Letter

Special care dentistry: Advanced care planning

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Main

Sir, it is greatly encouraging to see the findings arising from dental teams working with memory clinics as discussed by Emanuel and Sorensen.1 Aligned with applicable publications and guidelines,2,3 the article rightly concludes that we should be encouraging prevention of dental diseases in those with early signs of cognitive decline, especially when the potential future complexity of treating these patients is considered.

Despite the importance of disease prevention, multiple studies have shown that oral diseases persist in this patient cohort4,5 which often results in the need for active intervention from dental teams. As dementia progresses, there is the potential for patients to lose the ability to express their preferences regarding treatment and to lose the capacity to consent for their treatment. Related to those processes, best-interests decisions and treatment planning can become increasingly complex and treatment provision can be associated with a greater degree of risk.

The memory clinic is likely a useful setting in which to investigate patients' experiences of dental attendance and to plan prevention approaches. For those who don't attend dental settings, I wonder if this or similar services would also be suitable forums to gather patients' preferences for their future dental treatment needs? A similar approach could be taken by dental teams for those who do attend for routine care. Though these preferences would not be fully binding without an advanced directive, an awareness of patients' past preferences could significantly assist in determination of individual patients' best interests if dental intervention becomes necessary when dementia has progressed and patients are assessed to lack the capacity to consent for treatment.

References

  1. 1.

    , . A study of oral health prevention behaviours for patients with early stage dementia. Br Dent J 2018; 224: 38–42.

  2. 2.

    Faculty of General Dental Practitioners. Dementia-friendly dentistry. London: Faculty of General Dental Practitioners, 2017.

  3. 3.

    , , et al. The Seattle Care Pathway for securing oral health in older patients. Gerodontology 2014; 31 Suppl 1: 77–87.

  4. 4.

    , , et al. Oral hygiene in the elderly with different degrees of cognitive impairment and dementia. J Am Geriatr Soc 2016; 65: 642–647.

  5. 5.

    , , , , . Comparison of oral health among older people with and without dementia. Community Dent Health 2014; 31: 27–31.

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    • A. Geddis-Regan

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