The prevalence of denture loss within community residential settings.

Introduction Denture loss prevalence in community settings is unknown and results in deteriorating residents' systemic and psychosocial wellbeing.Materials and methods An electronic survey was distributed nationally through professional networks to community residential settings.Results Of the 156 responses from community residential settings, 69% of settings experienced at least one denture lost in the last two years. Sixty percent of responders reported no dentures were labelled, only 64% had received training about how to care for dentures and 86% felt they would benefit from further training on mouth care. In addition, 68% of staff found arranging dental care for their residents challenging.Discussion Extrapolated data suggest that at least 10,205 dentures are lost annually in community residential settings and are never found, costing the NHS Business Service Authority more than £3 million. A high prevalence of denture loss in community residential settings is likely due to residents with multiple comorbidities and frailty. Remaking dentures poses financial, logistical, and patient challenges, which may result in patients being unable to wear a remade denture.Conclusion The prevalence of denture loss within community residential settings needs to be understood to encourage targeted interventions, inform stakeholders, and encourage workflows that will improve service delivery and patients' oral health-related quality of life.

Prevention of oral diseases for the older person (Part 1).

Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.

Prevention of oral diseases for the older person (Part 2).

Older adults often experience poorer levels of oral health than younger adults, especially if they have become dependent on a third party to support their daily oral care routine. However, the deterioration of oral health does not need to be a part of the ageing process. Most oral diseases are largely preventable with the daily removal of dental plaque that forms on teeth and dentures, using a fluoride toothpaste, eating a healthy diet and reducing any tobacco consumption. The dental team have a duty of care to ensure that older people receive evidence-based oral health preventative advice tailored to the individual, taking into account individual risk factors that can increase with age. This can include the clinical application of topical fluoride and minimally invasive dentistry. Older people at an increased risk of poor oral health include those with cognitive conditions, physical impairments and certain medical conditions. Care home residents face particular barriers to attaining a satisfactory standard of oral care which are discussed herein. Good oral health preventative routines must be established early after the diagnosis of progressive chronic conditions and will help to prevent the need for dental intervention later in life when treatment can be more difficult to tolerate. Inclusion of oral health prevention within health policy and legislation is necessary to improve the oral health for older people living in all health and care settings.

A service evaluation of mouth care referrals for adult inpatients in an acute hospital.

Introduction Healthcare professionals working in hospitals often have inadequate training in supporting patients with mouth care, which is one reason oral health deteriorates in hospitalised patients.Aim The aim of this service evaluation is to assess the main reasons healthcare professionals request advice from the mouth care lead nurse and identify common trends.Method Data were collected for patients referred to the mouth care lead between 2020-2022, including age, sex, reason for referral, outcome and whether the patient needed redirecting to a dentist or doctor.Results A total of 204 referrals were analysed and 93% of patients referred were aged over 65 years of age. The most common reason for hospital admission was cancer (14%), followed by falls (9%) and stroke (7%). The most common reasons for mouth care referral were dry mouth (43%), poor oral hygiene (15%) and loose dentures (14%). Overall, 62% patients were deceased within a year of the referral.Conclusion This evaluation shows there is value in having a dedicated mouth care lead nurse who can provide training to staff when required for individual patients. Inpatients tend to be older, often in their last year of life, and there is a need to focus training on dry mouth.

Digital denture scanning and 3D printing for residents in care homes: A feasibility study for pre-empting denture loss.

OBJECTIVE: The aim of this study was to assess the feasibility of digitally scanning dentures and 3D printing replica dentures for care home residents. The study also investigated whether the process and replacement denture was acceptable to the resident. BACKGROUND: Denture loss is a significant issue for people living in care homes and impacts on nutrition, quality of life and dignity. Denture loss is underreported, and care home residents have barriers to accessing dental care. The conventional process for remaking a denture can often take approximately 2 months with multiple clinical stages, often not feasible in adults with frailty and cognitive impairment. Scanning and 3D (3 dimensional) printing are increasingly used in dentistry, this rapidly evolving technology may provide an innovative solution to denture loss. MATERIALS AND METHODS: A digital workflow was established using a handheld scanner and 3D printing technology. Care home residents wearing functional acrylic dentures were recruited. Dentures were scanned within the care home, and the scan was sent to a dental laboratory for 3D printing. The dentures were fitted at a subsequent visit, and semi-structured interviews were undertaken with the resident. Using thematic analysis, the feasibility of this pathway was assessed, and the use of digital scanning technology was explored. RESULTS: Eight residents successfully had dentures scanned and replicated to a satisfactory standard. It took, on average, 10 minutes to scan a denture and 20 minutes to print the denture. All replica dentures were satisfactory to the resident. Qualitative data from semi-structured interviews showed that study participants were satisfied with denture replacements and the process. The 3 main themes that emerged were: the significance of dentures to the individual, satisfaction with the scanning process and general low self-esteem and fatigue. CONCLUSIONS: This study has established a workflow for digitally storing dentures and replicating them satisfactorily. In the context of a care home setting, a scan of a denture can be used to provide a replacement denture if lost or broken. A large-scale study could follow now that the feasibility of this pathway has been demonstrated.

The impact of a quality improvement initiative to reduce denture loss in an acute hospital.

