The International Association for the Study of Pain (IASP) defines chronic pain as that which persists beyond the expected healing time which often has no identifiable cause, and no clear pathway to a cure (IASP 2020, Malik 2020). Common chronic pain syndromes are well documented within the care home setting, but what about dental pain? We therefore decided to facilitate a stakeholder event. The aims were:
The aim of the stakeholder event was to bring together experts to:
- Identify current dental practice in the community and in particular care homes locally (Plymouth) and nationally
- Identify policy initiatives regarding dental care of the older population with a particular focus on care home residents (CQC, referral pathways, access to care)
- Identify barriers and facilitators to providing dental services in the UK care home sector
- Identify potential innovations around dental practices
Attendees to the stakeholder event were dental professionals (dental nurses, dentists and special care dentists), medical professionals (including GP’s and community nurses) service providers, including care home managers and staff, and policy makers, with experience, expertise or knowledge of caring for those with dementia which could be implemented into the care home settings. The event lasted two hours and was via zoom. To help guide the discussions, the event presented preliminary findings from an evidence synthesis looking at the current dental pain assessment tools within the literature, for identifying oral pain in elderly living with dementia (submitted for publication). The evidence synthesis used a systematic review approach to explore the validity of dental pain assessment tools and experiences of using them with those residing in care homes, who are reliant on carers to identify their dental pain and advocate on their behalf.
The audio of the stakeholder event was downloaded and transcribed onto a word document. The Zoom chat was downloaded and saved onto a word document. The Padlet was exported onto a pdf document. All three documents were uploaded to NVivo 12. Framework analysis was used to code data based on six topics.
1) Experiences and opinions of dental pain assessment and dental pain assessment tools
2) Referral pathways and access to dental services
3) Prevention of dental pain for care home residents with dementia
4) Opinions of training needs for care home staff
5) Opinions of knowledge exchange needs between dental services to care homes and between care homes
6) Innovations which may facilitate the findings from the previous four topics. Each of these topics were then summarised.
Overall, the stakeholder event achieved its aim and objectives, with important key issues being discussed. Having the discussions with all attendees as opposed to break out rooms was helpful in allowing all care provisions voice their experiences and opinions so experiences of the challenges from both sides could be understood.
A vital take home message from the stakeholder event was the importance of having a collaborative approach with care home staff when designing interventions, and an understanding that care home staff are trying their best. This collaboration needs to take a whole system responsibility approach to ensure the burden of dental disease management doesn’t fall solely on the care home staff, as dementia residents are already in a poor state of dental health when they arrive at care homes.
These findings have influenced a shift in attitude and a proposal to change a perhaps outdated format of oral health education, which may assume a lack of oral health knowledge to one of oral health collaboration, which supports turning oral health knowledge into valuable and achievable practice. Oral health collaboration is underpinned by an understanding of the challenges faced by care home staff in carrying out best practice, so interventions are designed compassionately in the best interest of all.