EXECUTIVE SUMMARY

  Recently as the final part of my degree I undertook a piece of empirical research to explore the extent to which the provision of dental care services for people with a learning disability in West Lancashire achieve the recommendations set out by the Department of Health 2001.

  In order to achieve the aim of this study the objectives were:

—  To identify any unmet dental needs for people with a learning disability in West Lancashire.

—  Explore the provision of general anaesthetic dental care for people with learning disabilities within West Lancashire.

—  Provide a framework to develop individual dental health action plans following dental check ups.

—  Investigate the experiences of people with a learning disability, their families and carers in seeking and attending dental services to highlight any unmet needs and gaps in the service provided.

FINDINGS/CONCLUSIONS AND RECOMMENDATIONS

GENERAL ANAESTHETIC

  This research study highlighted that at present the general anaesthetic services are inadequate in West Lancashire. The general response was that treatment that was able to take place in the general dentist chair was excellent, with appointments generally available when needed. However, when treatment under general anaesthetic was discussed participants expressed distress and anger around the long waiting lists for treatment. These waiting lists had been as long as eighteen months in some cases. Although the vast majority of respondents said they usually had to wait between nine and 12 months.

  One Learning Disability Community Nurse expressed great concern around a patient who had been referred for treatment under general anaesthetic but had to wait for twelve months for the treatment of eight extractions. `Whilst waiting for the treatment the patient's behaviour became more challenging due to pain and discomfort. Antibiotics were needed for abscesses that formed and when treatment was eventually received the person with the learning disability needed all their teeth removing. This person is now left with no natural teeth; unable to tolerate dentures they are forced to live the rest of their life without teeth.

This research highlighted the concern of family carers around multiple extractions. Many people with a learning disability would not be able to wear dentures and this led to very emotive discussions around nutrition and diet, freedom of choice, quality of life and self esteem. The question was asked by a family carer how many people without a learning disability would have to wait the same length of time for their dental care? Was this morally right and acceptable?

Recommendations

1.  Reduce waiting times around treatment under general anaesthetic.

2.  Direct patients that could cope with treatment under slight sedation to more General dental practices to free up Specialist Dentist for more complex patients.

ACCESS TO DENTAL SERVICES

  Accessing dental care for a person with a learning disability is often reliant upon the availability and willingness of a family carer and support worker. It is quite often a traumatic and frightening experience often with a limited understanding of the treatment people are likely to receive and a limited level of communication can increase worries and anxieties. This research study highlighted the need to increase desensitising programmes which would allow patients to visit dental surgeries without receiving treatment to meet dental staff, see dental instruments and acclimatise to the surgery environment.

  In this research the majority of respondents agreed that dental professionals should take the lead from the carer or support worker accompanying the patient in how to communicate and relate appropriately.

  Concern was expressed by family carers around the inequity of "out of hours" dental care for people with learning disabilities. Reasons for the inequity given included the lack of information about the patient's medical history and lack of experience in special care dentistry of the dentist on call.

Recommendations

1.  Development of more desensitisation programmes.

2.  Dental Surgeries can clinical schedule to be adapted to need the people with learning disabilities.

3.  Use of visual aids and resources to improve communication about procedures.

4.  Improvement of "out of hours" services. Improvement in a system to share Medical histories.

PREVENTION OF ORAL DISEASE

  In this research few family carers or people with a learning disability felt that they had received adequate formal training in oral health care. Family carers felt that the planning of oral health initiative are led mainly by dentists but should be altered to a multi-disciplinary approach with more input from carers, other and social care providers and the people with a learning disability themselves.

Recommendations

1.  Information and training for family carers and people with a learning disability around oral hygiene.

2.  As part of a Health Action Plan early prevention advice. Development of a Multi-disciplinary approach to include Learning Disability Community Nurses, Specialist Dental Services, Health Visitors, Support Workers and Family Carers.

3.  Improved access to dental hygienists for education and regular appointments.

4.  Transport issues to be raised with local authorities.