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People with learning disabilities and oral health

We campaign to ensure equality of access to dental services, so that everyone can maintain good oral health, including adults and children/young people with learning disabilities, who often face extra barriers to care.

What’s the issue?

The NHS estimates there are around 1.5 million people in the UK with a learning disability. It’s thought up to 350,000 people have a severe learning disability and this figure is increasing.

 

The NHS Long Term Plan is committed to supporting people with a learning disability and/ or autism as patients, and to ensure adjustments to care are made so people get equal access to high quality care.

 

People with learning disabilities may seek treatment across the various settings in which dentistry operates – high street practices, the community dental service, or hospital care. Residents in care homes may also receive treatment and this can be on a domiciliary basis.

 

During the COVID-19 pandemic, access to dentistry was severely impacted for all patients. At the start of the pandemic in England, dentists were forced to down tools, cease all routine face-to-face care and work on advice, analgesics and antimicrobials (AAA). Urgent Dental Centres were set up but only a limited amount of patients could be seen and many had long waits, whilst experiencing dental pain and infection, and with long distances for treatment. Early evidence shows that for those who have a more severe or profound learning disability, the experience and ability to access care was worse.

 

A PHE report looking at oral health inequalities says approximately one in three adults with learning disabilities have unhealthy teeth and gums (2019), and surveys also show patients with learning disabilities have higher rates of untreated decay, a greater number of extractions and a higher prevalence of complete tooth loss, than the general population.

 

Research has shown that communication is often a factor in whether someone with a learning disability has a positive or negative experience of going to the dentist. Anxiety is a major factor influencing whether those with learning disabilities will regularly accessing a dental service.

 

People with learning disabilities may be at an increased risk of some of the general factors that lead to poor oral health, such as frequent sugar intake and social deprivation. Poor oral health can also have an impact on a person’s general health.

 

What are we doing?

NHS charging and the system of patient-exemptions is complex and we secured a Government turnaround on erroneous patient fines in 2019. The NHS Business Service Authority confirmed they would be abandoning the discredited ‘fines first’ approach for patients, many of who had accidently ticked the wrong box on a confusing form.

 

We continue to campaign on:

 

  • Looking at workforce planning, the number of dentists in the CDS is decreasing, with many due for retirement and we have concerns about the future staff numbers for the service. We are also investigating the provision of specialist training, and the numbers of paediatric and special care dentists to ensure patient needs are met.
  • We are calling for better tracking of data in dentistry to help inform the experiences of people with learning disabilities and the state of their oral health.
  • We are calling for an urgent investigation into the state of backlogs and waiting lists for GA for dental treatment across England, due to the Covid-19 pandemic, to get an idea of the scale of the problem and to suggest solutions.
  • We have commented on a new commissioning standard being developed by the OCDO, regarding special educational schools.
  • We are calling for a basic oral health assessment to be included in the health checks offered on an annual basis to people with learning disabilities.
  • We continue to call for radical action to lower people’s sugar intake and safeguard oral health. 

 

What can dentists do?

The Equality Act 2010 says that services must make reasonable adjustments so that people with additional needs receive the care they need – just like everyone else.

 

Dentists can help enable this by:

 

  • Booking the first or last appointment of the day, so the surgery is not busy and there is less waiting time.
  • Explaining and demonstrate each procedure before it happens.
  • Giving a ‘count down’ when doing procedures, e.g. ’10 seconds then finished’.
  • Reducing the amount of medical equipment and clothing, where possible, if these make the person anxious.
  • Being aware of good practice in communication with learning disability patients, including making use of communications aids, like Makaton - watch 'Your dental appointment – a positive choice'.
  • Ensuring appropriate referral to CDS or specialist services, if required. 

 

Useful resources

Delivering better oral health: an evidence-based toolkit for prevention by PHE and the DHSC - preventative oral health information and should be adhered to by dental care professionals.

 

Oral care and people with learning disabilities - PHE Guidance: guidance for dental teams and family carers and paid supporters that help someone with their daily oral care and in accessing dental service

 

Learning disabilities and oral care - the Oral Health Foundation: includes information about special care dentistry

 

Learning disability explained - Mencap

 

How social care staff can recognise and manage pain in people with learning disabilities – PHE

 

Dental care and autism – a guide for dentists

 

Advice for parents of children with autism - BSPD

 

Mouth care matters - HEE: an initiative which aims to improve oral health for adults in hospital, with free elearning and Mini Mouth Care Matters for children.

 

Delivering sensory health services – e-learning for health

 

Safeguarding in general dental practice – PHE

 

BDA safeguarding resources

 

BDA Library special care ebooks