provide. Wider systemic challenges in dental access significantly affect our patients. Without a general dental practitioner (GDP), patients often struggle to be referred, worsening their condition and increasing their treatment needs.
Our shared care model aims to refer patients back to GDPs after treatment, but this is becoming harder, placing additional pressure on our services. We support measures highlighted by the Association of Dental Groups (ADG) – of which we are a member – and the wider profession to increase the NHS workforce and provide a better dental contract. Many of our patients would not have the means to access private dentistry as an option for routine or maintenance care.
‘COVID generation’ of children
We are seeing more referrals from the ‘COVID generation’ of children, who have high clinical need combined with severe dental anxiety. In fact, some have never visited a dentist, missing early acclimatisation and preventative care. Where behaviour management or sedation is insufficient, we provide treatment under GA.
Greater transparency in waiting list data, similar to other NHS services, is essential to ensure equitable access to interventions such a general anaesthesia via flexible commissioning. These services and waiting lists worsened during COVID, and have not recovered in some areas.
Community-based interventions
We welcome greater investment in supervised toothbrushing programmes, which oral health teams have proven to be effective. However, more initiatives are needed to address the child oral health crisis.
Our ‘pop-up’ screen-and-intervene clinics, offering examinations, oral health advice, fluoride varnish, and ongoing treatment pathways, could be scaled up with flexible commissioning. Community-based initiatives such as this reduce pressure on acute services.
Similarly, we have been early adopters of child focused dental practices, in partnership with general practice, to reduce paediatric waiting lists and pressure on the acute sector.
Careers in community dental services
Training and ongoing development are crucial for dental professionals to view community dental services as an attractive career option. New community dental fellow posts enable early-career professionals to combine clinical practice with funding for postgraduate education.
Overall, this is a challenging, exciting and rewarding area of dentistry, focused on ensuring our most vulnerable patients receive the dental care they need to thrive.
For more information about the Association of Dental Groups, visit www.theadg.co.uk.
This article is sponsored by the Association of Dental Groups.
