that impact on a given issue (in this case, confidence, body image and body language, and self-esteem).
CHAPTER 2
Tips and Tricks for
Optimal Oral Care
It is often very challenging to maintain good standards of oral care with people living with dementia or a mental health challenge. For this reason, it is necessary to be creative and think outside the box.
I had a patient who, for the sake of confidentiality, I will refer to as Max. He was 26 years old with a diagnosis of young onset Alzheimer’s disease. Throughout his life, Max had neglected his teeth, choosing to brush them rarely and never visiting a dentist. When I met him, he had a severe case of halitosis, his teeth were badly discoloured from nicotine and coffee and it was clear there was much more gum and tooth disease that required attention.
The model I follow when implementing an intervention that requires blue sky thinking (thinking outside the box of normal, everyday clinical practice) is based on four key factors as identified in Figure 2.1.
Figure 2.1: Blue sky thinking
In the case of Max, this model proved useful in achieving the aim of encouraging and supporting him to see a dentist. It is a process that any caregiver, formal or informal, can implement with equal success.
Spotlighting
This is a technique I use when I am working with a patient to identify the underlying problem that has brought them to see me. With Max, it was imperative that I uncovered why he had avoided visiting the dentist throughout his 26 years of life.
I start by establishing a therapeutic relationship, and with Max it was based around our mutual liking for music and sport, both boxing and rugby. He was very nervous, anxious and driven by fear, typical of someone living with dementia.
Once Max felt safe with me, I was able to explore the reasons for his fear of going to the dentist. As a young boy, his father had pulled one of Max’s loose teeth with his fingers. It had hurt so badly he would never allow anyone to touch his teeth again.
Strategy
The next step in this model is to develop a strategy, with the patient being at the very core of any game plan created. At this stage, it was imperative that Max took the lead, made the decisions and controlled everything moving forward.
Action
Once we knew the cause of Max’s anxiety around visiting the dentist, we were able to empower him in developing a strategy that put him in the driving seat of finding a resolution. It transpired that Max’s favourite band was Queen, with Freddie Mercury being his rock idol. That was somewhat fortuitous because the dentist I referred him to was also a huge fan of Freddie and Queen! Together we agreed the following action:
• I would arrange for Max to go and see Dr Jones for a dental examination.
• Prior to Max’s wife taking him to the dental office, she would play his favourite album, A Kind of Magic, both at home and in the car (it transpired that they both rocked out to this album as they made their way to see the dentist!).
• Dr Jones would play a Queen song in his office while working with Max.
Outcome
Max and his wife had an amazing surprise when they arrived at the dental office. In reception were numerous photos of Queen playing venues such as Wembley stadium. Dr Jones had also put some magazines and other memorabilia on the tables, which distracted Max from worrying about the examination, thus decreasing his anxiety levels.
Once he was in the office and in the dentist’s chair, Max became engrossed in a conversation with Dr Jones about Queen. When it was time for the examination, there were no issues and a further appointment was made where Max agreed to have his teeth and gums treated.
It is essential that we think outside the box and work collaboratively to support people to live as well as possible through their unique journey of dementia.
I will now consider some tricks and tips used in the dental office that can lead to optimal oral care. These strategies require a team effort involving the patient, professionals and family members and/or friends.
TIP NUMBER 1: GETTING TO KNOW YOU
Get to know the patient – this refers to the entire dental practice team, from the receptionist to the most senior dentist.
One way of doing this is to hold a monthly ‘Getting to know you. Getting to know us’ event specifically aimed at families or individuals currently on their journey through cognitive change. This could be in an early evening or on a Saturday.
Provide some snacks and beverages and have all the team available. Prepare some flyers containing basic information on how the team work with people who have additional complex needs and demonstrate that every member of the team has received extra training in supporting people living with various forms of cognitive challenge.
You could also do an informal presentation and hold a Q and A session.
TIP NUMBER 2: LIFE STORY
Ensure that you have an entire history of the patient. Not only is medical information and history important, but life history too. The following page of Five things I like/Five things I don’t like/Five things I like to do/Five things I don’t like to do is sufficient and can be completed with the involvement of everyone:
| Five things I like | Five things I don’t like |
| 1 2 3 4 5 | 1 2 3 4 5 |
| Five things I like to do | Five things I don’t like to do |
| 1 2 3 4 5 | 1 2 3 4 5 |
| Knowing a person makes a huge difference to their sense of personhood. When referring to personhood, I include things such as sense of purpose and being, likes and dislikes, choices, individuality, personality and character. All the things that make up a person are the things that lead to personhood. The aim is always to avoid malignant social psychology, or negative care strategies, approaches and interventions that diminish an individual. |
TIP NUMBER 3: POINTS OF CONVERSATION
Ensure that you have three points of conversation based on the individual’s life history. I suggest the following:
1. Past or previous occupation: We spend our lives in various roles. We may be a father or mother, an auntie or uncle, a son or a daughter. We behave differently in each of these roles due to the responsibilities bestowed on us. However, one of the things that most of us
