Health Access

Initiative for Adults

with Learning

Disabilities in

Central London

6th July 2012

John Whelan BDS

Today’s Session

• Background• Service Outline• This is what we found• This is how we did it• Barriers• Lessons Learned• Recommendations

Background

• National evidence of poorer oral health in people with learning disabilities

• A need to build up our local knowledge base

• A need to review our dental pathway

• We formed a small working group

The Community Dental service provides care for people

who cannot access high street dentists for various

medical and behavioural reasons.

Service Outline

DentistDental TherapistDental Nurses

PodiatristDietician

LD Community Nurse

Looking for:Optician

Audiologist

This is what we found

Health Facts:• 28% had dental decay• 11% had no teeth

Observed oral health hygiene:• 70 % received support

with brushing from others

• 15% were able to be independent

• 73% were fully mobile

Demographics:•73% were Caucasian •17% were Afro Caribbean•5% were Arabic •3% were Asian

Aims of the Oral Health Needs

Assessment (JSNA)

1.Improve oral health in people with LD2.Improve access to services3.Reduce the need for emergency admissions4.Reduce the need for GA

• Extremely low uptake of care from ‘high street’ dentists

• Need for great improvement in Oral Hygiene of people in residential care

• Greater training for family members/ social care staff

• The DNA (did not attend) rate is far greater for LD patients.

• Higher number of service users require dental treatment under sedation or general anaesthetic, than general population

This is how we did it

• Outreach work in residential homes, day centres and drop in centres

• Oral Health Action Plans in place to improve self care and management

• Providing training on Oral Hygiene & Tooth brushing

• Building relationships through Multiagency / disciplinary approach, engaging with people, organisations and other networks at the interface (WLDP, Podiatrists, Dieticians, Community Nurses)

• Holistic “Health MOT’s” meeting the needs of service users and improving access

The Oral Health Action Plan project

•411 on the register of which 318 have been contacted and 269 seen•Only 30 had their own ‘high street’ dentist and were happy to continue seeing them•95% seen from residential placements or live with their families•As a result of this project the number of people receiving treatment within the Community Dental Service has almost doubled

– 111 new patients– 11 have their treatment with

help of inhalation and/or oral sedation

– 30 referred to UCLH/Guys Hospital for treatment under General Anaesthetic

– 3 referred for specialist consultation in restorative/Oral Surgery/Oral Medicine

Progressive project working with young people to ensure a seamless transition from child oral health into adult oral health care – Young People in Transition (YPT)

Screen higher classes in specialist schools and providing oral care workshops to the specialist school staff

Rolling out service across CLCH borough’s starting with Kensington & Chelsea and soon to follow Hammersmith & Fulham

Flagging to GP’s to inform them that their patients are accessing the service. Poor response to communication so far…

Barriers

• Some resistance from service providers

• Accessing people who live independently

• Making oral hygiene a priority for everyone

• Other priorities for people with complex medical conditions

• Large uptake from Black Caribbean ethnic minority but low uptake within the Asian and Bengali community

• Often relying on support workers and carers

• Building trust and a working relationship is key

Successes & Recommendations • The Oral Health Action Plan now raises oral

awareness in people with learning disabilities

• More people are now registered with our service with the lowest hospital admissions for tooth ache in London

• Oral Health has improved and can be evidenced through the number of reductions in patients requiring GA and reduction in treatment rates to maintenance

• Oral health awareness is much higher in carers and support workers and considered an integral part of general health & wellbeing

• Patients lost to Podiatry Service now back on recall

• Several referrals to Choosing the Chance to Change

• Greater education for service users and carers/family members to achieve and maintain good oral hygiene

• A more consistent approach needed towards improving oral hygiene within care homes

• Starting work in Special Schools

• YPT screening

Contact

John Whelan

john.whelan@clch.nhs.uk

The Medical Centre7e Woodfield RoadLondon W9 3XZ