Mouth Care Matters in an Acute Setting: “Dentist on the Wards – A Dental Core Trainee Perspective”

A reflection by Rachael Otukoya, a Dental Core Trainee in Special Care Dentistry at Surrey & Sussex Healthcare NHS Trust.

Working in East Surrey Hospital as a dental core trainee has given me a unique insight into seeing patients on the wards. Patients, of different ages, genders and reasons for being admitted into hospital-either due to acute illness, trauma, or long term stay, are seen in bays and side rooms, where hospital staff work tirelessly to ensure the health and wellbeing of their patients, and their rehabilitation back to their usual place of residence, hospices, care homes, or other areas outside of the hospital environment.

In the advent of Mouth Care Matters, ward staff are taking an active part in mouth care, and increasingly we are seeing referrals of patients who need additional help with oral care, or have specific problems with their mouths which could be delaying their rehabilitation (be that a loose tooth, a lost denture, an abscess or an ulcer) to name but a few. Being able to see the patients on the wards means that patients can be seen in a relatively short amount of time, and if required, could have their emergency treatment done whilst they are an inpatient, or, if treatment is not required at that specific point, can be seen by their own dentist on discharge. This provides a necessary service by which, if Mouth Care Matters and the Dental Department did not exist, would prove to be logistically very difficult for our most vulnerable patients.

An example I was faced with was a 48 year old man with severe learning difficulties and epilepsy. The nursing and medical staff were concerned that this patient had a decline in oral intake and during his inpatient stay, in which he had been admitted multiple times for aspiration pneumonia in the preceding 6 months. They were also concerned that he, although non-verbal, would repeatedly point to his mouth. On examination of the mouth, he had poor oral hygiene, and in particular an extremely loose lower front tooth which was causing him to squint his eyes on palpation, causing him visibly evident pain. Not only this, he was at risk of aspirating this tooth if it were to be left in situ. After a discussion with the carers and next of kin, it was evident that it was in the patient’s best interests to have this tooth removed under local anaesthetic. This was performed at his bedside, and in the subsequent days that followed, had a slow increase in oral intake. Not only was the aspiration risk removed, but the patient was noticeably more comfortable.

Another example was that of a blind woman who was admitted to hospital following a fall in her home. She had an extremely well fitting lower partial denture which she was unable to remove for a couple of days, whereas usually she would be able to place and remove this independently. She was therefore worried about potential infection by leaving this denture in. After removing this denture, I was then able to adjust the clasps which made the denture so snug, so not only could she remove and replace the denture, it also was not loose, so it felt ‘like her own teeth’ again. Simple adjustments would not have been possible had there not been a dentist available to go to the wards and see this patient. As a result she felt much happier using and removing her dentures for cleaning.

Additionally I saw a patient with a low white cell count, at risk of infection following chemotherapy on the ward who had lost a filling a few days before and was having sensitivity and food packing in the tooth. Due to risk of developing infection, she could not be seen outside of the ward on the department for a temporary filling, so we went to the ward to place a temporary filling in the tooth. She was much happier as she could eat and drink without sensitivity and, without food packing in the area.

During my time in hospital, being on the wards has opened my eyes to the needs of inpatients, some fully independent, and others completely dependent on hospital staff for basic care needs. Mouth Care Matters continues to bolster staff with the knowledge of how to care for mouths, know what is normal, and how to refer if they are concerned about a patient’s oral health. For those with acute dental infections or problems which are inevitably linked to a patients’ overall health and wellbeing, having a dentist available to see these patients and deliver emergency treatment when required has undoubtedly helped patients journey on the road to recovery.