Dental treatment and dementia
As a person's dementia progresses, their dental needs may become more complicated. The person might need specialist treatment and mental capacity to consent to treatment may need to be assessed.
It can be a good idea to see the dentist soon after getting a diagnosis of dementia.
They can spot any problems that need treatment and get it done before it becomes too difficult for the person to tolerate.
They may also agree a plan to do some procedures in the future. For example, they may suggest removing teeth that are likely to cause problems.
If you are supporting a person with dementia, it is important that you are involved in these plans.
Visiting the dentist as a person with dementia
Many people with dementia already have a regular NHS dentist before their diagnosis.
Ideally, they should continue to see the same dentist for routine treatment and advice for as long as possible.
Finding an NHS dentist who is currently accepting new patients can be extremely difficult. Many will have a waiting list though and it’s generally a good idea to get registered if you can – even if it means having to use a private dentist in the meantime.
Try to book with an NHS dentist well before any dental problems happen – particularly if seeing a private dentist is not affordable.
Eventually a person’s dementia will progress to a point where their regular NHS dentist can no longer manage their treatment needs.
When this happens, they may be referred to a specialist community dental service. The dentists at these services are usually experienced in providing dental care for people with disabilities and complex medical conditions.
Finding dental services
Consent to dental treatment
Having dementia doesn’t mean a person can’t make decisions about their dental care and treatment.
Under a law called ‘The Mental Capacity Act 2005’, everybody, regardless of their condition, should be assumed to be able to make their own decisions. This includes being able to agree to, or refuse, medical treatment.
This law tells us that a dentist must assess the mental capacity of a person with dementia to see if they are able, or unable, to make a decision about their dental treatment.
This involves explaining the situation clearly and checking that the person understands the reasons for the treatment, as well as the potential risks, and can retain this information for as long as is needed to make their decision.
If the person can make their own decision, then they can either agree or refuse to have the treatment.
It’s very important to remember that a person with dementia is always free to make a ‘bad’ decision, just as they might have done before they developed the condition.
The dentist must respect the person’s decision, even if they disagree with it.
If the person can’t process the information with the right support or can’t communicate their decision, then they will be assessed as being unable to make this decision at this time about their medical treatment.
The law says that if the person is unable to consent to, or refuse, treatment, a decision can sometimes be made in their ‘best interests’ by someone legally authorised to make decisions for them.
This could be someone who has a Lasting Power of Attorney (LPA) for their health and welfare.
Supporting someone with dementia having dental treatment
Although some people with dementia may be able to tolerate simple dental procedures during the early stage, this becomes increasingly difficult as their dementia progresses.
The sounds and feelings caused by these procedures can be overwhelming and distressing.
Many people find it comforting to have a friend or family member accompany them on a visit to the dentist.
If the person with dementia is finding dental treatment difficult or upsetting, reassuring them and explaining what is about to happen can help.
This might include things that seem obvious – for example, you could say: ‘When you sit down, the dentist is going to make your chair tip back so you are leaning backwards. This makes it easier for her to see inside your mouth’.
The dentist may also recommend sedation or general anaesthesia before dental care if they think this will be safer and less complicated for the person with dementia.
The dentist may also be able to make a home visit if the person with dementia can’t go to them. This is sometimes called ‘domiciliary dental care’.
Seeing a dentist in the later stage of dementia
In the later stage of dementia, most people experience severe memory loss and problems with communication.
They may also experience changes in behaviour and physical health problems. This can make visiting the dentist very challenging, and often distressing.
The person may also no longer be capable of consenting to dental care or co-operating with treatment.
Dental treatment for a person at this stage of dementia is much more likely to focus on having a regular routine for brushing and checking the mouth for problems.
A person in the later stage of dementia may be referred to a special care dentistry service, which has teams with specialist training and more experience.
However, sometimes these services can be very difficult to access with long waiting lists. If they need urgent dental treatment, they may need sedation or general anaesthetic.
This can be risky, and so the treatment needs to be discussed with the person with dementia as well as their family and carers.
Dental care in care homes
If a person you care for is moving into residential care, there are things you can do to ensure their dental care needs are met.
For example, if the person has agreed a mouth care plan with their dentist, you could share this with the care home staff.
Care homes have a duty to ensure that their residents’ healthcare needs are met, including all aspects of mouth care.
They may have a local dentist who visits the home to provide regular check-ups, or they may have visits from a local community dental care service.
The care home manager should be able to give you information about their arrangements for dental care.
Ideally, they should also have a member of staff who is a mouth care champion, providing a link between care homes and dental professionals.
You could let them know if the person finds dental treatment particularly distressing or tell them how they like to carry out their daily mouth care routine.
You may be able to continue helping with their mouth care when you visit, for example being there before they go to bed to help them brush their teeth.
If possible, the person should keep seeing their regular dentist (if they have one) after they move into residential care.