4 May 2019  •  Uncategorized  •  7min read By  • Nigel Jones

Urgent dental care – the pinch point of dentistry

Nigel Jones speaks to Yasmin Allen about the challenges in providing urgent dental care…

As many patients struggle to access routine dental care, they often find themselves attending urgent and emergency care for treatment. Often a large proportion of these patients are from vulnerable groups, which can lead to real challenges when it comes to delivering treatment and these are often a magnified reflection of the issues facing dentistry as a whole.

To discuss this subject I spoke to Yasmin Allen, from the Digital Urgent and Emergency Care Team, about these challenges, continuity of care and the impact contract reform may have…

Nigel Jones (NJ): What do you see as the main challenges for urgent care?

Yasmin Allen (YA): I think that dental urgent emergency care is right at the coalface and highlights the problems that we have in dentistry such as access, particularly for vulnerable groups, i.e. people in care homes and homeless people. Dental anxiety is often concentrated in this environment because people who put off going to see the dentist often end up in urgent care but we’ve actually got really limited time to treat them. It’s a really challenging environment and we see a lot of the problems from wider dentistry, because they all come to a pinch point in the urgent care setting.

NJ: That’s a really interesting point about the relevance of urgent care for some of the harder to reach groups in society. What sort of lessons are being learned when people are coming into contact with the urgent care services?

YA: Two inter-related issues are the fact that we have limited time in urgent care and we have people who use the service almost like their regular dentist. I think patients like attending urgent care because they can get an appointment on the same day, or very quickly, which they’ve not been able to do when accessing routine care. What this shows is that we might have some issues around access in particular parts of the country, and we need to be asking ‘how do we get people into care more quickly and more efficiently?’

Digital innovation could help with this. For example, people being able to book their appointments online. Making it easier for people to book appointments is key, especially for patients with dental anxiety who will do anything to delay seeing a dentist.

Children are one of the most challenging groups to address in an urgent care environment. You really need to give them a good experience, but if they’ve ended up in that setting then they’re likely to be in pain, and this will often be their first experience of dentistry. We really need to consider whether we need people with specialist paediatric expertise in those environments – which obviously has cost implications.

It’s often unavoidable that you will inadvertently provide a bad experience to a child in urgent care while trying to carry out treatment while they’re in pain. The issue is that they may then have bad memories of dentistry and will grow up to be someone who doesn’t want to attend routine care appointments. You’re almost creating a lifelong urgent care user.

NJ: Is it part of the clinician’s responsibility, then, to at least be thinking about how they integrate this person into routine care as opposed to becoming reliant on urgent care?

YA: I think that’s a really important point about trying to find really easy pathways or develop those pathways that people can follow into routine care. A lot of people who come into urgent care ask if they can use these services as their ‘normal dentist’ and you have to explain that that’s not possible because you only work in that setting. But it would be really good to develop that kind of continuity of care.

One of my major bugbears, and I think it might be the same for a lot of people who work in these environments, is time. Fifteen minutes is not enough time to be able to introduce yourself, make somebody feel comfortable, do a full and complete medical history, identify the problem, diagnose, give them the treatment options, deliver the treatment, and then try to guide them back into regular care. You’d have to be a magician to be able to do that in 15 minutes. From a commissioning perspective, we need to have the appropriate time to be able to do that.

NJ: Routine general dentistry seems to work very well for people that are already committed, to a certain degree, to their oral health, and a lot of commissioning seems to be focused on them. Whereas, actually, the need is probably greater elsewhere, for example the elderly living in care homes, and I imagine you see those people in urgent care all the time?

YA: There’s a very high proportion of people who we term vulnerable groups accessing urgent care services. One anecdote I can tell you about is a daughter who tried to find dental care for her mother who was in a care home and they couldn’t get the denture out of her mouth. She visited an orthodontist who told her to go to community dental services, who said she would face a six-month wait.

Without anywhere else to go, and a problem that needed fixing quickly, they went to A&E. Luckily, in this particular A&E, they had a dental unit. When they looked at the patient, the gum had grown all around the denture and they literally couldn’t physically remove it without performing surgery.

That has happened within the last year, and it happens consistently, and we really need to make sure that we give appropriate information to patients to try to prevent it. But also, as you alluded to, we have to make sure we have the right services that are accessible for those patients. I’m not saying that we need to have domiciliary care everywhere, because I don’t believe that’s the answer, but we really need to look at the pathways of how people access dental care.

NJ: That’s an appalling story. Do you have any thoughts around how you’d like a new NHS dental contract to shape up given your experience in urgent care?

YA: That’s a very tricky one! First of all, we need to go right back to basics and look at the information that we’re collecting about our population and our services, and collect data that helps us to understand the needs of people who don’t access services, as well as those who do.

We talk a lot about patient involvement and participation in health care, but I really don’t think that we do it very well. We talk amongst ourselves about it, but I don’t think that we really aggregate that data and communicate effectively to the decision-makers and policy-makers.

We also need to have a frank, open and honest conversation about what we can provide as NHS dentistry. I don’t believe that we should go to an emergency-only provision, because I think that would be tantamount to saying ‘Oh, well, NHS dentistry doesn’t work, so let’s just scrap it.’ But one thing I do know for certain is that we can’t solve it without true engagement with patients and with healthcare professionals, dentists and DCPs.

NJ: Yasmin, it’s been a truly interesting discussion, thank you so much for talking about this area of dentistry with me.

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