Word of mouth: Challenges lie ahead, but I’m optimistic
[ Words: Dr Paul O D’wyer BDS MSc (Healthcare Mgmt) ]
Treatment planning is at the centre of what we do as clinicians. The Oxford English Dictionary tells us that “treatment” (in the medical context) is the care or therapy given to a patient. The Treatment Plan is that documentation that sets out, in clear terms, a series of steps that will help improve our patient’s health and well-being. We gather information from the patient’s previous experiences, their history and the current condition – and apply our knowledge, expertise and judgement to better improve their overall wellbeing.
At the recent Irish Dental Association Annual Conference in Galway, many colleagues were talking of the recently launched (and much anticipated) National Oral Health Policy. This is a significant document that has been long awaited. It replaces the previous plan, the Dental Health Action Plan (1994) – which was published while I was still an undergraduate! The country has changed significantly since that time.
To fully understand the goals, objectives and implications of this new policy, which is evidence informed by national and international findings, will require time.
However, being clinicians, it is helpful to view the document through the lens of a National Treatment Plan, if you will – where our country’s previous experiences, history, current condition are considered and weighed against our sum knowledge, expertise, resources and best practice. The Oral Health Policy is effectively the Nation’s Treatment Plan.
As has featured regularly on these pages, we are living in an ageing population. The largest cohort of patients in the coming decades will be over 60 years old. The CSO projects that just over 31 per cent of the population will be over 60 years by 2046 (at current trends).
Provision for the treatment of this group will inevitably take centre stage. In thinking about our current 60 years+ cohort, what are the specific challenges that present in our surgeries right now in 2019? A review of current literature suggests that this group are healthier and longer living. They tend to be substantially or completely dentate with most having had advanced restorative treatments in the past – notably crowns, bridges and (increasingly) implants. The biggest hurdle (from experience) with this group of patients is simple: intermittent attendance.
How many times have we sat in our surgeries with a patient in this age group, on review of their treatment needs and wished that they had attended earlier? The old adage of “prevention is better than cure” is never more true than found cradling a 30-year-old full upper denture, which had started life when Glenroe was on television. It typically has multiple additions/repairs and features every shade of red/pink PMMA available! Coupled with that is the ageing face, slacker peri-oral musculature and (increasingly frequently) xerostomia caused by medications.
These are average everyday clinical challenges that face us in our surgeries. Treatment planning and securing good clinical outcomes can prove very difficult – and that’s with the patient sitting in your dental surgery chair – and not off-site in a care home.
From experience, when in practice in rural Tipperary, I undertook to treat patients in residential nursing homes through regular domiciliary visits. A familiar pattern of scant dental history, ancient dentures, poor oral hygiene and lack of planning became all to common. Over time, I understand that this picture has improved – particularly with the advent of specific HIQA standards in this area – in particular the necessity for an “Oral Health Review” (cf “Guidance for Assessment of Centres for Older People” – HIQA (Updated February 2019)).
However, the resources/personnel required to provide a comprehensive dental/oral healthcare service for this remit remain challenging. From first hand experience, I can relate that securing optimal clinical outcomes (off-site) proves difficult when faced with poor oral musculature tone, heightened gag reflex or hemi-facial paralysis following CVA/stroke. Canvassing offspring/relatives to transport these patients to the dental surgery setting, securing consent and establishing costs are just some of the obstacles that then follow – particularly when we factor in limited DTSS treatment options for this cohort.
The National Oral Health Plan makes specific mention of our younger patients too – particularly Care Packages for the Under 16s. It will take some time to better understand how this will work also. However, it is encouraging to read in the document that the team lead nature of oral health care provision is at the centre of treatment delivery. The roles and responsibilities for all of us as oral healthcare professionals will invariably change to meet the growing needs of all our patients.
My own hope is that this new National Oral Health Policy is the definitive Treatment Plan for the nation – and it is encouraging to see particular emphasis placed on the fact that it will evolve as data is collected, to better meet the needs of our ageing population. And as always, a plan is only a plan until it is implemented.