A Not So Quick Trip To The Dentist

So this week marks the end of week 3 of placement.

I have again done a lot and some days not so much. I have laminated things, I have designed tables for patient information. I have answered phones and replied to emails.

As I am on placement with a third year I have learnt a lot from them. But in some ways this puts my learning to a disadvantage as they get them to do a lot rather than myself. So I have had to speak up and offer to do these things as well. The staff don't want to rush me or pressure me but I have said with my previous experience I want to be pushed rather than just guided.

This has meant that I have learnt from the student but I have also had to say I want to learn more.

Luckily enough though my mentor has been great and I have had plenty of opportunities. 

This week I have been able to go to the day care facilities, I have been to the dentist who specialises with patients with learning disabilities and I have been able to witness how resettling goes for our patients who are moving to the community and I have had my midway review. This is a discussion between my mentor and I and how we believe my progress is coming along or indeed if I'm not progressing.

My visit to the dentist was definitely eye opening this week. I was lucky enough to have the patient to consent to me being in the room during their treatment and the other health care professionals (HCP's) were more than accommodating. I was able to see the dentist, the dental nurse, the learning disability nurse who works in the dental department and the doctor who is there to oversee things and to administer the medications needed. 

The treatment was, what would to be to you and I, a basic check up and maybe a scale and polish. As this patient was very nervous and unsure of the dentist, the protocols involved in the treatment were quite extensive. The patient has a learning disability, and as such is unable to consent to treatment due to lack of capacity and understanding. This means that the patient's next of kin and carers had to be involved as well as others in a multi disciplinary meeting to ensure that the treatment is in the patient's best interests. Then after the meeting and the outcome has been decided, the various HCP's then have to decide how the treatment will take place and when. 

The patient is monitored and the procedure is explained to them in a way that they may understand and will reassure them. The amount of paperwork and meetings involved for this patient to have a dental check up is quite extensive. During the treatment, the patient's observations are taken and monitored. The patient is given a small amount of sedative to relax them and make them feel at ease by the doctor who is present during treatment. The dentist and dental nurse then work in tandem to complete the treatment, while myself and the specialist learning disability nurse continue to monitor the patient, assessing their respiratory status at all times and reassure the patient and monitor for any signs of distress. The patient's carer meanwhile, waits in the waiting room. The doctor was able to explain to me the medications used and why they are used for patients that are nervous of the dentist. As the medication is a light sedation that has been decided in a multi disciplinary meeting then the patient is deemed to be at risk but a small one. As the patient has their check up and plaque removed, it is thought necessary that the patient again be referred due to a tooth possibly needing further treatment. This will again involve a referral and perhaps several more meetings before it is decided whether to continue further treatment is in that patient's best interests. Health, age, mental status, ability to consent, their capacity and next of kin's opinion is all taken into consideration within these meetings. 

As the patient received a small amount of sedative, they are given medication to counteract this once the treatment is complete. They are monitored within the dental surgery for a short while before they are deemed okay to leave. The venflon is then removed and the patient is again observed for any signs of tenderness or allergic reaction to anything used in the treatment.

Different sized venflons

Before the treatment can even go ahead, the patient's medical records are scrutinised for anything that may deem the treatment unnecessary or that may affect the treatment whilst it is ongoing, such as epilepsy and any medications they may be on for that. 

So for a check up for you and I that may take perhaps ten minutes. this treatment took just over an hour. 

So next time you take a trip to the dentist, please try and remember that even if you feel a little nervous, you are able to reassure yourself and understand what is happening. For someone with a learning disability, this can be the most stressful time, full of anxiety and worry.  It is remarkable the process that goes into ensuring someone with a learning disability can access dental care.  If you happen to care for someone with a learning disability, professionally or personally, then please remember dental care is very important. Dental care is essential, and if someone has toothache or any cavities, this can impact on their diet, their self esteem, their behaviour and perhaps their relationships.  Even if a person has no teeth, gum care and pallet care are still as important. Oral cancer and differentiations in pallet can indicate a multitude of things. Thus the dentist will still require a visit! 

This week? Remember communication isn't just speech, it is your body language, it is music, games, sexual activity, symbols, gestures, objects of reference. It all makes a difference to that person's day.