Community dental services are vitally important to people who cannot get to a high-street dental practice, not least elderly people living in care homes. Without access to "monitoring and care, care- home residents" may develop health problems which are not only painful but also impair their general health and well being. Recent research by Professor Clive Holmes at the University of Southampton has shown that infections can increase threefold the rate of cognitive decline in people with Alzheimer’s disease – an additional reason to prevent and treat dental gingivitis.

I attended  Priorities for Social Services in Wales-Integration, Regional Working and the National Dementia Strategy- a timely seminar organized by, Westminster Health Forum and held in Cardiff on 12th Dec 2017. Although this interesting and useful event focussed on social care and its integration  with health care in Wales, some important points emerged about community dental services.

Speaker Sarah Rochira, the Older People’s Commissioner for Wales, had carried out  a wide-ranging investigation in 2014 of the quality of life of older people living in care homes in Wales.  She took evidence from the Welsh Government’s Senior Dental Officer and the British Dental Association.  Her team made unannounced visits to 100 care homes. Her 150-page report, A Place to Call Home?, recounts that the majority of residents and family members consulted stated that they or their loved ones rarely or never had access to a dentist. She considered this state of affairs was causing a significant deterioration in care home residents’ oral health. Her report also maintained:

In reply to a question from www.2020Dentistry.com at the seminar Ms  Rochira  explained that while preparing her report:

“One of the things I picked up on was access to primary care, and plainly dental care was part of that. If those individuals had lived in their own homes they would have had access to community-based dental services, but many people in care homes didn’t.”

Miss Rochira gave  examples of similar situations she had encountered recently:

“I was in a care home in North Wales and the community dental service turned up, and it was wonderful. It wasn’t just about teeth and fillings, but also wider oral health and hygiene, and it was clearly related to nutrition. It was the bee’s knees. But I was contacted by another individual whose mother’s teeth had rotted away because nobody had looked in her mouth for three years. So there was, and clearly still is to some extent, an issue about people living in care homes, where too many are still being denied access to basic services. It’s improving, but it needs to improve more quickly, because nobody should be excluded from the services that they would have if they lived in their own home.”

Ms Rochira also made a wider point which has implications for the provision not only of community dentistry but also of other peripatetic community healthcare services, such as optometry and nursing:

“The slightly wider issue that you touch on in your question is, as we grow older, how can we ensure we continue to access primary care services. I think that’s challenging in many ways. One of the ways it’s challenging is that a lot of people can’t get out of the house, whether because of physical challenges, perhaps because you’re a carer for someone, perhaps because of cognitive challenges, perhaps you can’t see very well – age brings trials and tribulations in many forms. The question primary care services need to ask themselves is: if people can’t come to our services, how can we get to them?”

Another example is the case in which Ms Rochira  had been involved in which a man was unable to get his ears syringed because he could not get to his GP surgery, syringing had only taken place after her intervention and this is her concluding remark:

This discussion resonated with a debate that had taken place at another Westminster Health Forum seminar the previous week in London entitled The Future of General Practice in England. At the seminar on 7th Dec, 2017, Dr Crystal Oldman, chief executive of The Queen’s Nursing Institute, revealed that 50 per cent of universities were considering closing their district nursing programmes in 2018. This is against a background of a massive decline in the number of district nurses in England – their numbers halved between 2000 and 2016, according to calculations by The King’s Fund. To try to counter urgently the cutbacks in district nursing training, Dr Oldman urged that its funding should be ring-fenced. 

The number of people aged over 85 in the UK is expected to more than double in the next 23 years, to more than 3.4.million. Many of these people will come into the categories Sarah Rochira listed of people who find getting out to access health services difficult, if not impossible. Is it not high time for clinical commissioning groups, health boards and health and social care trusts seriously to consider how best to provide preventative, curative and palliative healthcare – not least in the field of dentistry – to these citizens too?

Marion Shoard is a freelance writer and the author of How to Handle Later Life (Amaranth Books, 2017).