Information for dental health professionals
Information for supporters and carers
Some medical words explained

Information for dental health professionals

Communication methods

Good communication is vital in every aspect of life but more so in situations where people are anxious, uncertain, fearful and possibly in pain. Communication needs to be clear, direct and simple, and some general rules of thumb are included below.

Communication within the dental team

Do place appropriate alerts on notes. For example, how a particular individual behaves when feeling anxious.
Do ask the supporter and inform the nurse, in advance if possible, of any things which might help to make the individual feel more at ease and treatment more successful. For example, a person may feel comforted by holding the nurse’s hand or twisting paper for reassurance.
Do ensure the entire dental team is able to use a variety of communication styles and approaches (augmentative and alternative communication, AAC) such as:
- this book – Going to the Dentist
- gestures and body language
- sign language
- objects of reference
- drawings, symbols, photographs and videos
- technology, e.g. using tablets with adjustable viewing size for people with a visual impairment.

Communicating with the patient and supporter

Use the most appropriate method of communication for each person.
Talk to the individual but don’t talk down.
Allow time for the person to process your question before repeating it or asking another.
Make eye contact as you would with all patients, unless the patient avoids eye gaze.
Speak clearly and slowly with simple words and short sentences.
Check for understanding by asking them to explain what they have understood.

Capacity assessments for informed consent

In England and Wales the person is assumed to have decision-making capacity. It is the dental professional’s responsibility to do a mental capacity assessment if there is any doubt.

A mental capacity assessment determines whether an individual:

can understand relevant information pertaining to each specific decision about dental treatment;
can retain that information;
can weigh up the pros and cons of that information to arrive at a decision;
can communicate that decision to you in words, signs, pictures or behaviour.

If you think that an individual lacks capacity or you are uncertain, first check whether it is just an ‘off’ day and the person is feeling unwell. If so, reschedule the appointment. You could also consider referral to a special care dental service. If you remain concerned about the person’s capacity to make a decision, then a best interest meeting with people who know the patient well is necessary.

Reasonable adjustments

There are many simple steps that can be taken to encourage dental attendance, taking into consideration the needs of both supporters and patients.

Try to schedule appointments so that the timings are optimal, for example early mornings may be difficult for supporters and patients.
Try to see anxious people on time so that they are not kept waiting unnecessarily. It may be a good idea to schedule appointments first thing after lunch.
If possible, shorten the duration of appointments so that individuals can cope comfortably.
Wear a transparent full face visor, rather than a face mask so that patients can see your smile and read your lips if necessary.
Explain each stage of the treatment in short sentences with no jargon.
Do not move the dental chair without first informing the person.
Use topical anaesthesia; your patients will appreciate it!
Provide a distraction, such as pictures on the ceiling.
Play relaxing background music or allow the patient to wear headphones, especially during drilling.
Encourage the person’s accompanying supporter to stay with them if that helps.

Time taken to build a solid foundation of trust is priceless and will reap dividends for future dental care. An initial familiarisation visit will help to build confidence. In an urgent situation or when confidence building and anxiety reduction has not been possible there are a range of treatment possibilities:

behaviour management – non-pharmacological (for example desensitisation where a person is slowly introduced to various aspects of a dental visit) and/or pharmacological (where a patient is prescribed medicine to relax them the night before an appointment)
inhalational sedation
intravenous sedation
general anaesthesia.

General tips

Although appointments and patients are part of your daily routine, for some people, a dental visit will have a big impact and leave a lasting impression on them, so always make sure you smile and:

recognise that each person is an individual;
learn about the support needs that are typical for a person with this condition;
read the notes before seeing the person and take special note of any advice given by family carers;
understand how the person usually behaves when anxious.

Information for supporters and carers

Communication

Good communication is key. There are many useful pieces of information you can give the dental team to contribute to a successful appointment.

Up-to-date and complete medical information is necessary to carry out dental treatment safely. Please do give the dental team all available medical information even if you think it may have no connection to dental treatment. The mouth is a part of the body and sometimes it’s surprising how another condition or medication can affect a person. Below are some more things you can do.

Bring an up-to-date list of medication and details of any recent or relevant hospital admissions/appointments.
Inform the dental team of what to expect when the individual is anxious, for example some people might run away when they are anxious.
Bring an item which may add reassurance, e.g. a favourite object, item of clothing or MP3 player.
Do not be afraid to ask questions or raise concerns.

Consent

The dentist will not start any treatment without first giving an explanation. As is the case with all health professionals, dentists will not undertake any treatment on anyone without first seeking informed consent. Consent can be verbal and/or written and involves understanding what is involved in carrying out treatment(s), the various options available, and likely outcomes. This means that the dentist will explain what will happen, for example in a check-up. The dentist will explain the risks and benefits of the various options that are available, before agreeing the treatment plan. Please be reassured that:

dentists treat everyone as an individual;
dentists recognise that an individual has the right to participate in decisions about dental treatment.

General tips

If you are supporting someone with complex needs or someone who has a heightened sensitivity to touch or sound, such as a person with autism, you might prefer to find a special care dentist. Your GP can organise a referral to a special care service. Alternatively, in the UK, the General Dental Council (GDC) has a database of all registered special care dentists which you can search on their website to find your nearest service. See ‘Useful resources’ for more information.

Remember, dentists enter the profession of dentistry to help relieve others of pain. Below are some ways you can help.

Do not tell any dental ‘horror stories’ prior to the appointment.
Make the evening and night before the appointment as stress free as possible.
Try to make sure the patient has enough sleep the night before.
On the day of the appointment, make sure both you and the patient are feeling as positive as you can.
If you are frightened of the dentist, try not to transfer your fear to the person who is the patient.

Some medical words explained

Local anaesthetic: Before you have any treatment the dentist will give you a special medicine called an anaesthetic. This medicine will make your mouth go numb so that the treatment doesn’t hurt you. Sometimes it’s given through an injection and sometimes by rubbing on a gel.

Appointment: The date and time when people have to see the dentist. The dentist’s surgery sends people appointment cards or letters. These tell them what day and time they need to be there. You should tell the dentist’s surgery if you need any special adjustments to the time, for example if you need the first or last appointment, or a longer appointment.

Cavity: A hole in your tooth.

Check-up: A regular appointment where your dentist can check that all parts of your teeth, gums and mouth are healthy. Your dentist will tell you how often you need a check-up.

Decay: Cavities (holes) in your teeth and rotten teeth are types of tooth decay.

Dental nurse: They are trained to help the dentist and to help patients feel more comfortable. They wear a different uniform to the dentist.

Dentist: A type of doctor for your teeth.

Enamel: The hard, outside layer on your teeth. Brushing your teeth helps to protect the enamel.

Floss: Very thin string that you use to clean between your teeth.

Filling: When the dentist repairs a cavity (a hole) in one of your teeth they will fill the hole with a tooth coloured or metal paste that hardens.

Gums: The pink skin around your teeth. You should clean the areas where your gums meet your teeth (as well as the different sides of each of your teeth) to keep them healthy and stop gum disease.

Mouthwash: A liquid to rinse your mouth with to get rid of the germs in your mouth. It usually tastes minty.

Plaque: A sticky coating that builds up on your teeth. Plaque can lead to tooth decay and gum disease. It is important to brush your teeth and clean around your gums to get rid of plaque.

Toothache and mouth pain: You should go to see your dentist if your teeth or gums hurt, or if any part of your mouth feels or looks strange. The dentist can check your teeth, gums and mouth to see why it hurts.

X-ray: This is a type of photograph that can see the bones and teeth inside your mouth. When the x-ray is taken you must keep still.