Background Denture loss is a significant problem for patients admitted to hospital in the UK. Initiatives aimed at staff and patients have been introduced at many hospitals to try and reduce and solve this issue.Aim This investigation aimed to evaluate the impact of a quality improvement programme on denture loss at an acute hospital, including the reasons dentures were reported as lost or broken and who reported them.Method Information on dentures which were lost or broken was collected in an acute hospital between 2016-2021 and included the number of losses, the reason for the loss/breakage and who reported them. The number of complaints and financial reimbursement related to denture loss was also obtained from the trust for the same period.Results In total, 123 dentures were reported as lost or broken between 2016-2021. The most commonly reported reasons for loss were patient transfers between wards, being left on hospital trays, or when patients were sleeping. Patients or carers are more likely to report a lost denture compared to hospital staff. Reimbursement paid by the trust for denture incidents is much lower than the numbers reported.Conclusion Creating a single reporting pathway for denture loss and implementing methods to reduce denture loss led to an increase in the numbers of dentures reported as lost. This is likely to be attributed to an increased awareness of reporting pathways. Denture loss is a significant financial burden to the NHS, in addition to causing patients and families distress and is most likely under-reported in many hospitals.

Effective mouth care for older people living in nursing homes.

Oral health for older people living in nursing homes has long been an area of interest and concern, with suboptimal oral health often having significant effects on their general health, well-being and quality of life. This article outlines the reasons why oral health can deteriorate in nursing home residents and the potential effects of this, and provides information about relevant national guidance. The article also details practical recommendations for nursing home staff on improving residents' oral hygiene, including undertaking oral health assessments, delivering mouth care and accessing dental services.

Oral health for healthy ageing.

Over the past 70 years, the global population and age structure have been changing rapidly. Analyses from the 2017 Global Burden of Diseases, Injuries, and Risk Factors Study forecasted a continuation of global ageing throughout the remainder of the 21st century, creating major challenges for health-care systems to ensure healthy longevity for ageing societies. Oral health is an intrinsic constituent of general health and wellbeing; however, oral health is largely overlooked on the global health agenda. Oral conditions are mostly preventable or treatable, yet older people often do not receive the necessary routine care to maintain a good standard of oral health. The neglect of oral health constitutes a failure of global health policy and a failure to deliver the basic human rights of older people. The aim of this Personal View is to encourage a refreshed vision of oral health, enabling policy makers to recognise the implications of poor oral health in older adults. We call for urgent action to manage the projected challenges throughout the coming decades, to ensure that additional years of life are spent in a state of good health and to help mark global ageing, not as a burden, but as a major anthropological achievement.

Mouth care training and practice: a survey of nursing staff working in National Health Service hospitals in England.

Background: This study investigated the training and mouth care practice of nursing staff in hospital Trusts across England. Oral health has been found to deteriorate during hospital admission, mouth care standards have been found to be poor. Aims: The objectives of the study were to assess if and what the barriers are to supporting inpatients' mouth care, and to assess how confident nursing staff are in carrying out mouth care assessments and mouth care and see if this is related to previous training. Methods: A cross-sectional descriptive survey was conducted in 33 Trusts in England with 1576 members of the nursing team including nurses and nursing assistants. Nursing staff were asked to complete a questionnaire on previous oral health training and their current practice. Results: Nursing staff reported that they had limited training in mouth care. The main barriers to mouth care were time and patient compliance. Confidence in recognising oral cancer was low. Conclusions: Nursing staff would benefit from mouth care training targeted at assessing the mouth and providing mouth care for all inpatients.

Dental care pathways for adult inpatients in an acute hospital: a five-year service evaluation.

Introduction The oral health of adult inpatients has been found to deteriorate during hospital admissions, which can impact on eating and drinking, risk of hospital-acquired infections and overall recovery, thus extending the length of admission.Aim The aim of this paper was to evaluate the reasons for inpatient referrals to the dental and maxillofacial department and the treatment outcomes through analysis of referrals over a five-year period collected prospectively.Method Data were collected from inpatient referrals to the dental and maxillofacial department at East Surrey Hospital over five years from January 2014 to December 2018. Information about reason for referral and treatment outcomes was reflected on.Results In total, 851 referrals were received from hospital staff over five years. The most common reason for referral was related to acute dental pain and potential analgesic overdose (16%), followed by suspected dental abscess or facial swelling (12%) and dental assessment for cardiac inpatients (11%). The most common treatment outcomes included consultation and advice only (16%) or dental extraction (16%). A large proportion of outcomes related to management of oral pain due to dry mouth (9%), oral ulceration (6%), broken dentures (8%) or fillings (5%).Conclusion The data collected show there is a clear need and benefit for hospitals to commission dental services for inpatients.

A survey of the knowledge of junior doctors in managing oral conditions in adult inpatients.

Background Adult inpatients are at risk of developing oral health-related problems during their admission that may require input from their medical team. Doctors have minimal training in oral health which may lead to inappropriate diagnosis and management of oral conditions.Aim The aim of this survey was to investigate the knowledge of junior doctors in managing oral health conditions in hospitalised patients.Method A survey was carried out with 146 junior doctors in Kent, Surrey and Sussex who attended oral health training sessions, which included scenario-based questions on diagnosis and management.Results Ninety-two percent of doctors did not feel confident in diagnosing common oral conditions and 50% did not routinely assess the mouth as part of their overall health assessment. Of those surveyed, 97% expressed that they would like further training in oral health.Conclusion There is a need to incorporate oral health training into the teaching programme for junior doctors to improve their confidence in the diagnosis and management of oral conditions. This would help improve the management of patients who develop oral problems during their hospital stay.